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.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

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

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

MedTrainer

FEBRUARY 12, 2024

government collected $2.2B Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

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

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

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. 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.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

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. The policy issuer for malpractice insurance verifies insurance coverage.

Governance 52

Governance Licensing Malpractice Medicaid 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

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

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

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

AIHC

NOVEMBER 29, 2023

Hospital reimbursement also changed. In 1983 Medicare shifted to the inpatient Prospective Payment System (PPS) and DRGs (Diagnostic Related Groups) and only paying a limited number of days to the hospital regardless of the actual length of stay. The poor quality of care, inefficiencies, and total cost to the U.S.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare IT News - Telehealth

JULY 16, 2020

Now, the question becomes : How many of those changes, particularly regarding temporary waivers issued by the Centers for Medicare and Medicaid Services, will become permanent? "Currently there's parity between in-person and telehealth visits," Leary pointed out. "We anticipate a lot of discussion around that."

COVID-19 139

COVID-19 Medicare Medicare Governance 139

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Compliance Fraud 52

AIHC

NOVEMBER 29, 2023

Hospital reimbursement also changed. In 1983 Medicare shifted to the inpatient Prospective Payment System (PPS) and DRGs (Diagnostic Related Groups) and only paying a limited number of days to the hospital regardless of the actual length of stay. The poor quality of care, inefficiencies, and total cost to the U.S.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

MARCH 20, 2023

Scott advises health care organizations on a broad range of regulatory and transactional matters, with a particular focus on issues relating to value-based care, fraud and abuse and the implementation of innovative health care delivery and payment models. from the University of North Carolina School of Law.

Fraud 40

Fraud Medicare Medicare Medicaid 40

Verisys

NOVEMBER 14, 2023

The Importance of Thorough Credentialing The credentialing process for hospitals and health systems prioritizes in-depth research and meticulous accuracy, which means that it is not a speedy process, often taking from 90 to 120 days to complete. However, verifying a provider’s credentials is essential.

Licensing 52

Licensing Medicaid Medicaid Governance 52

YouCompli

DECEMBER 7, 2022

These exclusions are generally related to criminal activity like fraud or healthcare-related misconduct. Felony convictions for other healthcare-related fraud, theft, or other financial misconduct. A Puerto Rican hospital settled for $105,000 for allegedly hiring an excluded individual as a medical utilization director.

Fraud 52

Fraud US Department of Health and Human Services Compliance Medicaid 52

Verisys

FEBRUARY 23, 2022

As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Facilities increasingly rely on healthcare compliance officers (HCOs) to bridge the gap between government regulation and daily operations.

Compliance Officers 52

Compliance Officers Compliance US Department of Health and Human Services Governance 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

Provider Trust

JULY 8, 2022

In this quick guide, we’ll explore the importance of including NPDB monitoring in your routine license and exclusion monitoring to protect your organization and the patients you serve from fraud, waste, and abuse. Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S.

Licensing 52

Licensing Malpractice Fraud Compliance 52

Healthcare IT News - Telehealth

JANUARY 26, 2022

Ain Shams University Virtual Hospital (ASUVH) in Cairo, Egypt, employs a model of care where they reach patients throughout the continent by connecting with local clinics. Further, telehealth providers can help reduce the chance for fraud, waste and abuse by implementing risk-management policies and mechanisms.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. What is Healthcare Compliance?

Compliance 52

Compliance HIPAA Telemedicine ACA 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

HIPAA Journal

OCTOBER 10, 2022

The presentation was then forwarded by the Council to employees working for certain county government agencies and the presentation was posted to the DHS website as part of the meeting minutes. According to the substitute breach notification on the law firm’s website, the security breach was detected on August 9, 2021.

Medicaid 57

Medicaid Medicaid Governance Fraud 57

Verisys

MARCH 1, 2022

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. Government and Non-Government Sources. And the list goes on.…

Governance 52

Governance Licensing Malpractice Medicaid 52

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. Let’s delve into the importance of healthcare compliance laws and regulations, their impact on providers and organizations, and the guidelines governing their implementation.

Compliance 52

Compliance Compliance Officers Fraud Compliance Framework 52

Provider Trust

MAY 17, 2022

Our research shows, on average, a hospital with 1,000+ employees also contracts with and/or relies upon an even larger network of vendors. It handles Protected Health Information and processes and stores such data for a hospital. Vendor Y is a supplier of surgical instruments to a hospital.

Compliance 52

Compliance Medicare Medicare Due Diligence 52

Kaiser Health News

NOVEMBER 11, 2021

In response, the Centers for Medicare & Medicaid Services has threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers. She told the woman she had reported the calls to CMS, the AARP Fraud Watch Network Helpline and the FTC.

Medicare 144

Medicare Medicare Doctors Fraud 144

MedTrainer

NOVEMBER 6, 2023

While specific compliance requirements vary depending on the type of facility — from large hospitals and surgery centers to clinics and nursing homes — having a well-structured compliance plan is essential for all medical settings. But what exactly is a compliance plan in healthcare, and why is it so crucial?

Compliance 52

Compliance Fraud Nursing Homes Governance 52

Compliancy Group

JANUARY 3, 2024

This mistake resulted in millions of dollars in lost revenue for hospitals. When auditing claims, medical records, and financial documentation, it is essential to incorporate guidance based on the following questions: Are all codes for services and supplies correct?

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

MedTrainer

FEBRUARY 12, 2024

In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare. Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

Compliance 52

Compliance Licensing Governance Fraud 52

Hall Render

JULY 28, 2023

million for rural hospital expansion Hospices in Arizona & other states receive scrutiny over concerns of fraud, waste & abuse Phoenix Children’s Building New 44,000-Square Foot Level IV Neonatal Intensive Care Unit Firefighters oppose Banner’s planned $400M hospital There’s a growing nurse shortage in Arizona.

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

Verisys

JANUARY 18, 2022

The credentialing process for hospitals and health systems prioritizes in-depth research and meticulous accuracy, which means that it is not a speedy process, often taking from 90 to 120 days to complete. It is critical for hospitals and health systems to know that everyone on the staff is compliant and in good standing at all times.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Med Law Blog

MAY 1, 2023

Similar issues were raised with respect to the private equity acquisition of Hahnemann Hospital. In the article entitled “The Death of Hahnemann Hospital” published in the New Yorker magazine in May 2021. Christopher’s Hospital, to American Academic Health System, which then closed Hahnemann Hospital in June of 2019.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52