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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Compliance Compliance Officers Fraud HIPAA 110

Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

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Fraud Nurses Medicare Medicare 98

Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas. The psychologist was convicted of four counts of healthcare fraud.

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

Healthicity

SEPTEMBER 26, 2024

In the latest episode of Compliance Conversations , host Dr. CJ Wolf sits down with Rebecca Busch , a healthcare compliance expert with over four decades of experience.

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Med-Net Compliance

AUGUST 16, 2022

Five individuals and two for-profit skilled nursing facilities (SNFs) in Pennsylvania were indicted on charges of conspiracy to defraud the United States and related healthcare fraud charges. The post Five Individuals and Two Nursing Facilities Indicted on Healthcare Fraud Charges appeared first on Med-Net.

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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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COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

Healthcare Compliance Blog

FEBRUARY 2, 2022

A New York optician has pled guilty to grand larceny for submitting false claims for optician services that he alleged were for specific nursing home residents, but which were never provided. Many of the residents for whom the optician submitted claims were deceased, and he never visited the nursing homes on the dates of the those claims.

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Nursing Homes Fraud Medicaid Medicaid 59

Healthcare Blog

JANUARY 19, 2025

One key offering that is entirely unique to CAHs is the swing bed program, which allows hospitals to use the same beds for both acute care and skilled nursing services. For patients, swing beds reduce the stress and logistical challenges of being transferred to a separate skilled nursing facility.

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Medicare Medicare Compliance Nurses 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.

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Fraud Compliance Medicaid Medicaid 59

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 Doctors 52

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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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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MedTrainer

AUGUST 8, 2024

Why Additional Training Is Required for Medicare-Enrolled Providers Training helps providers understand and adhere to Medicare’s complex regulations and guidelines, essential for maintaining compliance. It also addresses Medicare Parts C and D compliance requirements.

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Medicare Medicare Compliance Medicaid 93

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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Compliance Compliance Officers Fraud Nurses 64

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.

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Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. As healthcare providers navigate the complexities of SNF billing, maintaining compliance is essential to avoid penalties, denials, and financial losses.

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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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Medicare Medicare Compliance Fraud 52

Healthcare IT Today

MARCH 27, 2025

With only 6% of organizations having fully operationalized responsible AI frameworks , the healthcare industry must take a measured approach to ensure AI integration aligns with patient safety and regulatory compliance.

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Governance Compliance HIPAA Regulatory Compliance 60

Verisys

FEBRUARY 6, 2025

What Is Nurse Credentialing? Nurse credentialing is a crucial process in healthcare that ensures nurses have the qualifications, skills, and experience to provide safe and effective patient care. The primary purpose of nurse credentialing is to protect patients and maintain the integrity of healthcare organizations.

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Nurses US Department of Health and Human Services Licensing Regulatory Compliance 52

Hall Render

NOVEMBER 25, 2024

Department of Health and Human Services (“HHS”) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (“Nursing Facility ICPG”) for nursing home members of the health care compliance community.

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Nurses Compliance Compliance Officers Medicare 40

Compliancy Group

DECEMBER 20, 2024

On October 31, 2017, OCR initiated a compliance review of HVHS after the media reported that HVHS had experienced a ransomware attack. Several of these were brought against nursing facilities who failed to provide requested records to patients personal representatives.

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Ransomware HIPAA Fraud Electronic Medical Records 98

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. The OIG's audit report of nursing home life safety and emergency preparedness noncompliance.

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Compliance Nursing Homes HIPAA Fraud 52

Provider Trust

MARCH 13, 2023

Between 2016 and 2021, over 7,600 fake diplomas were sold to nursing students who used the fraudulent degrees to qualify for the National Council Licensure Exam (NCLEX). In addition, an estimated 37 percent of student nurses with fake diplomas passed the NCLEX.

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Fraud US Department of Health and Human Services Licensing Nurses 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.

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Compliance Compliance Officers Fraud Electronic Medical Records 52

Compliancy Group

APRIL 30, 2025

If they are, consider reporting the issue through the OIGs Health Care Fraud Self-Disclosure. Compliancy Groups Exclusion Monitoring Tool is an exclusion screening software that helps build that structure into your workflow. The post Why Exclusion Screening Isnt Optional appeared first on Compliancy Group.

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Compliance Fraud FDA Medicaid 52

Healthcare IT Today

DECEMBER 20, 2022

Five former employees of Methodist Hospital in Memphis, TN, including a recently-licensed Registered Nurse, were indicted by a federal grand jury for allegedly selling medical information about car accident victims to personal injury attorneys and chiropractors. Mike Semel is the President and Chief Compliance Officer at Semel Consulting.

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HIPAA Nurses Licensing Compliance 107

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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Healthcare Compliance Blog

MARCH 11, 2022

A Boston registered nurse (RN) has pled guilty to one count of tampering with a consumer product and one count of obtaining a controlled substance by fraud and deception. The RN was working in a nursing home when she tampered with morphine that was prescribed to a resident under her care.

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Nurses Nursing Homes Fraud Licensing 59

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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Compliance Fraud Nurses Medicare 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. Issue: Nursing staff should monitor telemedicine appointments held with their residents, review related medical record documentation, and report any concerns with observed practices immediately.

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Fraud Telemedicine Medicare Medicare 59

Healthcare Compliance Blog

JANUARY 10, 2022

A South Carolina man has been arrested for financial transaction card fraud and exploitation of a vulnerable adult who was a resident of a nursing home. Due to his past criminal record, he also faces enhancement to the financial transaction card fraud charge.

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Fraud Nursing Homes Nurses Medicaid 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.

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Compliance Nursing Homes Nurses Fraud 52

Healthcare Law Blog

NOVEMBER 9, 2023

In late April this year, the Office of Inspector General, Department of Health and Human Services (OIG) announced that it would make changes to its existing body of healthcare compliance program guidance (CPGs) as part of its current Modernization Initiative. [1] On November 6, 2023, OIG finally published the GCPG on its website [3].

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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. 6:00 p.m.

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MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

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Governance Compliance Nursing Homes Medicaid 52

Healthcare Compliance Blog

MARCH 10, 2022

Complaints of resident abuse in a Michigan nursing home led to an investigation by the Michigan Office of Attorney General’s Health Care Fraud Division, working with the Michigan Sentinel Project. The investigation determined that a nurse was working at the nursing home while her license was suspended, which is a felony.

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Nursing Homes Nurses Licensing Fraud 59

Med-Net Compliance

JUNE 29, 2022

An Oklahoma nurse aide pleaded guilty to abusing a nursing home resident and was placed on a deferred sentence probation for three years under the supervision of the Oklahoma Department of Corrections. toward the cost of the investigation to the Office of the Attorney General Medicaid Fraud Control Unit (MFCU), $300.00

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