Healthcare Compliance Blog

MAY 10, 2022

An ineligible Medicaid provider was arrested in Florida for defrauding Medicaid of more than $68,000. According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application. List of Excluded Individuals/Entities ?

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Healthcare IT Today

JANUARY 2, 2024

Combining this with the increasing number of digital-first health applications and services on the market, protecting data at every touchpoint is mission-critical. By analyzing policyholder data trends, health insurers can learn where their resources are over or underutilized and adjust as needed to better balance their initiatives.

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Healthcare IT News - Telehealth

JUNE 28, 2021

Department of Health and Human Services aims to protect the integrity of federal healthcare programs, in addition to the health of beneficiaries. "We believe health technology should be used in the service of care to achieve better health and value," said VanLandingham.

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HIPAA Journal

JANUARY 30, 2023

The National HIPAA Summit is the leading forum on healthcare EDI, privacy, breach notification, confidentiality, data security, and HIPAA compliance, and the deadline for registration for the Virtual 40th National HIPAA Summit is fast approaching.

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US Department of Health and Human Services HIPAA Compliance Medicaid 84

Compliancy Group

FEBRUARY 12, 2024

In one incident, a New Jersey pharmacy admitted to conspiracies to defraud benefits providers, including Medicare and Medicaid, of $65 million for medications never provided to patients. Department of Health and Human Services, Office of Inspector General (HHS-OIG), said.

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MedTrainer

FEBRUARY 29, 2024

The World Health Organization (WHO) defines a near miss as “an error that has the potential to cause an adverse event [patient harm] but fails to do so because of chance or because it is intercepted.” More than three-fourths (77%) were due to emergency department overcrowding and medication administration errors.

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US Department of Health and Human Services Compliance Nurses World Health 52

Verisys

FEBRUARY 23, 2022

As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Accordingly, maintaining compliance has become a key focus for healthcare facilities. Training employees on compliance issues.

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American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff.

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American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff.

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YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. In fact, some enforcement agencies are on the lookout for unjustified price increases.

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Compliance US Department of Health and Human Services Overpayments Overpayment 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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Healthcare Compliance Blog

APRIL 26, 2022

The Office of Inspector General (OIG) for the US Department of Health and Human Services (HHS) has made educational resources available for healthcare providers to comply with federal healthcare laws and regulations. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.

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Healthcare Compliance Blog

MAY 9, 2022

A home health services company headquartered in Kentucky, and its related entities, paid $2.1 million to the United States government to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida.

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Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. A federal district court judge will determine any sentence after considering the US Sentencing Guidelines and other statutory factors.

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

Med-Net Compliance

OCTOBER 19, 2022

The settlement resolves allegations that between 2013 and 2020, the company paid remuneration to its home health medical directors in Oklahoma and Texas for the purpose of inducing referrals of Medicare and TRICARE home health patients. The corporate officers were previously the CEO and COO of the company.

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Med-Net Compliance

SEPTEMBER 14, 2022

A Massachusetts home health aide, who was licensed as a Certified Nursing Assistant (CNA), has been indicted in connection with a home surveillance video showing her abusing an elderly patient, Attorney General Maura Healey announced. The aide was indicted by a grand jury on two charges of assault and battery on an elder by a caretaker.

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US Department of Health and Human Services Fraud Medicaid Medicaid 59

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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Med-Net Compliance

AUGUST 18, 2022

An Indiana provider of skilled nursing and long-term care services has agreed to pay $5,591,044.66 It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.? Train all staff on your compliance and ethics policies and procedures upon hire and at least annually.

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

YouCompli

DECEMBER 7, 2022

Do your hiring managers and Human Resources colleagues know what to look for? Department of Health and Human Services Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. Provision of unnecessary or substandard services.

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Healthcare IT News - Telehealth

NOVEMBER 25, 2020

Department of Health and Human Services' final rules regarding the Physician Self-Referral Law (also known as the Stark Law) and the Federal Anti-Kickback Statute. The American Telemedicine Association this week issued a statement in response to the U.S. WHY IT MATTERS.

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Healthcare Compliance Blog

JUNE 9, 2022

His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”.

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Med-Net Compliance

NOVEMBER 8, 2022

On November 3, 2022, the OIG released the results of a recent inspection of a nursing home by the Texas Health and Human Services (HHS) Office of Inspector General Audit and Inspections Division (OIG Inspections).

