YouCompli

JANUARY 4, 2022

Ross addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance Forum in December 2021. . They provide great insight for Compliance practitioners. YouCompli sponsored MHA’s 2021 Healthcare Legal Compliance Forum in 2021. Her detailed slides are available from PYA here.

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Compliance Compliance Officers HIPAA Fraud 40

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 Medical Billing HIPAA Due Diligence 52

Innovaare Compliance

OCTOBER 6, 2022

The purpose of these audits is to evaluate a plan sponsor’s efforts to prevent, detect, and correct fraud, waste, and abuse (FWA) in the Medicare Part C and Part D programs. If you have any questions, or you’d like to discuss these changes with one of our compliance experts, please call us at 1.408.850.2235. or Contact Us.

Medicare 52

Medicare Medicare Compliance Public Health 52

MedTrainer

SEPTEMBER 20, 2023

Watch this one-demand webinar for insider tips straight from seasoned compliance surveyors. Additionally, CMS’s guidelines, or Conditions of Participation/Conditions for Coverage (CoPs/CfCs) , are specific to each type of covered health care facility, along with regulations pertaining to each organization’s state and locality.

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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. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

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Fraud Medicaid Medicaid Medicare 52

Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders.

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 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.

Licensing 52

Licensing Fraud Compliance Nurses 52

Compliancy Group

APRIL 27, 2022

The publication covers a significant trend in cybersecurity: More and more, healthcare organization data breaches are being caused by internal (employee) action as opposed to actions from outside third parties. Let’s Simplify Compliance HIPAA compliance helps to prevent insider data breaches. Become compliant today!

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Fraud Compliance HIPAA Public Health 98

Healthcare Law Blog

DECEMBER 12, 2022

The COVID-19 Public Health Emergency (“PHE”) led to a rapid expansion in the utilization of telehealth. Now, almost three years later, governmental entities have focused their attention on telehealth services and the potential for fraud and abuse. in healthcare fraud for fraudulent telemedicine schemes. Looking Forward.

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COVID-19 Fraud Telemedicine Public Health 52

Health Care Law Brief

JUNE 24, 2022

This guidance is a direct response to a December 2021 Executive Order that tasked HHS with developing HIPAA guidance for telehealth services, with the stated goals of improving “patient experience and convenience” as the COVID-19 public health emergency subsides. The new HIPAA guidance affects covered entities in four key ways.

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HIPAA Fraud Compliance COVID-19 52

Healthcare Law Blog

MAY 8, 2023

Department of Health and Human Services (“HHS”) is responsible for detecting and preventing fraud, waste, and abuse in federal health care programs. The majority of the advisory opinions involved arrangements that the OIG determined would generate prohibited remuneration, but presented minimal risk of fraud and abuse.

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Fraud COVID-19 Public Health Compliance 52

YouCompli

AUGUST 9, 2023

An opportunity to reframe, regroup, and refocus  Now that the COVID-19 Public Health Emergency (PHE) is well behind us, we have an opportunity to reframe patient expectations – and regroup and refocus on compliance-related patient care needs. You can use commercially available tools or create your own.

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Compliance COVID-19 ACA Fraud 52

YouCompli

AUGUST 2, 2022

Healthcare compliance history has shown that when the government disperses significant funds, audits and enforcement associated with the disbursement of those funds will shortly follow. The Federal government spent unprecedented trillions of dollars throughout the COVID public health emergency (PHE). Let’s look at a few.

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COVID-19 Vaccine COVID-19 Nursing Homes Compliance Officers 52

YouCompli

JULY 12, 2022

Key Point for Compliance Professionals: Medical necessity is the overarching criterion for the performance and billing of any service. National fraud takedown: $1.1 Department of Justice (DOJ) announced a national health care fraud enforcement action involving over $1.4 billion in false and fraudulent telehealth claims.

COVID-19 52

COVID-19 Medicare Medicare Telemedicine 52

Compliance Now

JANUARY 11, 2022

The guidance also expressly provides that these tests must be made available without an order or individualized assessment by a public health provider. Avoiding Fraud. Plans are permitted to take reasonable steps to avoid fraud as long as they do not “create significant barriers.” Reimbursement Programs.

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COVID-19 Fraud Public Health Compliance 100

Med-Net Compliance

SEPTEMBER 14, 2022

Shortly thereafter, the home health agency terminated the aide’s employment and reported her to the Nurse Aide Registry and the Department of Public Health (DPH). A subsequent investigation by DPH resulted in a suspension of the aide’s license and a referral to the Attorney General’s Medicaid Fraud Division.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Medicaid Medicaid 59

HIPAA Journal

JANUARY 12, 2023

Despite the challenges of compliance and the gaps in HIPAA , the legislation has provided many benefits for healthcare organizations, healthcare professionals, patients, and health plan members. Before the introduction of HIPAA, healthcare fraud was rife and was costing the healthcare industry around $7 billion a year.

