Compliancy Group

APRIL 25, 2024

Maintaining Medicare compliance and avoiding legal and financial repercussions requires Medicare compliance training for employees at all organizational levels. Examples of Medicare fraud include billing for unrendered services and using a billing code or a service that’s more expensive than what a patient received.

Fraud 59

Fraud Medicare Medicare Compliance 59

Compliancy Group

FEBRUARY 16, 2024

This month, fraud in the medical industry has been making headlines fairly frequently. We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. Each charge also comes with five years probation, while the fraud charge includes 18 months of house arrest.

Fraud 52

Fraud Licensing Medicaid Medicaid 52

Compliancy Group

SEPTEMBER 16, 2024

Office of Inspector General (OIG) enforces the General Compliance Program Guidance. In November, updates for 2024 appeared in the OIG General Compliance Program Guidance, including recommendations for Medicare, nursing facilities, and other industry-specific entities. Organizations should ramp up their risk assessment efforts.

Compliance 52

Compliance Compliance Officers Fraud Electronic Medical Records 52

Compliancy Group

OCTOBER 9, 2024

The primary place where healthcare organizations go wrong with their compliance efforts is that their compliance programs are reactive versus proactive. Workforce compliance in healthcare involves a comprehensive approach to establishing certain protocols and guidelines and helps maintain a continuously safe working environment.

Compliance 52

Compliance Compliance Officers HIPAA Fraud 52

American Medical Compliance

AUGUST 15, 2024

In the healthcare industry, where sensitive financial and personal information is regularly processed, maintaining secure Payment Card Industry (PCI) compliance is critical. PCI compliance not only protects patient payment data but also ensures that healthcare organizations meet stringent regulatory requirements.

Compliance 93

Compliance Payment Systems Fraud 93

Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! Each month we will give a roundup of recent healthcare fraudsters and compliance busters. The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys. Secure your success by choosing Verisys.

Fraud 52

Fraud Telemedicine Licensing Compliance 52

AIHC

SEPTEMBER 3, 2024

Celebrating the Healthcare Compliance Officer The American Institute of Healthcare Compliance is recognizing healthcare Compliance Officers – hats off to you! The primary goal of a compliance officer is to mitigate risk. This involves investigating complaints and conducting internal auditing and monitoring for compliance.

Compliance Officers 52

Compliance Officers Compliance Fraud Medicare 52

Compliancy Group

JUNE 13, 2024

Data privacy is only part of Office of the Inspector General (OIG) compliance. Since the start of the data privacy rule in 2003 alone, there have been at least 350,000 Health Insurance Portability and Accountability Act complaints with 1,188 compliance reviews. While these compliance programs are voluntary, they are essential.

Compliance 59

Compliance Fraud Regulatory Compliance Health Insurance 59

MedTrainer

JANUARY 10, 2024

It may seem a little early to do some spring cleaning, but not when it comes to compliance! It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. The OIG is making major investments to systematically detect and prosecute fraud.

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

Compliancy Group

DECEMBER 15, 2023

Differentiating Fraud, Abuse, and Waste Detecting and stopping fraud, abuse, and waste rely on distinguishing these behaviors in the healthcare context. What is Healthcare Fraud? Providers commit Medicare and Medicaid fraud when they knowingly submit or contribute to the submission of a false claim for financial gain.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Compliancy Group

AUGUST 9, 2024

Maintaining healthcare compliance depends on having many tools and strategies at your disposal, especially when faced with an audit or incident of non-compliance. Perhaps the most essential element is compliance documentation. What Does Compliance Documentation Involve?

Compliance 72

Compliance Compliance Officers Regulations Compliance HIPAA 72

Compliancy Group

JULY 10, 2024

Compliance with healthcare regulations protects patients, safeguards employee safety, and maintains the security of electronic medical records (EMRs) and cyber networks. Ensuring compliance with critical regulations falls on the compliance officer. What Does a Compliance Officer Do?

Compliance Officers 64

Compliance Officers Compliance Fraud Electronic Medical Records 64

Compliancy Group

AUGUST 30, 2024

Ensuring compliance in your hospital, private practice, or healthcare company means safeguarding patient data, optimizing working conditions for employees, and promoting the highest quality of care. We suggest incorporating them into an annual compliance checklist for companies across the healthcare sector.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 52

American Medical Compliance

JULY 9, 2024

The Medicare FWA Compliance Training aims to educate healthcare providers (HCP) on the definitions of fraud, waste, and abuse in the context of Medicare. American Medical Compliance is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education to physicians.

Medicare 52

Medicare Medicare Compliance Fraud 52

Hall Render

NOVEMBER 21, 2023

The United States District Court for the Eastern District of Wisconsin recently issued a decision involving protections for employees whose jobs involve the investigation of fraud. This category of individuals is sometimes called a “fraud alert employee.” Since 2009, the FCA’s anti-retaliation provision,(codified at 31 U.S.C.

Fraud 72

Fraud Compliance 72

Provider Trust

AUGUST 6, 2024

Healthcare compliance monitoring has never been easy. So, what makes an effective compliance monitoring program? The compliance spectrum helps organizations of all sizes identify the effectiveness of their compliance monitoring based on three key factors: population, primary sources, and frequency.

Compliance 52

Compliance Licensing Fraud 52

Compliancy Group

OCTOBER 4, 2024

Despite your best efforts in meeting healthcare compliance requirements, errors may still occur. Maintaining the security and integrity of sensitive information and preventing waste, fraud, and abuse is essential to quality healthcare and promoting workplace safety. What is an Audit in Healthcare?

