Compliancy Group

AUGUST 28, 2023

We will explore the importance of healthcare regulatory services, the healthcare compliance resources they provide, and how healthcare regulatory advisory services can benefit both patients and providers. By providing up-to-date information, these resources empower organizations to make informed decisions while remaining compliant.

Compliance 52

Compliance Informed Consent Fraud Health Insurance 52

Compliancy Group

NOVEMBER 28, 2023

With countless lives at stake every day, it becomes crucial to establish effective compliance programs in healthcare organizations. We will delve into the world of compliance programs in healthcare and explore their numerous benefits. What Are Compliance Programs in Healthcare?

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Compliance Fraud Governance 52

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. Let’s delve into the importance of healthcare compliance laws and regulations, their impact on providers and organizations, and the guidelines governing their implementation.

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Compliance Compliance Officers Fraud Compliance Framework 52

Compliancy Group

OCTOBER 2, 2023

In the fast-paced world of healthcare, compliance reporting plays a vital role in ensuring accountability and transparency. This article will explore the significance of compliance reporting in healthcare and how it helps organizations maintain data integrity and mitigate risks. What is Compliance Reporting in Healthcare?

Compliance 52

Compliance Regulatory Compliance Fraud Health Insurance 52

Compliancy Group

AUGUST 17, 2023

This responsibility falls on the shoulders of healthcare compliance managers, professionals who play a vital role in ensuring that healthcare organizations operate within legal boundaries and maintain the highest standards of integrity. Rated #1 on G2 “Compliancy Group makes a highly complex process easy to understand.” Please Wait.

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Compliance Fraud Health Insurance HIPAA 52

Compliancy Group

AUGUST 2, 2023

As the healthcare industry grows and changes, organizations face increasing challenges regarding compliance and risk management. Healthcare GRC (Governance, Risk, and Compliance) is a crucial framework that helps healthcare providers navigate these complexities effectively. Please Wait.

Compliance 52

Compliance Regulatory Compliance Governance Fraud 52

Hall Render

NOVEMBER 10, 2023

Department of Health and Human Services (“HHS”) issued new General Compliance Program Guidance (“GCPG”) for members of the health care compliance community and other health care stakeholders. Key Highlights of the GCPG Much of what is covered in the GCPG is not new to the health care compliance industry.

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Compliance Compliance Officers Fraud Governance 40

AIHC

AUGUST 30, 2023

Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM Due to the high volume of fraud schemes involving telemarketing revealed by the Department of Justice (DOJ) over recent years, it is important that providers heed “buyer beware” when engaging with a telemarketing firm. “If If it is too good to be true it probably isn't.”

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Compliance Fraud Medicare Medicare 52

Compliancy Group

AUGUST 14, 2023

Regulatory compliance in the healthcare industry plays a crucial role in patient safety, maintaining quality standards, and preventing fraud and abuse. 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!

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Regulatory Compliance Compliance Compliance Officers Fraud 52

Compliancy Group

OCTOBER 26, 2023

Maintaining compliance with regulations and ethical standards is crucial for Community Health Centers. To ensure that community health centers operate efficiently and ethically, they must establish robust compliance programs. Rated #1 on G2 “Compliancy Group makes a highly complex process easy to understand.”

Compliance 52

Compliance Informed Consent Fraud HIPAA 52

Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. What is an effective healthcare compliance program?

Compliance 52

Compliance Compliance Officers ADA Governance 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.

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Fraud Compliance Medicaid Medicaid 98

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.

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

AIHC

MAY 24, 2022

Once your suspicions have been reported to the Compliance Officer, were you asked to partake in evidence gathering during the investigation? Forensic investigations are specialized in nature, and the work requires detailed knowledge of fraud investigation techniques and the legal framework.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 52

YouCompli

JULY 20, 2022

Anstine is a compliance professional and consultant in Colorado. He is writing a series of articles on compliance culture for the YouCompli blog. This post looks at engaging the compliance committee. Within the business of healthcare, we talk a lot about a culture of compliance.

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Compliance Compliance Officers Fraud Nurses 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?

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Fraud US Department of Health and Human Services Medicaid Medicaid 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Integrating this strategy into your compliance culture can help your organization avoid penalties and deliver compliant patient care. For staff, compliance officers should support annual online FWA compliance training.

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

Compliancy Group

JANUARY 17, 2024

The OIG Work Plan, sometimes referred to as “the Work Plan” or “the Plan,” is an essential tool in securing and maintaining healthcare regulatory compliance for patient safety, privacy, and quality care. The OIG Compliance Work Plan identifies significant risks and areas that require attention within the healthcare system.

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US Department of Health and Human Services Compliance Regulatory Compliance Regulations Compliance 52

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. chief executive officer, chief financial officer, general counsel, director of health information management, director of human resources, physician practice office manager, etc.) at a provider that furnishes items or services payable by Federal health care programs. Case Study: S.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Total Medical Compliance Resources

OCTOBER 10, 2023

One of the critical aspects of achieving HIPAA compliance is enforcing a mandatory password policy. Once inside, hackers can steal personal health information (PHI), leading to data breaches that tarnish the reputation of the healthcare provider and put patients at risk of identity theft and medical fraud.

