Bill of Health

FEBRUARY 10, 2023

Or an extension of the doctrine of public fraud? The traditional definition of the Police Power is the responsibility of the state to protect “health, safety, morals and general welfare.” What is missing from the revised definition of the police power is the responsibility to take moral action to protect the public.

Public Health 261

Public Health Health Care Reform ACA COVID-19 261

HIT Consultant

MAY 11, 2023

1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation’s $2.26 Simply stated, one definition of artificial intelligence (AI) is technology that thinks and does what a human can do, but much faster.

Fraud 98

Fraud Governance Public Health 98

Med Com Blog

JANUARY 18, 2023

By definition, Revenue Cycle Management (RCM) is the process by which healthcare providers manage and track the revenue generated by patient care. Fraud detection: AI can be used to detect and prevent fraudulent activity in the revenue cycle, such as billing for services that were not provided or upcoding of services.

Patient Satisfaction 52

Patient Satisfaction Fraud Compliance COVID-19 52

Healthcare Law Blog

FEBRUARY 2, 2023

A well-crafted letter of intent (“LOI”) adds value for the negotiating principals by helping to ensure the parties are in agreement on key deal terms before they spend significant time and money on diligence and definitive documents. Define indemnification terms. Schedule certain defined terms.

Due Diligence 52

Due Diligence Fraud Compliance 52

HIPAA Journal

JANUARY 3, 2023

Due to the lack of accurate data released by healthcare organizations and their business associates, it is not possible to definitively determine whether ransomware attacks have plateaued, are increasing, or declining. Out of the 24 confirmed attacks on hospitals, data theft occurred in 17 of those attacks (68%).

Ransomware 106

Ransomware Hospitals HIPAA Governance 106

AIHC

SEPTEMBER 21, 2023

On September 14, 2023, the Office of Inspector General (OIG) posted the Final Rule “ Fraud & Abuse; Information Blocking; OIG’s Civil Money Penalty Rules ” describing enforcement of the Information Blocking rule. 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 Care Law Brief

JUNE 20, 2023

Second , the defendants argued that, based on the Court’s interpretation of the common‑law definitions of “knowing” and “reckless” in Safeco , the FCA should be read with the same interpretation— i.e. , using an objective reasonableness test. Because the FCA incorporates the common law of fraud, it embodies that same limitation.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

YouCompli

MAY 25, 2022

This post establishes a working definition of compliance culture and puts it in the context of overall healthcare priorities. Just look at the rampant, unreported fraud that took down Enron in the early 2000s. Definition of compliance culture in healthcare. Anstine, JD is a compliance professional and consultant in Colorado.

Compliance 52

Compliance Compliance Officers Fraud Regulatory Compliance 52

Healthcare Law Today

JANUARY 11, 2023

” The press release warned that “[t]he resolution of this matter illustrates the government’s emphasis on combating health care fraud.” The FDA has jurisdiction to regulate products that meet the definition of “device” under section 201(h) of the FDCA.

FDA 59

FDA Governance Medicare Medicare 59

Compliancy Group

JANUARY 3, 2024

This is why a regular review of these contracts is essential so that providers and administrators can clear up uncertainties in the terms or conditions, remain compliant, and ensure the payer is engaging in fair practices.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

HIT Consultant

MAY 4, 2023

But as the average recovery cost for a healthcare organization after a breach has now passed the $10 million mark in 2022 , a 40% increase from 2020, the time for definitive action is now. As organizations harden their security posture in response to specific threats, new threats emerge that companies may not be aware of.

Hospitals 97

Hospitals Regulatory Compliance HIPAA Compliance 97

Healthcare Compliance Blog

JUNE 9, 2022

Those claims were for presumptive and definitive Urine Drug Tests (UDTs) that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients. Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

HIT Consultant

FEBRUARY 23, 2023

We need to think beyond our current systems to develop a broader definition of interoperability—one rooted in “possibility thinking” that focuses first and foremost on the patient experience. Trying to create interoperability with tools and processes we already have is limited thinking that leads to limited results.

COVID-19 96

COVID-19 Fraud Hospitals 96

Healthcare Law Blog

MAY 11, 2023

Review of the Proposed Arrangement Under Federal AKS At a high level, the OIG concluded that the Arrangement presents a minimal risk of fraud and abuse under the AKS. Finally, the OIG noted that the listed safeguards set forth by the Companies reduce the risk of fraud and abuse.

Medicare 52

Medicare Medicare Fraud Compliance 52

Healthcare Law Blog

MAY 16, 2022

Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2 The only changes made to the final definition were to include “individuals” as potential TPMOs, and to clarify that agents and brokers are TPMOs. and 422.107). 423.100 [3].

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

AUGUST 24, 2023

Beginning CY 2019, activities related to fraud reduction and improvement of health care quality are included in the MLR calculation as expenditures.

Medicare 52

Medicare Medicare Fraud Medicaid 52

Health Care Law Brief

APRIL 12, 2023

405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. The Court also held that the 60 Day Rule imposed a burdensome definition for “identified” without adequate notice to insurers. 3d 173, 191 (D.D.C. rather than a ‘limited duty to inquire.” UnitedHealthcare Ins.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Health Care Law Brief

APRIL 6, 2023

Measured by this definition,” the Sixth Circuit concluded, “the complaint [by the plaintiffs] fail[ed] to allege a cognizable kickback scheme.” Or consider the general practitioner who refuses to send patients for kidney dialysis treatment at a local health care facility until it obtains more state-of-the-art equipment. emphasis added).

