YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. This three-pronged strategy focuses on educating patients and staff about how to avoid misconduct. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse.

US Department of Health and Human Services 52

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

Health Care Law Brief

APRIL 12, 2023

405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. MA plans will be required to have a Utilization Management Committee that conducts annual reviews of policies to ensure compliance with the foregoing. Final Rule at p. See 42 U.S.C. 1320a-7k(d)(2) (“60 Day Rule”). See Proposed Rule at 79559.

Medicare 52

Medicare Medicare Overpayments Overpayment 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

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

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. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud 52

Fraud Compliance Medicare 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. Telemedicine is considered to be under the umbrella of telehealth and refers specifically to clinical services.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare IT Today

FEBRUARY 2, 2023

It has given every indication that it intends to investigate fraud, waste, and abuse more robustly in the foreseeable future. The Justice Department has joined the fraud case against one large national insurer. One last note about conducting quality assurance audits: Remember to close the loop.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

CMS.gov

NOVEMBER 16, 2018

Fraud, waste, & abuse. Improper payments are not necessarily measures of fraud, but instead are payments that did not meet statutory, regulatory, administrative, or other legally applicable requirements. These improper payments may be overpayments or underpayments and do not necessarily represent expenses that should not have occurred.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

AIHC

MARCH 28, 2022

But first, learn more about how a complex payer audit system works. For example, the GAO states that they identified about $77.6 billion in financial benefits in fiscal year 2020— a return of about $114 for every $1 invested. Make sure to read Part 1: Managing Denials is Important to Good A/R Hygiene. Audited by a payer?

Medicare 52

Medicare Medicare Compliance Governance 52

Medisys Compliance

MARCH 7, 2022

An EHR system provides accurate, up-to-date information about the patient. These are usually just innocuous mistakes that do not represent any intent to commit billing fraud. In the unfortunate event when you receive such overpayment demand letters, don’t acquiesce without conducting an analysis first. Interval HPI.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Overpayments Overpayment 52

Hall Render

AUGUST 26, 2022

Compliance with Oct. Oklahoma doctor raises concerns about life-threatening virus, polio. Charles workers launch petition, refuse to repay overpayments without outside audit; union files BOLI complaint. CHS faces class-action fraud suit. Project to bring about 216 senior housing units to McKinney. PENNSYLVANIA.

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

MARCH 22, 2024

NATIONAL 79 percent have positive outlook for senior living and care: NIC 12 key legal issues impacting health systems AHA: 94% of hospitals financially impacted by Change Healthcare’s cyberattack A conversation about the HHS plan on AI in health care A new kind of hospital is coming to rural America.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40