article thumbnail

Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know

HIT Consultant

What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. The new baseline appears non-reactive to the emergence of new COVID-19 cases.

Fraud 98
article thumbnail

April 2024 Bad Actors Roundup

Verisys

With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Here is a round up of bad actors: Doctor sentenced to 10 years in prison for unlawfully dispensing controlled substances ( Full Story ) Doctor Convicted for $5.4M

Fraud 52
Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

COVID-19 Vaccination Statuses of 500,000 VA Employees have been Impermissibly Disclosed

HIPAA Journal

The COVID-19 vaccination statuses of approximately 500,000 Department of Veterans Affairs employees have been impermissibly disclosed. The spreadsheet also included details of claimed religious and medical exceptions to COVID-19 vaccination.

article thumbnail

Three Challenges Impacting Healthcare License Verifications

Provider Trust

Organizations across the healthcare continuum have experienced several workforce trends that are creating gaps in license monitoring and verifications. Many of these trends evolved in response to the COVID-19 pandemic, but show no signs of slowing despite a wavering rate of hospitalizations.

article thumbnail

License Verification and Monitoring Critical Amidst Healthcare Labor Shortages

Provider Trust

However, this solution comes with its share of compliance risks, especially if interstate licenses are involved. There’s no doubt that frontline nurses have been warriors throughout the spread of COVID-19, providing critical care during an unstable and dangerous time. This can spell trouble for everyone involved.

article thumbnail

How To Prepare for an OIG Inspection

MedTrainer

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. But what exactly is considered fraud, waste, and abuse? These complaints can trigger an audit. Data Analysis and Trends.

Fraud 98
article thumbnail

Highlights from the HHS-OIG 2023 Spring Semiannual Report

Provider Trust

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. A Message from Acting Inspector General Christi A.