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.

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Fraud Compliance Medicaid Medicaid 98

Med-Net Compliance

SEPTEMBER 20, 2022

The defendant was also convicted for falsification of records designed to prevent detection of this fraud and aggravated identity theft for falsely corresponding with Medicare under the name of another physician. Million Healthcare Fraud Scheme appeared first on Med-Net. He is scheduled to be sentenced on Jan.

Fraud 59

Fraud US Department of Health and Human Services Medicare Medicare 59

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.

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Fraud US Department of Health and Human Services Medicaid Medicaid 52

Med-Net Compliance

JULY 26, 2022

In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds. Additionally, the Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), announced that it took administrative actions against 52 providers involved in similar schemes.

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Fraud Telemedicine Medicare Medicare 59

Healthcare IT News - Telehealth

JUNE 28, 2021

" VanLandingham, who is senior counselor, Medicaid Policy/Acting Health IT at the agency, will be presenting at HIMSS21 this summer, HHS-OIG colleague, Assistant Inspector General for Legal Affairs Lisa Re. " VanLandingham explained that the healthcare fraud space gets "tens of thousands of complaints."

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US Department of Health and Human Services Fraud Compliance Medicaid 190

MedTrainer

SEPTEMBER 20, 2023

Watch this one-demand webinar for insider tips straight from seasoned compliance surveyors. If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. What Is the Scope of a CMS Inspection?

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Medicaid Medicaid Medicare Medicare 97

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. With Medicaid, the challenges are equally formidable.

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Fraud Medicaid Medicaid Medicare 52

C&M Health Law

DECEMBER 18, 2023

Department of Health and Human Services (HHS) published the General Compliance Program Guidance (GCPG) on November 6, 2023. The GCPG provides updated descriptions of the seven elements of an effective compliance program that health care entities have long relied upon. The Office of the Inspector General (OIG) of the U.S.

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Compliance Compliance Officers Governance Overpayments 52

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

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Medicaid Medicaid Medicare Medicare 52

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. The risk categories are described as follows: Highest Risk—Exclusion: Parties that the OIG determines present the highest risk of fraud will be excluded from Federal healthcare programs to protect those programs and their beneficiaries.

Fraud 59

Fraud Compliance Medicare Medicare 59

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. OIG may exclude the provider if certain circumstances regarding the ownership are present. However, healthcare receives federal funding, and thus OFAC is an additional sanction list that you should add to your vendor compliance plan/program. Case Study: S. Martino-Fleming v.

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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?

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Nursing Homes COVID-19 Fraud Medicaid 52

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

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Nurses Licensing Fraud Medicaid 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. Variety of Risks Present in Telehealth Arrangements. Does the state apply different standards, for example, to Medicaid encounters? Provider Licenses.

Public Health 52

Public Health Compliance COVID-19 Licensing 52

Medisys Compliance

OCTOBER 20, 2023

Insurance Reimbursement: Emergency medical services are typically covered by various insurance plans, including public programs like Medicare and Medicaid, as well as private insurance. Staying current with industry updates and regulatory changes is vital to ensure compliance and maximize revenue.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Compliance 59

AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. Prior to appealing a Medicare, Medicaid, TriCare or other Federal Program claim, you should verify that your organization is compliant in this area ( click here ).

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Fraud Compliance Medicare Medicare 52

Hall Render

JANUARY 11, 2023

The Tool presents developers of mobile health apps with a series of questions to help them understand which federal laws and regulations may apply. The Tool does not present a comprehensive list of laws and regulations that may apply to mobile health apps. Regulatory Landscape. Practical Takeaways.

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Compliance HIPAA FDA Due Diligence 40

McGuire Wood

OCTOBER 2, 2023

Further, if ancillary services are involved, there should be analysis to confirm compliance with the Stark Law and the AKS. If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure. DOJ Voluntary Self-Disclosure.

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Fraud Governance Compliance Medicare 52

Verisys

JANUARY 6, 2022

Payments from Medicare, Medicaid, TRICARE, CHIP, and other federal programs are a significant source of funds for nearly every healthcare organization and provider. The OIG through the Social Security Act has the power to bar individuals and entities from receiving federal payments as the result of intentional fraud or abuse.

