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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Health Care Performance

APRIL 19, 2023

Department of Justice, Criminal Division, publishes a guidance document: Evaluation of Corporate Compliance Programs (ECCP). This guidance is used in two ways: Federal prosecutors conducting criminal fraud or misconduct investigations (including healthcare fraud) use it to evaluate the effectiveness of a corporation’s compliance program.

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Compliance Fraud 52

Healthcare IT Today

APRIL 5, 2023

Today, we’re featuring the Vice President, Compliance and Program Development position that was recently posted on Healthcare IT Central. We like to regularly feature a healthcare IT job that might be of interest to readers. This position was posted by Easterseals Louisiana Inc. and is in Louisiana, New Orleans.

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Compliance HIPAA Fraud Governance 112

Verisys

MAY 9, 2023

Data Compliance: 3 Focus Areas for Mitigating Organizational Risk A three-part compliance series that focuses on using technology to help you achieve your compliance goals. There is no question that healthcare organizations should have an effective healthcare compliance program.

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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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Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.

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Fraud Medicare Medicare Overpayments 72

Healthcare Law Blog

MAY 11, 2023

The Department of Health and Human Services Office of Inspector General (OIG) recently announced changes to its process for informing healthcare industry stakeholders of new or updated Compliance Program Guidance (CPG). Historically, sector-specific CPG has been published in the Federal Register.

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Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. government or a government contractor.

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American Medical Compliance

FEBRUARY 15, 2023

The EMS 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. Fraud schemes range from solo ventures to widespread activities of an institution or group.

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Fraud Medicare Medicare Medicaid 52

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

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Medicare Medicare Fraud US Department of Health and Human Services 52

Med-Net Compliance

OCTOBER 27, 2022

The psychologist was convicted of four counts of healthcare fraud. The FBI and HHS-OIG investigated the case, which was brought as part of the Chicago Strike Force, supervised by the Criminal Division’s Fraud Section and the US Attorney’s Office for the Northern District of Illinois.

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Nursing Homes Fraud Nurses US Department of Health and Human Services 59

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

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Medicaid Medicaid Fraud Compliance 59

AIHC

JUNE 6, 2023

AI Use in Healthcare Research & Quality As posted in the American Institute of Healthcare Compliance (AIHC) June monthly newsletter, the Agency for Healthcare Research & Quality (AHRQ) grantee is testing AI for use to improve breast cancer screening accuracy and efficiency.

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Compliance HIPAA Medical Billing Due Diligence 59

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.

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Total Medical Compliance Resources

MAY 11, 2023

trillion is spent on healthcare in the United States, of which an estimated $60 billion is attributable to fraud and abuse. In order to combat this, HIPAA established the Healthcare Fraud and Abuse Control Program (HCFAC). Criminal Health Care Fraud Statute – 18 U.S.C. Every year a minimum of $4.3

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Med-Net Compliance

JULY 20, 2022

He was convicted of one count of healthcare fraud and one count of making a false claim. Healthcare providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties can use the OIG’s Provider Self-Disclosure Protocol to voluntarily disclose self-discovered evidence of potential fraud.

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Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. What is an effective healthcare compliance program?

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JNC Compliance

SEPTEMBER 6, 2022

The post 5 Tactics to Combat Healthcare Fraud appeared first on JNC Healthcare Compliance Group. In this series, I shared that the government recovered five billion dollars from the healthcare False Claims Act in 2021, one of the most significant recoveries […].

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Health Care Performance

MAY 25, 2022

We summarize enforcement trends and deliver the latest compliance and HIPAA developments to your inbox with our Monthly Compliance News Report. Read MPA’s News Report to stay current with compliance news and developments. The DOJ's first settlement under its Civil Cyber-Fraud Initiative. Items added to the OIG Work Plan.

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Compliance HIPAA COVID-19 Fraud 52

Health Care Performance

AUGUST 25, 2022

We summarize enforcement trends and deliver the latest compliance and HIPAA developments to your inbox with our Monthly Compliance News Report. Read MPA’s News Report to stay current with compliance news and developments. MPA scours OIG, DOJ, FBI, OSHA, & OCR updates so you don't have to. Items added to the OIG Work Plan.

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Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. In March 2020 she pleaded guilty to one count of healthcare fraud, one count of wire fraud, and one count of theft of government funds. Provide periodic retraining to members of the compliance and ethics committee as well.

