Innovaare Compliance

JULY 19, 2024

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

Fraud 52

Fraud Medicare Medicare Compliance 52

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The post CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance appeared first on Inovaare.

Fraud 52

Fraud Medicare Medicare Medicaid 52

HIPAA Journal

JANUARY 30, 2023

The event provides a tremendous opportunity for learning through HIPAA workforce training sessions and keynote speeches from top government officials and leading industry professionals. Tennant, MA The full schedule for the event can be downloaded here – HIPAA Summit Schedule (PDF).

US Department of Health and Human Services 83

US Department of Health and Human Services HIPAA Compliance Medicaid 83

Healthcare IT Today

DECEMBER 30, 2024

Additionally, AI can be a game-changer for risk and design; predictive analytics can reshape trials by identifying high-impact patient populations and preventing adverse events, thus, offering practical strategies to reduce inefficiencies and align trials with real-world patient needs.

US Department of Health and Human Services 88

US Department of Health and Human Services Nurses Medicare Medicare 88

Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. The toolkits include: Measuring Compliance Program Effectiveness: A Resource Guide Adverse Events Trigger Tools Handout: A Toolkit for Healthcare Boards.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Compliance Medicaid 59

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

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Fraud Compliance Medicare Medicare 52

Med-Net Compliance

OCTOBER 13, 2022

The case was investigated and prosecuted by the Medicaid Fraud Control Unit, a division of the North Dakota Attorney General’s Office, with assistance from the local police department. I want to thank the Medicaid Fraud Control Unit for thoroughly investigating this crime and successfully pursuing justice.

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Nursing Homes Nurses Fraud Medicaid 59

C&M Health Law

SEPTEMBER 11, 2023

Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (“CMS”) issued a much anticipated and contested proposed rule that seeks to establish minimum staffing level requirements for nursing homes. On September 1, 2023, the U.S. The 2001 recommendation of 4.1 HPRD consisted of 0.75 HPRD from NAs.

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Nursing Homes Nurses Medicaid Medicaid 98

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. With Medicaid, the challenges are equally formidable.

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Fraud Medicaid Medicaid Medicare 52

HIPAA Journal

AUGUST 31, 2023

According to a Notice of Data Event on the company’s website, Mom’s Meals experienced a cyberattack between January 16, 2023, and February 22, 2023, that resulted in customer, employee, and contractor data being encrypted. It is also providing credit monitoring, fraud consultation, and identity theft restoration services for a year.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

MedTrainer

MAY 12, 2025

Exclusion Checks : Lists providers barred from participating in federal (Medicare) or state (Medicaid) healthcare programs. The NPDB strictly focuses on misconduct and adverse event data, making it an indispensable tool for risk management. Not taking action if the event turns out not to be reportable.

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Malpractice Compliance Licensing Medicaid 52

MedTrainer

JANUARY 12, 2024

Here are some of the key organizations involved in regulating healthcare compliance: Centers for Medicare & Medicaid Services (CMS): CMS is a federal agency within the U.S. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

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Compliance Fraud Medicaid Medicaid 52

HIPAA Journal

JULY 24, 2023

The team’s roles are to investigate and audit the Department’s operations to prevent fraud, waste, and abuse within the Department, and also to audit and investigate potential crimes against the Department. In addition to HHS OIG enforcement actions, Medicare Fraud Control Units (MFCUs) operate in every state and territory.

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Fraud Medicare Medicare Medicaid 52

American Medical Compliance

JANUARY 9, 2024

This type of theft is just one example of healthcare fraud. Through Medicare, Medicaid, and the Children’s Health Insurance Program, the federal government and state governments offer health care coverage to nearly 100 million individuals. As a result of their large size, these healthcare systems are easy targets for fraud.

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Fraud Medicare Medicare Compliance 52

Compliancy Group

AUGUST 30, 2024

Emergency preparedness : Developing and improving contingency plans to protect patients and employees during crisis events, including regular drills, training, emergency communication protocols, and evacuation routes. Under the direction of the U.S.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 52

Compliancy Group

MAY 27, 2022

The complaint further alleges that the affected patients have suffered anxiety and loss of time and now face a substantial risk of fraud and identity theft due to this data breach. Solara Medical will also implement a security information event and management (SIEM) tool with a 400-day lookback on activity logs.

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HIPAA Ransomware Hospitals Health Insurance 98

Health Law RX

JUNE 2, 2023

The Prior SafeCo Standard Until yesterday, defendants could seek dismissal of fraud claims based on the absence of scienter by relying on the two-part test codified by the Court in SafeCo Ins. A mistake is still a mistake, not fraud. of America v. 3] That test posed two questions. per 30-day supply). [9] per 30-day supply). [10]

Fraud 52

Fraud Governance Medicaid Medicaid 52

AIHC

APRIL 10, 2024

What is your procedure to notify patients in the event of a data breach? Does your organization have materials for patient education and risks of identity theft and medical fraud? In the event of a data breach, when the data was encrypted, the breach is not required to be reported. How are security breaches prevented?

