HIT Consultant

DECEMBER 10, 2021

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. Hospital-Psychiatric Unit. Report Background. Physician/Psychiatry. Psychologist, Clinical.

Fraud 97

Fraud COVID-19 Nurses Licensing 97

HIT Consultant

APRIL 1, 2024

to settle a civil fraud lawsuit filed by the U.S. will be divided between the US government and various states. Key Allegations The lawsuit alleged that TRG engaged in improper billing practices related to radiology services provided to hospitals and other healthcare providers across the country.

Governance 89

Governance Licensing Fraud Medicare 89

Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT Today

FEBRUARY 9, 2024

government and leading medical associations call upon stakeholders to do their part. Currently, in-patient and facility claims (such as extended hospital stays) account for a significant portion of costs in healthcare — as high as 45%. Even worse, up to 10% of this spending is rife with waste, abuse, and fraud.

Fraud 110

Fraud Governance Hospitals Licensing 110

HIT Consultant

MAY 4, 2023

Monitoring and maintaining the security of IT infrastructure is often overemphasized within hospitals and health systems, while the human side of reducing risk is often under-emphasized. The answer is training, continual training to help create a culture of security within your hospital or health system.

Hospitals 90

Hospitals Regulatory Compliance HIPAA Compliance 90

Healthcare Compliance Blog

MAY 19, 2022

An acute care hospital in Oklahoma has paid over $1.1 Following an internal review and audit, the hospital discovered irregularities regarding its billing of certain services, and proactively contacted the United States to self-disclose the issues.? Throughout the investigation, the hospital cooperated with the above entities.

US Department of Health and Human Services 59

US Department of Health and Human Services Hospitals Medicare Medicare 59

Healthcare Law Blog

FEBRUARY 9, 2024

Following the resolution of this case, hospitals are encouraged to revisit their arrangements with private physician groups to ensure that proper safeguards are in place to mitigate FCA risk. Hospitals may also want audit rights to ensure that it has the ability to monitor billing compliance by private physicians on a regular basis.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

The Health Law Firm

JANUARY 23, 2019

On January 23, 2019, a Miami woman pled guilty to conspiring to defraud the government and paying and receiving kickbacks as part of a $1 billion health care fraud scheme. The former Director of Outreach Programs at Larkin Community Hospital will face a prison sentence of up to five years on the single count. Indest III, J.D.,

Fraud 40

Fraud Governance Hospitals 40

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

MedTrainer

MARCH 8, 2024

It educates employees on the laws, regulations, and policies governing their work and ensures they understand their responsibilities and obligations as healthcare professionals. Successful training is when team members understand and comply with various laws, regulations, and policies that govern the healthcare industry.

Compliance 52

Compliance Fraud Governance HIPAA 52

Healthcare IT Today

JANUARY 19, 2024

Governments are starting to act in response to the growing amount of cyber threats in the healthcare industry. Artificial intelligence (AI)-powered threat protection also helps healthcare security leaders prevent account takeover (ATO) and fraud at all points of authentication. AI should also be used for identity governance.

Fraud 88

Fraud Governance Ransomware Compliance 88

Hall Render

FEBRUARY 25, 2022

Under the Donors’ agreement with the Children’s Hospital (“Agreement”), the Hospital and the Fund would pay all out-of-pocket costs incurred by qualified families for their child’s medical care in the cancer, cardiac or neurosurgical programs, referred to as the “Initial Supported Programs.”

Fraud 40

Fraud Hospitals Medicare Medicare 40

MedTrainer

JULY 28, 2023

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? Risk Assessment. Legislation and Congressional Requests.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicare Medicare Governance 40

Hall Render

OCTOBER 11, 2023

Eric also assists health care clients, such as hospitals, physician groups and health systems, with additional services related to contract drafting, corporate governance and fraud and abuse compliance. He is dedicated to providing practical solutions to complex legal and business-related problems.

Fraud 40

Fraud Governance Compliance Hospitals 40

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Findings from OIG audits can identify compliance areas needing improvement. and cybersecurity threats.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

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. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Health Law Advisor

FEBRUARY 10, 2023

The total recoveries in fraud cases brought with respect to the health care and life sciences industries fell to the lowest level since 2009. billion was recovered in qui tam cases in which the government declined to intervene. By contrast, $777 million was recovered in cases where the government intervened or otherwise pursued.

Fraud 52

Fraud COVID-19 Governance Medicaid 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

The Health Law Firm

MARCH 14, 2013

Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. In many cases the activity may amount to fraud on the government. Often they are even asked to participate in it.