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Fraud Medicaid Medicaid Compliance 59

Health Care Performance

APRIL 20, 2022

We summarize enforcement trends and deliver the latest compliance and HIPAA developments to your inbox with our Monthly Compliance News Report. Read MPA’s News Report to stay current with compliance news and developments. The DOJ's first settlement under its Civil Cyber-Fraud Initiative. Items added to the OIG Work Plan.

Compliance 52

Compliance HIPAA COVID-19 Fraud 52

Medisys Compliance

JANUARY 30, 2023

Let us discuss the top compliance issues in the medical billing industry, shall we? Medical billing companies and healthcare providers that participate in these programs must comply with a variety of regulations, including billing and coding guidelines, documentation requirements, and fraud and abuse laws.

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Compliance Medical Billing HIPAA Telemedicine 52

Total HIPAA

MARCH 22, 2023

In this blog post, we’ll discuss the potential consequences of HIPAA non-compliance for insurance agents. The most significant consequence of HIPAA non-compliance is the potential for legal action. In addition to financial penalties, HIPAA non-compliance can damage an insurance agent’s reputation and lead to a loss of clients.

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HIPAA US Department of Health and Human Services Compliance Health Insurance 52

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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Medicaid Medicaid Fraud Nursing Homes 59

Compliancy Group

AUGUST 31, 2022

Department of Justice’s (DOJ) Civil Cyber Fraud Initiative (CCFI). Details of DOJ Cyber Fraud Initiative Settlements. Let’s Simplify Compliance Do you need help with HIPAA? Compliancy Group can help! × Automated HIPAA Compliance. DOJ Cyber Fraud Initiative and the HIPAA Connection. Learn More! ×

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Fraud HIPAA Electronic Medical Records Compliance 52

AIHC

MAY 24, 2022

Once your suspicions have been reported to the Compliance Officer, were you asked to partake in evidence gathering during the investigation? Forensic investigations are specialized in nature, and the work requires detailed knowledge of fraud investigation techniques and the legal framework.

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Compliance Fraud Compliance Officers HIPAA 52

Provider Trust

FEBRUARY 3, 2023

Hosted by Co-Founder of ProviderTrust Michael Rosen and Chief Compliance Officer Donna Thiel, our webinar outlined various factors affecting the healthcare space in the new year, from staffing strikes to increased scrutiny around private equity investment firms. What does this mean for compliance and oversight or management of these risks?

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AIHC

JANUARY 5, 2023

Learn about the 7 steps to Medicare Compliance Medicare is federally regulated and requires healthcare providers to ensure that they comply with the many requirements before being eligible for reimbursement. Applying for Medicare compliance can be a daunting task for healthcare providers. What does this mean?

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Medicare Medicare Compliance Medicaid 59

Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. Donna Thiel, Chief Compliance Officer at ProviderTrust, said, “It’s an opportunity to promote partnership between HR and compliance.

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

Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. Discussion Points: Review your policy and procedure for preventing and reporting false claims, kickbacks, or other fraud, waste, and abuse violations.

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Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

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Healthcare Law Blog

FEBRUARY 3, 2023

New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1]

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Medicaid Medicaid Compliance Overpayments 52

Med-Net Compliance

JUNE 15, 2022

Division of Medi-Cal Fraud and Elder Abuse (DMFEA) and the US Attorney’s Office for the Eastern District of California intervened in the? The investigation culminated in the doctor pleading guilty to one count of federal healthcare fraud, and on May 2, 2022, he was sentenced to a?prison prison term?of of three years and five months?and

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Med-Net Compliance

JUNE 22, 2022

A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud.

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YouCompli

JULY 20, 2022

Anstine is a compliance professional and consultant in Colorado. He is writing a series of articles on compliance culture for the YouCompli blog. This post looks at engaging the compliance committee. Within the business of healthcare, we talk a lot about a culture of compliance.

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Healthcare Compliance Blog

FEBRUARY 22, 2022

Two women, one from Colorado and the other from Houston, have been sentenced in federal court for their roles a multi-million dollar Medicare Fraud Scheme. Each woman pled guilty to one count of conspiracy to commit healthcare fraud. The post Two Women Sentenced for Conspiracy to Commit Healthcare Fraud appeared first on.

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