Compliancy Group

DECEMBER 15, 2023

Knowing how to detect, report, and prevent inappropriate use of funds associated with the Centers for Medicare and Medicaid Services (CMS) is essential. All three practices result in unnecessary costs, but they often differ in intent and nature of their impacts. taxpayers over $100 billion annually.

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Fraud Medicaid Medicaid Medicare 52

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Health Law RX

FEBRUARY 21, 2024

The Centers for Medicare & Medicaid Services (CMS) has revised certain payment policies under the Medicare physician fee schedule, and updated provider and supplier enrollment regulations. For example, “stay of enrollment” may be used when a provider fails to report a change of practice location.

Medicare 52

Medicare Medicare Licensing Compliance 52

Med-Net Compliance

SEPTEMBER 9, 2022

A West Virginia ophthalmologist and his practice have paid $907,074.64 to resolve allegations that they submitted false claims to Medicare and Medicaid. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

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Medicare Medicare Medicaid Medicaid 59

Healthcare IT News - Telehealth

JUNE 8, 2022

The Department of Health and Human Services once again (for the ninth time) extended the public health emergency this past month , stretching it beyond mid-July. But sooner or later, that provision of the Public Health Service Act will draw to a close. Providers have been promised at least 60 days' notice.

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Total Medical ComplianceHIPAA

APRIL 12, 2024

We’re excited to announce the launch of our new service, Exclusion Screening, that will assist healthcare organizations in adherence to requirements such as the initial screening of potential employees/contractors and monthly screening of current employees/contractors. Permissive exclusions typically range from 0 to 3 years.

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Compliance Fraud Medicaid Medicaid 52

Compliancy Group

DECEMBER 8, 2023

Compliance with regulations, such as HIPAA (Health Insurance Portability and Accountability Act) , is critical in safeguarding patient privacy. Billing and Coding Practices Billing and coding errors are another area where compliance issues can arise.

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Compliance Medicare Medicare Fraud 52

McGuire Wood

OCTOBER 2, 2023

Oliver Street agreed to pay the United States $8.892 million to resolve self-reported allegations that its acquisition of several dermatology practices over five years violated the Physician Self-Referral Law (Stark Law), the Anti-Kickback Statute (AKS) and the False Claims Act (FCA). DOJ Voluntary Self-Disclosure.

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Fraud Governance Compliance Medicare 52

MedTrainer

JUNE 28, 2023

It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. CFEs use their knowledge of accounting principles, legal regulations, and investigative techniques to uncover fraudulent practices. Anti-Kickback Statute (AKS).

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Fraud Compliance Governance Compliance Officers 52

The Health Law Firm

APRIL 21, 2022

On February 23, 2022, a psychiatric practice and its owner agreed to pay $310,874 to resolve allegations they improperly hired and employed a physician who was excluded from federal healthcare programs. The physician who was hired was on the OIG's exclusion list, the "List of Excluded Individuals and Entities" (LEIE).

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Governance 52

Health Care Law Brief

JULY 25, 2023

Department of Health and Human Services (“ HHS ”) released its final rule (“ Final Rule ”) implementing penalties for information blocking. The Final Rule codifies the prohibition on “information blocking” introduced by the 21st Century Cures Act (“ Act ”), which was enacted on December 13, 2016.

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HIPAA Payment Systems Compliance Licensing 52

Health Law RX

NOVEMBER 10, 2022

Two recent multi-million dollar False Claims Act (“FCA”) settlements demonstrate the vigor with which the Department of Justice (“DOJ”) is investigating and prosecuting allegedly fraudulent health care billing practices. Exceptions to this default rule exist.

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Governance Medicare Medicare Medicaid 52

Provider Trust

JANUARY 26, 2022

In this post, we break down the basics of the False Claims Act, the OIG Fraud Risk Spectrum, and how your organization can best avoid employing bad actors on the OIG exclusion list. How False Claims Act Settlements Feed the OIG Fraud Risk Spectrum. How the OIG Finds & Prosecutes Healthcare Fraud.

