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.

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Fraud Licensing Medicaid Medicaid 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.

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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.

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Compliance Fraud Regulatory Compliance Health Insurance 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?

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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.

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Fraud Telemedicine Licensing Compliance 52

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.

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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.

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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.

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Fraud Medicare Medicare US Department of Health and Human Services 52

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.

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Regulatory Compliance Compliance HIPAA Ransomware 59

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.

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Compliancy Group

JULY 18, 2024

It’s becoming more well-known that billing is one of the most common compliance risk areas outlined by the Office of the Inspector General (OIG). The occurrence of these issues is consistent, and over time, they can result in thousands of dollars lost in compliance penalties. With the U.S.

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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?

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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.

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Compliance Fraud Medicaid Medicaid 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.

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Fraud Elder Abuse Governance 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.

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

Compliancy Group

JUNE 27, 2024

Completing compliance incident reports is crucial to reducing the number of accidents in the future and understanding why they occur. Understanding what incidents need reporting and how to complete an incident report can help providers, compliance officers, and other personnel maintain the highest safety standards.

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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?

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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.

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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.

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Compliance Hospitals Fraud Regulatory 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.

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MedTrainer

JULY 3, 2024

Determining the necessary compliance training and ensuring your staff stays ahead of these requirements can be complex without comprehensive home health training. Importance of Home Health Training Home health staff must complete compliance training like all healthcare professionals to provide safe, legal, and ethical services.

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Compliance HIPAA Fraud Health Insurance 52

American Medical Compliance

FEBRUARY 9, 2024

Compliance officers’ responsibilities extend far beyond merely checking boxes and ticking off regulatory requirements. In fact, 61% of the compliance teams from a Thomson Reuters report also work on long-range strategies for their companies by putting regulatory and legislative changes as a top priority.

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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?

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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.

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MedTrainer

JULY 8, 2024

However, staffing challenges and limited resources may make adhering to compliance rules difficult without physician office training programs. Moreover, compliance is often part of maintaining various professional certifications that elevate the office’s reputation and build patient trust.

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Compliance HIPAA Fraud Health Insurance 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).

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Fraud Nurses Licensing 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.

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Compliance US Department of Health and Human Services Fraud Medicare 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.

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Fraud Medicare Medicare Compliance 52

Total Medical ComplianceHIPAA

APRIL 12, 2024

As healthcare providers navigate the complex web of rules and regulations in compliance, one aspect that needs more attention is exclusion screening of those working with federally funded healthcare programs. Non-compliance with these requirements could result in financial penalties and jeopardize participation in Federal healthcare programs.

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Compliance Fraud Medicaid Medicaid 72

MedTrainer

MARCH 8, 2024

Employee compliance training is essential to any healthcare organization’s onboarding process. This blog post will explore why compliance training is vital for an industry where mistakes or non-compliance can seriously affect patients, staff, and the organization.

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Compliancy Group

MARCH 21, 2024

It’s challenging enough to stay on top of constantly changing compliance regulations in healthcare, including training. Instead of continuously working hard to maintain all these administrative and logistical functions, you can be more innovative by letting compliance training software do the heavy lifting.

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Compliance US Department of Health and Human Services Compliance Officers Fraud 52

Compliancy Group

MARCH 12, 2024

must also be mindful of these healthcare compliance frameworks. A Compliance Framework for the U.S. healthcare compliance framework serves these purposes: Protect patient privacy : Health records and protected health information must remain confidential and private, with only essential providers and personnel having access to it.

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Compliance Framework Compliance US Department of Health and Human Services Fraud 52

Provider Trust

APRIL 18, 2024

This comprehensive program provides healthcare organizations across the continuum of care a roadmap to implement top-tier compliance standards by addressing key population monitoring gaps, prioritizing financial efficiencies, and upholding community healthcare and success.

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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).

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Compliancy Group

FEBRUARY 9, 2024

One crucial tool that helps healthcare organizations achieve this is compliance program guidance documents. These comprehensive guidelines are designed to assist various healthcare settings in implementing effective compliance programs, ensuring that they operate within legal boundaries while providing quality care to patients.

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Compliancy Group

APRIL 8, 2024

Patient safety and regulatory compliance are paramount, and healthcare organizations face numerous challenges in effectively managing their operations. The complex nature of the healthcare industry calls for a robust framework to ensure governance, mitigate risks, and maintain compliance with various regulations.

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Verisys

FEBRUARY 8, 2024

Verisys can assist pharmaceutical manufacturers in maintaining compliance with OIG guidelines and other regulatory requirements through a multifaceted approach, leveraging its extensive suite of data solutions and compliance services. The post Pharmaceutical Manufacturers Guide to OIG Compliance appeared first on Verisys.

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