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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YouCompli

NOVEMBER 1, 2023

As compliance officers, we are continually placed in a position to influence the actions of others and help shape our organization’s compliance culture. One way to change that perception is to avoid creating “gotcha” moments when you’re working on a compliance-related matter. Here are four tips that will help.

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Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. The DOJ Announcement stresses the importance of investing in strong compliance programs for both the buyers and sellers in business transactions.

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Healthcare IT Today

JANUARY 17, 2024

Insights are also from auditing professional and hospital claims totaling more than $5 billion and denials from commercial and government payors exceeding $150 billion. Those are the high-level findings of MDaudit’s 2023 Benchmark Report on the trends, challenges, and opportunities encountered by U.S. healthcare organizations.

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Compliance Overpayments Overpayment Medicare 107

YouCompli

OCTOBER 26, 2022

Helping our clinical colleagues feel the urgency of compliance monitoring can be a huge challenge. And the Compliance team simply doesn’t have the clinical expertise to own the monitoring of these requirements. That’s a 41% error rate with an extrapolated overpayment of?$269 Don’t let processes overwhelm clinical colleagues.

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Healthcare Compliance Blog

MARCH 16, 2022

Erskine stated, “Nursing home facilities provide important services to our elderly; however, those facilities must uphold the trust placed in them by billing the government only for reasonable and necessary services. Periodically audit to ensure that skilled rehabilitation services being provided to residents are reasonable and necessary.

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Innovaare Compliance

MARCH 1, 2022

6] Improper payments can be overpayments and underpayments. Overpayments put an MAO at risk in a bid and a one-third financial audit while underpayments consume valuable staff time in resolving provider disputes and can also be a jeopardy in a one-third financial audit.

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Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. As a result, the OIG is not seeking to exclude them from those programs or to require a CIA.

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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.

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Hospitals Compliance Officers Compliance Overpayments 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

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Innovaare Compliance

MARCH 24, 2024

Poor dispute resolution could lead to compliance risks, reputational damage, and even loss of key providers. Inovaare’s comprehensive suite of HIPAA-compliant software solutions features best-practice regulatory processes to help healthcare organizations sustain audit readiness, reduce non-compliance risks, and lower operating costs.

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Health Law Blog

MAY 22, 2018

The government had accused the two owners of paying illegal kickbacks/bribes to “sober homes” in exchange for the referral of the sober homes’ insured residents to treatment program. If the allegations made by the government are to be believed, the treatment center is an illustration of exactly what intentional fraud looks like.

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Fraud Overpayments Overpayment Licensing 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. This requirement can sometimes apply to specific types of professionals when located in law or regulations governing their profession.

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Healthcare IT Today

MAY 5, 2023

The surge in genetic testing claims comes with a rise in fraud, waste and abuse across government and commercial payers. Common schemes include: Code stacking. This occurs when multiple CPT codes are used to delineate different phases in the genetic testing process—a process often rife with error.

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AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back. If in doubt, check it out.

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Florida Health Care Law Firm

DECEMBER 2, 2021

As described on the OIG website, “Self-disclosures give persons the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”. Any overpayment retained after this period may create liability under the Civil Monetary Penalties Law and the False Claims Act.

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YouCompli

SEPTEMBER 27, 2023

Two of the most significant healthcare compliance risks are medical coding and billing. Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. In essence, they routinely double-billed for certain aspects of patients’ care. She

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Compliance Medicare Medicare Overpayments 52

AIHC

MARCH 28, 2022

Government Accountability Office (GAO), improper payments have been estimated to total almost $1.7 trillion government-wide from fiscal years 2003 through 2019. Auditing and denying claims after the claims have been paid is “big money” for the government. According to the U.S.

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Healthcare Law Blog

JANUARY 5, 2023

The Proposed Rule includes changes on an array of topics including: Star Ratings, medication therapy management, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, behavioral health services, identification of overpayments , requirements for valid contract applications, and formulary changes.

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Hall Render

MARCH 22, 2024

Nevada Medicaid must cover abortion services, judge rules Clark County health rankings improve, but physicians per capita still well below U.S. Nevada Medicaid must cover abortion services, judge rules Clark County health rankings improve, but physicians per capita still well below U.S.

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