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How To Prepare for an OIG Inspection

MedTrainer

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. This ensures that medical facilities are not engaging in malpractice and following program rules and regulations.

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Are Provider Enrollment and Credentialing the Same?

MedTrainer

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. The employer may also review any pending and past medical malpractice cases or disciplinary actions. This helps uphold quality healthcare standards and protects against fraud, waste, and abuse.

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7 Red Flags to Watch for During Healthcare Credentialing

Verisys

Here are seven red flags to look out for and the reasons why: Incomplete or inconsistent application: Missing or conflicting data regarding education, training, work history, licensure, or malpractice history might indicate false information or attempts to conceal relevant details.

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The Importance of Primary Source Verification for Practitioner Credentials

Verisys

An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. The policy issuer for malpractice insurance verifies insurance coverage. Credentials Verification Organizations to the Rescue?

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Quick Guide to the National Practitioner Data Bank (NPDB)

Provider Trust

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.

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Privileges and Credentialing Aren’t the Same

MedTrainer

Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority. Whether it’s government regulation or healthcare facility requirements is a matter. Maintaining compliance helps protect against fraud, waste, and abuse.

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The Importance of Primary Source Verification for Practitioner Credentials

Verisys

An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. The policy issuer for malpractice insurance verifies insurance coverage. Government and Non-Government Sources. Criminal history.