Fraud 40

Fraud Governance Nursing Homes Nurses 40

The Health Law Firm

MARCH 13, 2013

Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. In many cases the activity may amount to fraud on the government. Often they are even asked to participate in it.

Fraud 40

Fraud Governance Nursing Homes Nurses 40

MedTrainer

JUNE 29, 2023

Healthcare is an industry governed by countless regulations. While it can sometimes feel like there’s dozens and dozens of different healthcare standards, the biggest governing policies really boil down to four major regulations. Why are Healthcare Regulations Important? Healthcare regulations are crucial for several reasons.

Fraud 52

Fraud HIPAA Compliance Governance 52

Hall Render

FEBRUARY 23, 2024

Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, with qui tam actions accounting for over $2.3 billion is attributed to cases involving the health care industry, including managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities and physicians.

Compliance 71

Compliance Governance Medicare Medicare 71

Verisys

DECEMBER 5, 2023

For the medical staff services team at a hospital to properly verify a healthcare practitioner’s credentials, dozens of primary sources must be contacted directly, and those primary source organizations must then verify the credentials of the practitioner in question. State licensing boards verify practitioner license type and status.

Governance 52

Governance Licensing Malpractice Medicaid 52

Verisys

MARCH 1, 2024

FACIS® for Compliance and Safety: Verisys, through its flagship product FACIS® (Fraud Abuse Control Information System) , provides a gold standard dataset for sanction and exclusion screening.

Compliance 52

Compliance Fraud Licensing Governance 52

Verisys

MAY 9, 2023

Organizations must meet specific criteria to meet or maintain their certification or accreditation. Many of these standard setting organizations are activity specific, catering to hospitals, practice groups, research, pharmaceutical marketing, or other specialized programs.

Compliance 52

Compliance Fraud Governance Licensing 52

Provider Trust

FEBRUARY 3, 2023

In a recent study by Becker’s Hospital Review , 17 different hospitals reported having to scale back for a variety of reasons, including staffing issues and financial challenges. The government and private whistleblowers have increasingly targeted PE firms’ portfolio companies and the firms themselves.

Compliance 52

Compliance Fraud Nurses Telemedicine 52

MedTrainer

FEBRUARY 12, 2024

government collected $2.2B With nearly 1,000 healthcare-specific courses, there are many options to ensure employees are educated on fraud detection and false claims. in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

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. Priorities for Massachusetts’s Medicaid Fraud Division.

Fraud 52

Fraud COVID-19 Compliance Medicaid 52

MedTrainer

MARCH 14, 2024

As the Centers for Medicare and Medicaid Services outlines, privileging isn’t required for every healthcare provider but is a requirement for those conducting medical services within a hospital or ambulatory surgery center (ASC). Courtesy: This is when a hospital occasionally allows a provider to admit and treat a patient.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

HIPAA Journal

MARCH 30, 2023

Medical device cybersecurity is of significant concern as the number of devices used by hospitals continues to increase. Synthetic accounts have been a problem in several sectors for many years but there is growing evidence that synthetic accounts are being used for healthcare fraud.

Ransomware 95

Ransomware Fraud Governance Medical Billing 95

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.

Compliance 52

Compliance Fraud HIPAA Governance 52

Health Law Advisor

APRIL 13, 2023

These FAQs address subjects including “ General Questions Regarding Certain Fraud and Abuse Authorities ,” the “ Application of Certain Fraud and Abuse Authorities to Certain Types of Arrangements ,” and “ Compliance Considerations.” The vast majority of the principles articulated in the updated FAQs will undoubtedly be familiar to many.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Department of Health and Human Services focuses on preventing fraud, abuse, and waste in federal healthcare programs. What is Healthcare Compliance?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

YouCompli

AUGUST 22, 2023

Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs. OIG’s audits, evaluations, and investigations have demonstrated that risks of fraud, waste, and abuse in managed care are real and significant.”

Medicare 52

Medicare Medicare US Department of Health and Human Services Compliance 52

C&M Health Law

APRIL 21, 2022

Department of Justice (DOJ) to resolve allegations that it had made donations in order to improperly inflate the funding four of its hospitals received from the federal Medicaid program. Florida Medicaid is administered by the state but jointly funded by both the state and federal governments.

Medicaid 52

Medicaid Medicaid Governance Fraud 52

AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse.

Fraud 52

Fraud Compliance Medicare Medicare 52