Compliance 99

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

MedTrainer

FEBRUARY 1, 2024

These programs help to promote lawful and ethical conduct within healthcare organizations and minimize the risk of legal violations, such as fraud, abuse, and other unethical behaviors. Prevent Fraud and Abuse: Helps avoid improper billing and monitors for potential fraudulent or waste activities.

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

NY Health Law

JANUARY 3, 2025

These allegations involved: (1) speaker events with few or no legitimate attendees; (2) excessive compensation of speakers for canceled events; and (3) the selection of speakers to reward and influence high prescribers.

Fraud 52

Fraud FDA Doctors Medicaid 52

Healthcare IT Today

SEPTEMBER 19, 2023

This critical information can help identify or avoid serious adverse events, including hospital readmissions. I would continue to advance CMS’ directive that by 2030 all Medicare and the bulk of Medicaid beneficiaries be in care engagements governed under a value-based contract.

Hospitals 139

Hospitals HIPAA Nurses Governance 139

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). Such providers must still separately report Reportable Events to the OIG pursuant to the CIA.

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Fraud Overpayments Overpayment Governance 52

MedTrainer

OCTOBER 4, 2023

These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. These requirements are designed to protect patient rights, privacy, and safety, as well as to prevent fraud, abuse, and other improper practices within healthcare organizations.

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Compliance Fraud HIPAA Governance 52

Compliancy Group

FEBRUARY 29, 2024

A Corporate Integrity Agreement is typically part of the civil settlement, and it prevents the violating entity from being added to HHS’s OIG Exclusion List , including organizations excluded from valuable programs like Medicare or Medicaid. IROs must be external to the participating organization and act with objectivity.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. That figure does not include even more funds recovered for state Medicaid programs. Health Care Fraud Actions.

Fraud 40

Fraud Governance Medicare Medicare 40

Verisys

MAY 3, 2023

Healthcare entities, especially those that receive funding from Medicaid or Medicare, must meet compliance standards set forth by the Office of Inspector General (OIG). These standards help mitigate an organization’s risk by preventing waste, fraud, and abuse. Respond to reported offenses promptly and undertake corrective action.

Compliance 52

Compliance Compliance Officers ADA Governance 52

Medisys Compliance

NOVEMBER 6, 2023

Compliance with Regulatory Guidelines Ensure that all claims are submitted per all applicable laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and the Medicare Fraud, Waste, and Abuse (FWA) laws. Stay up-to-date on all changes to regulatory requirements.

Compliance 59

Compliance Medical Billing Outsourcing Medical Billing ACA 59

Compliancy Group

OCTOBER 24, 2024

The number “50” represents significant milestones – birthdays, anniversaries, the years since events both tragic and inspiring. Gumbs alleged, was not entitled to the records because, Dr. Gumbs claimed, the Complainant would use the records to commit insurance fraud.

HIPAA 52

HIPAA Fraud Compliance Medicaid 52

Hall Render

NOVEMBER 25, 2024

Motivating factors for issuing the Nursing Facility ICPG included long-standing issues such as staffing, infection control, emergency preparedness, background checks, adverse events experienced by residents, inappropriate use of medications and other compliance and quality issues.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Healthcare Law Blog

AUGUST 11, 2022

The FQHC served predominantly low-income individuals [3] including Medicare and Medicaid beneficiaries and offered telehealth services to its patients through a telehealth application, which could be downloaded onto a smartphone. . The Arrangement.

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

AIHC

APRIL 10, 2024

What is your procedure to notify patients in the event of a data breach? Does your organization have materials for patient education and risks of identity theft and medical fraud? In the event of a data breach, when the data was encrypted, the breach is not required to be reported. How are security breaches prevented?

Compliance 52

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

HIPAA Journal

MARCH 20, 2025

This is because it takes longer for healthcare fraud to be discovered and stolen data can be used for longer compared to (for example) a stolen credit card which can be stopped as soon as the breach is discovered. Dominion National Insurance Company, and Dominion Dental Services USA, Inc.

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HIPAA Ransomware Compliance Hospitals 111

HIPAA Journal

APRIL 27, 2025

The practice claimed the complainant would not pay a $25 administrative fee for mailing the records (certified mail) and that the request was denied because the practice believed she would use the information to commit insurance fraud. Your graphs indicate the penalties for HIPAA violations are increasing. Is this the case?

HIPAA 85

HIPAA Ransomware Hospitals Compliance 85

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Moderated by David S.

Fraud 52

Fraud COVID-19 Compliance Medicaid 52

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.”

Compliance 52

Compliance Fraud Medicare Medicare 52

MedTrainer

NOVEMBER 15, 2023

It conducts audits, investigations, and evaluations to ensure efficiency and integrity in HHS programs, including Medicare and Medicaid. The OIG also enforces standards for healthcare providers and suppliers to prevent fraud and imposes penalties for non-compliance.

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Compliance Framework Governance Compliance Medicaid 52

Verisys

JANUARY 25, 2023

In short, an entity will lose the ability to service patients or members with Medicare or Medicaid insurance. Employing an individual will jeopardize a healthcare provider’s ability to continue federal programs. A heavy fine follows based on the length and engagement. states and jurisdictions.

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Fraud Telemedicine Compliance Licensing 52