Fraud Governance Hospitals Overpayment 
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. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.
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.
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Healthcare Law Blog
FEBRUARY 3, 2023
Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.
Healthcare IT News - Telehealth
JUNE 8, 2022
But even now, hospitals and health systems should be preparing proactively to meet the regulatory demands of a post-PHE future. State government executive orders. Additionally, any reimbursement resulting from these claims could be considered an overpayment. Providers have been promised at least 60 days' notice.
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.
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.
Hall Render
MAY 10, 2024
Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’
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