HIPAA 83

HIPAA Compliance Fraud COVID-19 83

Healthcare IT News - Telehealth

APRIL 18, 2022

Department of Health and Human Services Office of Inspector General, under which it will undertake compliance efforts. Concerns of fraud have dogged conversations around telehealth expansion beyond the public health emergency. "PPOA denies the allegations in Paragraph II.E and the Civil Actions."

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COVID-19 Telemedicine Fraud Public Health 135

Hall Render

FEBRUARY 27, 2023

This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. Over 77% of the funds recovered were related to the health care industry, which shows the federal government’s commitment to enforcing the FCA. Health Care Fraud Actions Medicaid.

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

Healthcare Law Today

JANUARY 11, 2023

As part of a deferred prosecution agreement, which must be approved by the court, Jet Medical admitted that it distributed misbranded devices and agreed to implement enhanced compliance measures. and Martech Medical Products Inc., violated the False Claims Act by causing medical providers to submit false claims to Medicare.

FDA 59

FDA Governance Medicare Medicare 59

Provider Trust

APRIL 26, 2023

Compliance and HR managers responsible for staffing should stay apprised of events that may have repercussions within the healthcare space. However, this solution comes with its share of compliance risks, especially if interstate licenses are involved. Compliance monitoring can get tricky with so much back and forth.

Licensing 52

Licensing Nurses Compliance COVID-19 52

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. Health Care Fraud Actions. Health care enforcement will continue and will remain a powerful tool for the federal government.

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Fraud Governance Medicare Medicare 40

Healthcare Compliance Blog

FEBRUARY 3, 2022

Bassett stated, “Vaccination fraud is a serious crime. It creates a threat to public health and undermines the safety of our healthcare professionals who are working around the clock to get us through the pandemic.

COVID-19 Vaccine 59

COVID-19 Vaccine COVID-19 Nursing Homes Nurses 59

HIT Consultant

NOVEMBER 24, 2022

– Delivery model : Whether to ship OTC products to a hearing clinic where the consumer can receive professional diagnosis, fitting and support, or ship directly to the consumer’s home thereby providing convenience but no professional support (and increased fraud risk), or offer both options? 4 And compliance decrease over time. .

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FDA Public Health Medicare Medicare 98

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. This information was published due to the end of the COVID-19 Public Health Emergency (PHE) which began May 12, 2023.

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COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare Compliance Blog

MARCH 31, 2022

The New York Wage Parity Act, Public Health Law sets minimum wage and benefit requirements for licensed home care services agencies (LHCSAs) that employ home care aides who render services to Medicaid recipients in New York City and three counties in New York. Under the terms of agreement, one of the agencies has paid $1.6

Medicaid 59

Medicaid Medicaid Governance Fraud 59

Provider Trust

JUNE 1, 2022

Challenge #1: Poor Communication Between Compliance and HR Departments. Checking licensing boards or searching the OIG exclusion lists are responsibilities that often involve several departments, creating administrative complexities, especially for Compliance and HR departments. These mobile, contracted positions are in high demand.

Licensing 52

Licensing Nurses COVID-19 Compliance 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

HIT Consultant

AUGUST 13, 2023

Here are seven identified cybersecurity vulnerabilities that can reveal a patient’s data and expose these healthcare organizations to fraud and fines: Limited budgets. Poor Cyberhealth and the Seven Deadly Sins The landing pad in healthcare for cybercriminals is long and wide and they have many ways to creep into the network and cause chaos.

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Ransomware Fraud Health Insurance Public Health 98

AIHC

SEPTEMBER 21, 2023

This article is subsequent to the original article “ HIPAA, The Cures Act and Information Blocking Compliance ” and Article on Right of Access Vs Information Blocking Part 1 and Part 2. The full definition of “health care provider” is available in the Public Health Service Act (42 U.S.C.

HIPAA 59

HIPAA Compliance Nurses Fraud 59

Health Law Advisor

APRIL 13, 2023

Department of Health and Human Services’ Office of Inspector General (“OIG”) updated its Frequently Asked Questions (“FAQs”), drafting 13 FAQs aimed at easing the transition from COVID-era flexibilities to the end of the Public Health Emergency (“PHE”) on May 11, 2023. 1395nn) (“Stark Law”) from AKS exceptions.

Public Health 52

Public Health Fraud COVID-19 Medicaid 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. Each state has a department or agency dedicated to upholding the integrity of Medicaid programs and public health.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT News - Telehealth

NOVEMBER 22, 2021

A survey put forward by the national healthcare, life science and workforce management law firm Epstein Becker Green found that telemental health services have increased in quantity this year – as have fraud-related enforcement actions at the state and federal levels. Healthcare IT News is a HIMSS Media publication.

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Fraud COVID-19 Medicare Medicare 174

Healthcare IT News - Telehealth

SEPTEMBER 28, 2022

Accountable Care Compliance & Legal Government & Policy Telehealth Workforce Healthcare organizations must urge the Senate to pass critical telehealth legislation, and enact at least a two-year extension of the important PHE-era policies while working toward a permanent solution. In January 2020, then-Secretary of the U.S.

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COVID-19 Public Health US Department of Health and Human Services Medicare 118

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 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