US Department of Health and Human Services 52

US Department of Health and Human Services Fraud Medicaid Medicaid 52

Innovaare Compliance

AUGUST 31, 2022

Medicare Advantage Organizations (MAOs) are private health plans that contract with the Centers for Medicare & Medicaid Services (CMS) to provide a menu of health care services similar to those offered under Original Medicare. Non-compliance can result in civil monetary penalties or even suspension of enrollment in severe cases. .

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Medicare Medicare Compliance Officers Fraud 52

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. Routine audits should be conducted, and the results of the audits should be reported at the compliance and ethics committee meetings and in reports to the governing body.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

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. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

AIHC

NOVEMBER 29, 2023

As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Provider Trust

JULY 8, 2022

In this quick guide, we’ll explore the importance of including NPDB monitoring in your routine license and exclusion monitoring to protect your organization and the patients you serve from fraud, waste, and abuse. Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S.

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Licensing Malpractice Fraud Compliance 52

AIHC

NOVEMBER 29, 2023

As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Blog

MAY 11, 2023

Review of the Proposed Arrangement Under Federal AKS At a high level, the OIG concluded that the Arrangement presents a minimal risk of fraud and abuse under the AKS. Second, the Arrangement would benefit patients and the Medicare program by promoting compliance with a recommended screening test.

Medicare 52

Medicare Medicare Fraud Compliance 52

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. However, the bundling of payment for these services raises compliance concerns for providers who use APPs.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Health Law Advisor

APRIL 10, 2023

This interpretation provided to be difficult to apply in real world situations because while we all might think of Amazon and WalMart as big-box stores, it was not clear what other stores might also fall into this category and present a compliance risk.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

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Fraud Medicaid Medicaid Nurses 52

Healthcare Law Blog

MAY 31, 2022

These advancements, present challenges and raise novel questions as to how the current healthcare and life sciences legal regime would apply to the metaverse. For example, services that are billed to Medicaid or Medicare must comply with regulations that may not apply to services that are paid for in cash. Data Privacy and Security.

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FDA HIPAA Medicare Medicare 90

Hall Render

JUNE 7, 2023

This practice implicated the pharmacies’ contracts with Pharmacy Benefit Managers (“PBMs”) as well as Medicaid and other federal health care programs. Thus, it’s important to seek legal counsel to resolve concerns about statutory or regulatory non-compliance.

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Fraud Medicaid Medicaid Governance 40

Health Law Advisor

APRIL 13, 2023

These FAQs address subjects including “ General Questions Regarding Certain Fraud and Abuse Authorities ,” the “ Application of Certain Fraud and Abuse Authorities to Certain Types of Arrangements ,” and “ Compliance Considerations.” The vast majority of the principles articulated in the updated FAQs will undoubtedly be familiar to many.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

Verisys

NOVEMBER 20, 2022

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. If you are looking for something to read prior to turkey or afterwards, here is a round up of bad actors: Pharma Fraud: . Pharma Fraud. Pharma Fraud . Pharma Fraud. Fraud Scheme. Fraud Scheme. Fraud Scheme .

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Fraud Medicaid Medicaid Nursing Homes 52

Health Law RX

JULY 18, 2023

Those subject to the CMP Final Rule should consider prioritizing their compliance efforts because the OIG will begin enforcing the Rule on September 1, 2023. Health IT vendors should consider information blocking to be a new frontier of fraud and abuse enforcement. See 42 U.S.C. 1320a–7a(d).

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Fraud Compliance Medicaid Medicaid 52

Hall Render

APRIL 6, 2022

Turning to the present case, in Safeway , the relator alleged that the defendant engaged in the submission of false claims to the government when it “reported its ‘retail’ price for certain drugs as its ‘usual and customary’ price.” Guidance Must Be Truly Authoritative and Must Come from An Actual Authority.

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Medicare Medicare Medicaid Medicaid 72