AIHC

FEBRUARY 17, 2025

When Audit Managers Knowingly Skew Audit Results Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. on fraud detection and prevention in healthcare.

Fraud 52

Fraud Compliance Overpayment Overpayments 52

HIPAA Journal

MARCH 30, 2022

Had HIPAA not addressed these issues, subsequent events in HIPAA history may never have happened. Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. Abuse and Fraud in the Health Care Industry. $7 In March 1996, Rep.

HIPAA 137

HIPAA Fraud Health Insurance Health Care Reform 137

HIT Consultant

JANUARY 9, 2024

Varying levels of economic development and legal systems lead to potential fraud and currency control complications as well. The integration of key clinical data from EDC systems, study budgets, agreements and schedules of events enables automated invoicing for streamlined efficiency and prevent payment errors.

Overpayments 95

Overpayments Overpayment COVID-19 Fraud 95

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.

Fraud 52

Fraud Overpayment Overpayments Governance 52

Compliancy Group

FEBRUARY 7, 2024

CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary. Given their significant impact, healthcare organizations must take UPIC audits seriously.

Fraud 52

Fraud Compliance Medicare Medicare 52

Compliancy Group

FEBRUARY 29, 2024

A Corporate Integrity Agreement outlines the healthcare entity’s future compliance obligations and the steps to prevent future fraud, abuse, and illegal activity incidents. Being able to opt into a Corporate Integrity Agreement typically depends on the severity and nature of the infraction and the entity’s previous compliance record.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

Medisys Compliance

MARCH 7, 2022

These are usually just innocuous mistakes that do not represent any intent to commit billing fraud. In the unfortunate event when you receive such overpayment demand letters, don’t acquiesce without conducting an analysis first. One error of this nature can lead to a reviewer casting aspersions on the integrity of your note.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Overpayments Overpayment 52