Hospitals 52

Hospitals Doctors Fraud 52

Healthcare Law Today

DECEMBER 12, 2022

Maureen has extensive experience handling malicious insider matters ranging from employee fraud, embezzlement, and misappropriation to breaches of non-solicitation, non-compete and confidentiality agreements. I’m currently Deputy General Counsel of LifeMD, a growing telemedicine company. Maureen Stewart.

Telemedicine 49

Telemedicine Fraud Governance Compliance 49

Health Law Advisor

APRIL 10, 2023

However, relying in part on its newly clarified definition of “instruments convertible to cash,” the OIG concluded that the offer and transfer of a Visa or MasterCard gift card in the proposed arrangement satisfied the requirements of the Preventive Care Exception under the Beneficiary Inducements CMP.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

YouCompli

DECEMBER 19, 2023

Users are encouraged to use the electronic version, to allow access to hyperlinked definitions and resource documents. To identify and prevent fraud and abuse risks in a complex health care environment, compliance officers should simply follow the money. As the compliance industry evolves, the OIG is right on track again.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

Hall Render

MAY 9, 2022

An exception to the Beneficiary Inducement CMP’s definition of “remuneration” exists for “remuneration which promotes access to care and poses a low risk of harm to patients and Federal health care programs” (the “Promotes Access to Care Exception”).

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

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. Plan sponsors will be notified in advance of the upcoming audit schedule and targeted universes under review for each audit type.

Medicare 52

Medicare Medicare Compliance Public Health 52

Provider Trust

MAY 17, 2022

In this post, we’ll break down the definition of healthcare vendors and summarize the most important and impactful laws and regulations that apply to vendors and the healthcare organizations that contract with them. So what does that mean for your healthcare organization’s compliance program? How to ensure vendor compliance.

Compliance 52

Compliance Medicare Medicare Due Diligence 52

AIHC

APRIL 10, 2024

HIPAA and HITECH is for all health care organizations falling under the definition as a Covered Entity, from solo practices to larger clinics and hospital medical networks to health plans and clearinghouses. Does your organization have materials for patient education and risks of identity theft and medical fraud?

Compliance 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

HIPAA Journal

SEPTEMBER 5, 2023

Among its objectives, the Act aims to address illegal and misleading online content, better protect Internet users from fraud, and provide more control over what personal data is collected and how it is used. Strictly speaking, such a website fulfils the definition of an online platform because users can interact with it.

Compliance 55

Compliance HIPAA Governance Fraud 55

Hall Render

JANUARY 11, 2023

Federal Food, Drug, and Cosmetic (“FD&C”) Act – If an app includes a software function that meets the definition of a medical device under section 201(h) of the FD&C Act, the app may be subject to regulatory oversight by the FDA.

Compliance 40

Compliance HIPAA FDA Due Diligence 40

YouCompli

NOVEMBER 29, 2023

Users are encouraged to use the electronic version, to allow access to hyperlinked definitions and resource documents. To identify and prevent fraud and abuse risks in a complex healthcare environment, compliance officers should simply follow the money. As the compliance industry evolves, the OIG appears to be right on track again.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

Healthcare Law Today

JANUARY 2, 2023

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. The FCA is a fraud statute, requiring intent. Potential Impact.

Overpayments 52

Overpayments Overpayment ACA Medicare 52

AIHC

SEPTEMBER 5, 2023

In many states, the definition of telemedicine and/or telehealth stipulates that the delivery of services must occur in “real time,” automatically excluding store-and-forward as a part of telemedicine and/or telehealth altogether. This includes understanding various fraud and abuse laws.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Total HIPAA

FEBRUARY 25, 2020

Healthcare data is extremely valuable on the black market because it can be used to commit healthcare fraud, which is very profitable. . A definition file is a list of known malware, which the software can use to find and eliminate malware. How to Protect Yourself from Ransomware. Back-up.

Ransomware 52

Ransomware HIPAA Compliance Fraud 52

AIHC

APRIL 10, 2024

HIPAA and HITECH is for all health care organizations falling under the definition as a Covered Entity, from solo practices to larger clinics and hospital medical networks to health plans and clearinghouses. Does your organization have materials for patient education and risks of identity theft and medical fraud?

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

Hall Render

NOVEMBER 15, 2023

The Arrangement contains safeguards that lower the risk of fraud and abuse under the federal AKS. Requestor certified that it does not take into account a physician’s volume or value of expected or past referrals when offering the Arrangement.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Provider Trust

MAY 18, 2022

As referenced in our recent post on definitions and regulations for healthcare vendors, the HHS Office of Inspector General Exclusions Program mandates that healthcare organizations refrain from doing business with “excluded or sanctioned” individuals or entities, which includes your organization’s network of vendors.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

AIHC

AUGUST 8, 2023

I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Use as many as will definitively detail the problem statement. First, in the assumption right now, the Cobra Effect has happened. First, we need to look at exactly what happened. If you have such training or experience, I recommend taking an investigative approach.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Health Law RX

JULY 18, 2023

The IB Rule, among other things, promulgated regulations further defining what information blocking is and establishing reasonable and necessary activities that do not constitute information blocking, i.e., exceptions to the definition of information blocking. The OIG anticipates working closely with ONC to make these threshold assessments.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Health Law Blog

MAY 25, 2018

There are a lot of lose ends on the definitions applicable to each of these requirements. All of these factors should be supported by the patient’s medical record. It is possible that additional details will be forthcoming when regulations are finalized.

Licensing 40

Licensing Fraud Telemedicine Compliance 40