MedTrainer

JANUARY 12, 2024

At its core, healthcare compliance ensures the quality of care, patient safety, and integrity of healthcare systems. Over the years, healthcare compliance has evolved significantly, driven by changing regulations, advances in technology, and a growing emphasis on patient-centric care. What is Healthcare Compliance?

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Verisys

APRIL 2, 2024

March 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3

Fraud 52

Fraud Telemedicine Licensing Doctors 52

Verisys

MARCH 8, 2024

February 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M Peters Physician Pleads Guilty to False Statements, Resulting in $1.4

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

JANUARY 26, 2024

Non-compliance in healthcare refers to the failure of healthcare providers, institutions, or individuals to adhere to the laws, regulations, and standards established to protect patient welfare, maintain data security, and ensure the efficient and ethical delivery of healthcare services. What is Healthcare Compliance?

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How the OIG Exclusion Database Came to Be HHS oversees the CMS (Center for Medicare Services), which administers the Medicare program.

Medicare 52

Medicare Medicare Fraud HIPAA 52

Healthcare IT News - Telehealth

JUNE 8, 2022

based attorney in the health law practice of Baker, Donelson, Bearman, Caldwell & Berkowitz about what providers should be doing to ensure compliance when the PHE finally sunsets. We spoke recently with Allison M. Cohen, a Washington, D.C.-based Here's what she had to say. What impact will the newly extended PHE have on providers?

US Department of Health and Human Services 176

US Department of Health and Human Services Compliance Overpayments Overpayment 176

MedTrainer

OCTOBER 4, 2023

To ensure organizations meet these standards, federal healthcare compliance requirements have been put in place. These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. What Are Federal Healthcare Compliance Requirements?

Compliance 52

Compliance Fraud HIPAA Governance 52

Verisys

FEBRUARY 9, 2024

January 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. That mean, maintaining compliance standards, efficient reporting, and conducting thorough internal audits are vital.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Innovaare Compliance

OCTOBER 6, 2022

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. In 2022, 48% of all eligible Medicare beneficiaries are enrolled in MAPD.

Medicare 52

Medicare Medicare Compliance Public Health 52

MedTrainer

OCTOBER 16, 2023

This is the essence of corporate compliance in healthcare. Just as every piece of the puzzle must fit perfectly, every compliance element in healthcare needs precise integration to ensure seamless, ethical, and effective operations. Dive with us as we explore the complexities and necessities of compliance in the healthcare sector.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Medicaid 52

Verisys

JANUARY 2, 2024

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Secure your success by choosing Verisys.

Fraud 52

Fraud Licensing Doctors Medicare 52

Verisys

JUNE 8, 2023

Data Compliance: How to Identify and Close Data Risk Gaps Using Technology A three-part compliance series that focuses on using technology to help you achieve your compliance goals. Hiring a provider with red flags, even if in the past, can put your organization at risk for non-compliance.

Compliance 52

Compliance Fraud Licensing Medicare 52

Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. Watch the Webinar During the Keynote Speech at the HCCA Compliance Institute this year, Office of Inspector General (OIG) Christi A.

Compliance 52

Compliance Nursing Homes Nurses Fraud 52

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. The audit also identified 1,714 providers whose billing for telehealth services for about a half million beneficiaries during the first year of the pandemic posed a high risk to Medicare.

Fraud 52

Fraud Medicare Medicare COVID-19 52

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors? Department of Justice (DOJ), the U.S.

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

Verisys

FEBRUARY 23, 2022

As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Accordingly, maintaining compliance has become a key focus for healthcare facilities. Nine Responsibilities of Healthcare Compliance Officers.

Compliance Officers 52

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

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. The audit also identified 1,714 providers whose billing for telehealth services during the first year of the pandemic posed a high risk to Medicare. million in Medicare fee-for-service payments.

Fraud 52

Fraud Compliance Medicare Medicare 52

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses. What is Provider Credentialing?

