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FBI; CMS Issue Warning About Fraud and Phishing Attempts on Healthcare Orgs

HIPAA Journal

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.

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Fraud Indicators and Red Flags

AIHC

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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Fraud Indicators and Red Flags, Part 1

AIHC

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.

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The Final Rule: How to Prevent $389,000 in Medicare Overpayments

Healthicity

In a recent audit of a New York hospital, the HHS OIG identified overpayments. New York Hospital to Pay $389,000 to Medicare.

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Update: CMS to Annually Audit All Medicare Advantage Plans and Accelerate Completion of Prior Payment Year RADV Audits

Hall Render

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.

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Three Strategies to Align Compliance with Revenue Cycle 

YouCompli

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.

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Will CMS’s Proposed Rule on “Identified Overpayments” Increase Reverse FCA Cases?

Healthcare Law Today

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.