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

Total HIPAA

JANUARY 18, 2022

HIPAA breaches involving fewer than 500 individuals which occurred during 2021 must be reported to the US Department of Health and Human Services (HHS) by Tuesday, March 1, 2022. Here are a few examples from the HHS website: A municipal social service agency disclosed PHI while processing Medicaid applications.

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Med-Net Compliance

OCTOBER 26, 2022

The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) has announced that they will be enhancing their focus on potentially preventable hospitalizations of Medicare-eligible skilled nursing facility (SNF) residents. and 42 CFR § 483.25).

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Provider Trust

MARCH 21, 2023

US Department of Health and Human Services (HHS) Office of Inspector General Christi A. But upon closer inspection, OIG found there were no service records to show that those plan enrollees received treatment for those conditions. Medicare Advantage will be no exception.

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Verisys

JUNE 13, 2023

A big thanks to our compliance team, who monitors state, federal, and international updates. It withdraws the regulations issued in the interim final rule published November 5, 2021 in “Omnibus COVID-19 Health Care Staff Vaccination”. Here is our monthly regulatory update. Also the removal of obsolete and irrelevant information. (§302)

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Healthcare IT News - Telehealth

AUGUST 11, 2021

Department of Health and Human Services works to ensure the integrity of federal healthcare programs and to safeguard the health and welfare of those programs' beneficiaries. And I think it's important for us to recognize that we don't know a whole lot right now.

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Verisys

JANUARY 19, 2022

Due to the complex nature of medical credentialing, it requires coordination between several disparate departments within an organization. According to recent surveys of major metropolitan hospitals , departments that typically share the responsibility for credentialing include: The Compliance Office. Human Resources.

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Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

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Verisys

JANUARY 6, 2022

Federal payments for healthcare services account for 28% of all healthcare spending in the United States. Payments from Medicare, Medicaid, TRICARE, CHIP, and other federal programs are a significant source of funds for nearly every healthcare organization and provider. There are two types of OIG exclusions : permissive and mandatory.

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US Department of Health and Human Services Fraud Medicaid Medicaid 52

Med-Net Compliance

SEPTEMBER 20, 2022

million scheme to defraud Medicare by billing for services under another doctor’s name after Medicare revoked his privileges to participate in the program. Once the new business was set up, he continued to bill Medicare for services just as he had prior to his revocation, only now exclusively under the name of his partner.

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Fraud US Department of Health and Human Services Medicare Medicare 59

Total HIPAA

FEBRUARY 23, 2023

Did you know that any HIPAA security breaches affecting less than 500 individuals in 2022 must be reported to the US Department of Health and Human Services by March 1, 2023? Here are a few examples from the HHS website: A municipal social service agency disclosed PHI while processing Medicaid applications.

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US Department of Health and Human Services HIPAA Compliance Medicaid 52

Provider Trust

JANUARY 26, 2022

Luckily for all us, there’s a spectrum–and it was created with visibility and safety in mind. Department of Justice (DOJ), the U.S. And when patient care and reimbursements are on the line, even one bad actor can put an entire organization’s reputation in jeopardy. How the OIG Finds & Prosecutes Healthcare Fraud.

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Verisys

JANUARY 27, 2022

COVID has impacted every aspect of daily life, and these changes have affected people’s mental health, making telehealth services for behavioral health more important than ever. Others may become susceptible to mental health issues, such as depression or anxiety. The use of telemedicine in the U.S.

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C&M Health Law

JANUARY 20, 2023

This builds on the HIPAA Transactions Rule standards for financial and administrative transactions among health care providers and health plans and aligns with Department of Health and Human Services (HHS) interoperability regulations.

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

Medval Compliance Blog

MARCH 10, 2022

by Frank Fairchok, Vice President of Medicare Reporting Services. Last week, the Centers for Medicare & Medicaid Services (CMS) advanced the rulemaking process in two long-awaited areas. 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047). 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047).

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Med-Net Compliance

JULY 19, 2022

In order to participate in the Medicare, Medicaid, and all federal healthcare programs once the term of exclusion ends, the individual or entity must apply for reinstatement and receive written notice from OIG that reinstatement has been granted. An individual or entity with a defined period of exclusion (e.g., 5 years, 10 years, etc.)

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