Licensing 52

Licensing Governance Compliance Fraud 52

Health Care Law Brief

JUNE 2, 2022

For the reasons discussed below, DTC telehealth platforms should re-visit their compliance plans and be prepared for increased state and federal regulatory scrutiny. For example, the Department of Justice has aggressively pursued health care fraud claims against individuals and entities involved in non-compliant telehealth models.

Public Health 52

Public Health Compliance COVID-19 Licensing 52

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. According to the U.S.

Licensing 52

Licensing Fraud Compliance Nurses 52

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. organizations that receive any funds from Medicare, Medicaid, TRICARE, or other federal programs cannot afford to employ individuals or entities excluded from even one program. Medicare opt out.

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Medicaid 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. Case Study: S.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

YouCompli

JULY 12, 2022

In fact, Medicare beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. An initial report from the OIG also notes that, “over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than two in five Medicare beneficiaries.

COVID-19 52

COVID-19 Medicare Medicare Telemedicine 52

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. Can I minimize risk of non-compliance with laws & regulations in healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

MedTrainer

MARCH 14, 2024

The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Meets compliance standards: Both processes verify a provider has met compliance standards. Maintaining compliance helps protect against fraud, waste, and abuse.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

MedTrainer

FEBRUARY 27, 2024

And like any healthcare professional, HHAs must adhere to the compliance standards that govern quality care. It is arguably more important — and harder — to maintain a standard level of compliance when staff are working in client homes, rather than in a central facility. What is the Role of Home Health Aides?

Compliance 52

Compliance HIPAA Fraud Licensing 52

Provider Trust

JULY 25, 2022

To eliminate fraud in your health ecosystem, you must stay compliant with federal and state requirements for referring and ordering physicians. Continuous compliance begins with automated monitoring, cross-departmental communication, and population-specific workflow. billion in Medicare charges. Recent OIG Enforcement Actions.

Electronic Medical Records 52

Electronic Medical Records Licensing Medicare Medicare 52

YouCompli

DECEMBER 7, 2022

These exclusions are generally related to criminal activity like fraud or healthcare-related misconduct. Felony convictions for other healthcare-related fraud, theft, or other financial misconduct. Compliance with these rules sounds like a straightforward process. Patient abuse or neglect. Register for emails from YouCompli.

Fraud 52

Fraud US Department of Health and Human Services Compliance Medicaid 52

Verisys

JULY 20, 2023

An organization must verify all certifications and licenses for every provider who administers patient services. 4: Not updating and verifying information Healthcare practitioners need to renew their licenses and credentials on a regular basis, according to federal and state laws. Mistake No. Mistake No. Mistake No. Mistake No.

Due Diligence 52

Due Diligence Malpractice Licensing Hospitals 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Med-Net Compliance

JULY 19, 2022

In order to participate in the Medicare, Medicaid, and all federal healthcare programs once the term of exclusion ends, the individual or entity must apply for reinstatement and receive written notice from OIG that reinstatement has been granted. OIG maintains a list of all currently excluded individuals and entities called the?

US Department of Health and Human Services 59

US Department of Health and Human Services Licensing Medicare Medicare 59

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Medicare covers many telebehavioral and telemental health services including audio-only services.

Telemedicine 59

Telemedicine COVID-19 Compliance Informed Consent 59

Med-Net Compliance

SEPTEMBER 7, 2022

A 49-year-old Texas physician assistant was arrested and charged for his role in a scheme to defraud Medicaid by working with a suspended medical license. On July 20, 2021, the Texas Medical Board allegedly ordered the immediate suspension of his physician assistant license, deeming him to be a “continuing threat to public welfare.”

Medicaid 59

Medicaid Medicaid Licensing Medical Personnel 59

Compliancy Group

SEPTEMBER 27, 2023

Rated #1 on G2 “Compliancy Group makes a highly complex process easy to understand.” Learn More × Rated #1 on G2 for Healthcare Compliance Find Out More! While no reports of identity theft or fraud have emerged thus far related to this incident, affected individuals are urged to remain vigilant. Please Wait. Please Wait.

HIPAA 52

HIPAA Compliance Health Insurance Fraud 52