HIPAA 52

HIPAA Compliance Fraud 52

AIHC

APRIL 5, 2022

This is the final article in a 3-part series on denials and appeals management. 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.

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Fraud Compliance Medicare Medicare 52

Total HIPAA

SEPTEMBER 11, 2019

This post aims to answer all of your HIPAA compliance questions. If you’re just learning about HIPAA compliance, or beginning the process of becoming HIPAA compliant, this article will guide you through the initial steps you must take to adhere to the law. What is HIPAA Compliance? Protected Health Information (PHI).

HIPAA 52

HIPAA Compliance US Department of Health and Human Services Health Insurance 52

Hall Render

JUNE 1, 2022

Ritu also serves as the Chair of the Hospitals and Health Systems Practice Group and has been a member of the Editorial Board for the Health Care Compliance Professionals Manual since 2019. Ritu is a shareholder in Hall Render’s health section and serves as a co-leader of the firm’s compliance service line.

Compliance 40

Compliance Fraud Governance Hospitals 40

Medisys Compliance

NOVEMBER 23, 2023

Utilize coding software and resources: Employ specialized coding software and reference materials to ensure accurate code selection and application. Review modifier usage regularly: Regularly audit modifier usage to identify any inconsistencies or errors and ensure compliance with payer guidelines.

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Medical Billing Outsourcing Medical Billing Compliance Fraud 59

Health Law RX

JUNE 27, 2023

Executive Health Resources, Inc., 3730(c)(3)). In Polansky , the relator argued (with agreement from Justice Thomas) that this language did not grant the Government any intervention rights after the Government’s initial decision to decline intervention early in the case ( Polansky , 2023 WL 4034314, at *3). SuperValu Inc.,

Governance 52

Governance Fraud Compliance 52

HIPAA Journal

FEBRUARY 9, 2024

Patient scheduling software is software that can be used by patients to self-book healthcare appointments, by physicians to fill their schedules, and by medical practices to synchronize patient appointments with physician and treatment room availability in order to optimize the use of time and resources.

HIPAA 40

HIPAA Compliance Payment Systems Ransomware 40

Compliancy Group

JUNE 21, 2023

In recent years, there has been an alarming rise in cyberattacks targeting healthcare providers, with hackers seeking valuable patient information for identity theft and fraud schemes. However, many institutions fall short in this area by underestimating its significance or failing to allocate necessary resources. Find Out More!

HIPAA 52

HIPAA Compliance Fraud Health Insurance 52

Medisys Compliance

JANUARY 17, 2023

Maintaining compliance with the ongoing regulatory changes and payer-specific adjudication rules or payment processing criteria is challenging, if not downright impossible. This assists you in maintaining high standards of care and ethics, lowering your vulnerability to fraud, and generally improving your revenue cycle. Recognition.

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Medical Billing Medical Billing Outsourcing Medical Billing Services Doctors 52

HIT Consultant

DECEMBER 12, 2022

Once focused intensely on preventing fraud, waste, and abuse and ensuring high-quality patient care, the compliance department is tasked with maintaining programs that meet the regulations and laws of numerous government bodies pertaining to various areas, especially electronic protected health information (ePHI). IT and compliance.

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Compliance Compliance Officers Fraud Governance 52

Provider Trust

OCTOBER 29, 2021

There are so many things pulling compliance and HR teams in every direction, I help solve the problem of “how do we do this more efficiently?”. I started my time with ProviderTrust as a client success manager being a resource for our enterprise clients and working with them to continually get the most out of our data and software.

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Fraud Nurses Compliance 97

Verisys

JULY 20, 2023

Hospitals or health systems may not allocate adequate resources or staff to complete the medical credentialing process. 3: Allowing a physician to treat patients before credentialing is completed Courts have held hospitals liable when a physician falsifies credentials, and the hospital fails to do its due diligence in verifying them.

Due Diligence 52

Due Diligence Malpractice Licensing Hospitals 52

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.

HIPAA 59

HIPAA Compliance Nurses Fraud 59

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. This plan, whatever it was set up the perverse incentives by not looking at critical elements to ensure compliance.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 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. 3 reasons why you should implement ongoing monitoring of OIG-LEIE, GSA-SAM, and State Medicaid exclusion lists.

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Medicaid Medicaid Medicare Medicare 52

Dot Compliance

MARCH 16, 2023

For example, AI can help providers determine the number of patients likely to need a specific procedure and allocate resources accordingly. Fraud detection: AI can help healthcare providers detect fraud by analyzing vast amounts of data to identify anomalies and patterns that may indicate fraudulent activity.

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Fraud Patient Satisfaction Compliance Hospitals 52

MedTrainer

AUGUST 8, 2022

The Office of Inspector General for the Department of Health and Human Services is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud.

US Department of Health and Human Services 40

US Department of Health and Human Services Medical Billing Hospitals Compliance 40

MedTrainer

FEBRUARY 13, 2022

The Office of Inspector General for the Department of Health and Human Services is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud.

US Department of Health and Human Services 40

US Department of Health and Human Services Medical Billing Hospitals Compliance 40