HIPAA Journal
JUNE 30, 2025
The Federal Bureau of Investigation (FBI), its Internet Crime Complaint Center (IC3), and the HHS Centers for Medicare & Medicaid Services (CMS) have issued warnings to the healthcare and public health (HPH) sector about ongoing fraud schemes.
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.
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AIHC
FEBRUARY 17, 2025
Part 1: 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.
Healthicity
FEBRUARY 8, 2022
In a recent audit of a New York hospital, the HHS OIG identified overpayments. New York Hospital to Pay $389,000 to Medicare.
Hall Render
JUNE 20, 2025
These changes follow CMS’s 2023 final rule allowing extrapolation of RADV overpayments and signal an era of heightened scrutiny of MA billing practices under the current administration. Background CMS’s recent announcement aligns with broader federal efforts to curb fraud, waste and abuse in federally funded programs.
YouCompli
JUNE 25, 2025
The HHS OIG has stated, “One of the best ways to identify fraud and abuse risks is to follow the money.” If a revenue cycle team’s internal monitoring identifies overpayments, it is critical for compliance departments to know the date of discovery , so the organization does not run afoul of the 60-day repayment rule.
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.
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