Compliance Officers 52

Compliance Officers Compliance Regulatory Compliance Fraud 52

HIPAA Journal

MARCH 30, 2023

The seven elements of a compliance program are integrated processes organizations in all industries can adopt to help them develop a culture of compliance in the workplace. While the seven elements of a compliance program apply to all industries, they originated in the healthcare industry in the 1990s.

Compliance 106

Compliance Compliance Officers Fraud HIPAA 106

MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Verisys

JANUARY 8, 2024

OIG compliance refers to adherence to the guidelines and regulations set forth by the Office of Inspector General (OIG) of the U.S. The OIG is responsible for combating fraud, waste, and abuse in health and human services programs, including Medicare and Medicaid. The post What is OIG Compliance? appeared first on Verisys.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Health Law Checkup

MARCH 13, 2023

The carrot or the stick … which motivates compliance conduct more? Department of Justice to motivate or cajole corporate compliance. In separate announcements over the past several weeks, DOJ dangled two new “carrots” in front of companies involved in fraud investigations and criminal cases.

Fraud 52

Fraud Compliance 52

American Medical Compliance

APRIL 6, 2023

Incidence of Healthcare Fraud Numerous scammers view this as a method to make quick, yet unlawful, money. Officials state that Florida, along with the rest of the nation, has been plagued by healthcare fraud. AMC is also a leader in the industry for compliance, Billing, and HR solutions. Reference NPR. 2023, January 27).

Fraud 52

Fraud Nurses Licensing Compliance 52

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

Compliancy Group

JULY 3, 2024

One area that is often overlooked in onboarding training is regulatory compliance. Healthcare regulatory compliance training is of particular importance as it ensures the safety and wellbeing of patients and staff, and that privacy standards are upheld. Some compliance training is mandatory, while others are recommended.

Regulatory Compliance 59

Regulatory Compliance Compliance HIPAA Ransomware 59

MedTrainer

JANUARY 31, 2024

Healthcare compliance isn’t a new concept. Who started the first healthcare compliance program? It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. What is Healthcare Compliance?

Compliance 52

Compliance Fraud Governance ACA 52

American Medical Compliance

MARCH 13, 2023

The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. Healthcare organizations must take all possible steps to prevent instances of fraud. Employees should receive training that educates them on how to identify, report, and combat fraud, waste, and abuse in the workplace.

Fraud 52

Fraud Medicare Medicare Compliance 52

Compliancy Group

MARCH 22, 2024

As a compliance officer or critical decision-maker, you can help your healthcare organization avoid exclusion from this valuable program by creating a comprehensive compliance program and using software to streamline your compliance processes. Remaining in good standing with Medicare has several advantages.

Medicare 52

Medicare Medicare Compliance Compliance Officers 52

Compliancy Group

JUNE 21, 2024

There seems to be a gap between chiropractic services and positive compliance outcomes. This is why an OIG compliance manual for chiropractors is essential. The purpose of an OIG audit is to prevent fraud and abuse or to detect it. What is the Focus of an OIG Audit for Chiropractors?

Compliance 52

Compliance Compliance Officers Medicare Medicare 52

AIHC

JUNE 14, 2024

Part 3 in a series of articles to support World Elder Abuse Awareness Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS of the American Institute of Healthcare Compliance ( AIHC ), a non-profit healthcare education organization. These scams are outlined in more detail below.

Fraud 52

Fraud Elder Abuse Governance Compliance 52

Compliancy Group

MAY 15, 2024

As we move deeper into 2024, hospitals must increasingly focus on compliance with regulations set forth by the Office of Inspector General (OIG). This guide outlines the OIG’s hospital compliance priorities and provides actionable advice on ensuring your hospital meets these rigorous standards.

Compliance 52

Compliance Hospitals Fraud Regulatory Compliance 52

MedTrainer

SEPTEMBER 10, 2024

When talking about healthcare compliance education, these misunderstandings can have significant repercussions, from compliance gaps to inefficiencies in operations. Understanding common, but dangerous misconceptions about healthcare compliance education can potentially prevent your organization from these issues in the long run.

Compliance 52

Compliance Compliance Officers HIPAA Medicare 52

Compliancy Group

JULY 29, 2024

In 2024, home health agencies face stringent new compliance requirements as outlined by the Office of Inspector General (OIG). This guide provides an overview of the OIG compliance program guidance for home health agencies and practical steps for staying compliant.

Compliance 59

Compliance Regulations Compliance Fraud HIPAA 59

MedTrainer

JULY 25, 2024

Adhering to the Health Insurance Portability and Accountability Act (HIPAA) standards is crucial to uphold compliance and regulatory requirements for any health organization. HIPAA, enacted in 1996, originally aimed to improve health insurance portability and reduce healthcare fraud. What Is HIPAA?

HIPAA 52

HIPAA Compliance Health Insurance Fraud 52

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. To become certified, please visit us at: American Medical Compliance (AMC).

Fraud 52

Fraud Medicare Medicare Compliance 52

Compliancy Group

FEBRUARY 28, 2024

Many industries have compliance rules and regulations to meet and follow, but few would argue that healthcare is one of the most stringent. Privacy and security – Compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient privacy and data security is crucial.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

Med-Net Compliance

JULY 11, 2022

The report says that in FY 2021 the DOJ opened 831 new criminal healthcare fraud investigations. Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, and a total of 312 defendants were convicted of healthcare fraud related crimes during the year. 2,947 investigations were pending at the end of FY 2021.

Fraud 59

Fraud Compliance Medicaid Medicaid 59