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

Total Medical Compliance Resources

MAY 11, 2023

With unethical billing practices being number one in healthcare fraud and abuse, there are also other recognized areas that have resulted in diverse laws, codes, and standards. In order to combat this, HIPAA established the Healthcare Fraud and Abuse Control Program (HCFAC). The Anti-Kickback Statute (AKS) – 42 U.S.C. 1320a-7b(b).

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Fraud HIPAA Medicare Medicare 59

McBrayer Law Blog

NOVEMBER 18, 2020

Posted In Code Enforcement , Hospitals It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake.

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Compliance Overpayments Overpayment Medicare 52

MedTrainer

OCTOBER 16, 2023

Health Insurance Portability and Accountability Act (HIPAA) HIPAA is a pivotal regulation that focuses on the protection of patient health information, enforced by the U.S. Department of Health and Human Services (HHS). False Claims Act The False Claims Act is enforced by the U.S.

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Compliance US Department of Health and Human Services HIPAA Medicaid 52

Medisys Compliance

OCTOBER 17, 2022

Other typical errors include paying for the same service more than once or adding incomplete or inaccurate information for a patient. Not to add to your list of worries but some service providers have been charged with “upcoding,” the deliberate use of false billing codes to enhance remuneration for their services.

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Medical Billing Medical Billing Outsourcing Medical Billing Services HIPAA 98

HIPAA Journal

FEBRUARY 2, 2023

The platform can also be used to arrange telehealth visits and access other health services. Users of the service provide personal and health information GoodRx, which also collects data from pharmacy benefit managers when users make purchases using GoodRx coupons.

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Prescription Drug Pricing HIPAA Compliance Telemedicine 100

MedTrainer

JUNE 29, 2023

Adhering to healthcare regulations is the best way to reduce risk, improve safety, boost patient and provider satisfaction, and enhance service quality. Above all, they play a fundamental role in protecting patient safety and ensuring the delivery of high-quality healthcare services.

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Healthcare Law Blog

FEBRUARY 9, 2024

Among other things, the complaint alleged that the system’s arrangements with various private physician groups resulted in federal False Claims Act (FCA) and Delaware False Claims and Reporting Act (DE FCA) liability. [2] ChristianaCare did not admit liability as part of the settlement.

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Hospitals Compliance Officers Compliance Overpayments 52

Healthcare Law Today

JANUARY 2, 2023

As a result, an overpayment would be “ identified ” when the entity has actual knowledge of an identified overpayment, or acts in reckless disregard or deliberate ignorance of an identified overpayment. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.

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Overpayments Overpayment ACA Medicare 52

Healthcare Law Today

JANUARY 11, 2023

Does violating requirements amount to fraud under the False Claims Act (FCA) when the requirements allegedly violated are unclear? There is currently a circuit split and petitions for review pending to the Supreme Court as to when the purported violation of ambiguous requirements can give rise to a FCA suit.

Governance 52

Governance Medicare Medicare Fraud 52

Health Law Advisor

JULY 14, 2023

The following summarizes some of the key initiatives included in the Implementation Plan that will directly impact critical infrastructure organizations , including healthcare, energy, manufacturing, information technology and financial services. Leveraging the False Claims Act to Improve Vendor Cybersecurity.

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Regulatory Compliance Fraud Compliance Governance 52

YouCompli

JULY 12, 2022

These summaries provide real-world examples of regulators’ response to practices that don’t fully comply with regulations. The COVID-19 pandemic opened the door to greater use of telehealth services, and healthcare providers and consumers walked through it. Medically unnecessary telehealth services.

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HIT Consultant

FEBRUARY 20, 2024

Over the last decade, private equity firms have invested nearly $1 trillion in approximately 8,000 healthcare deals, encompassing a wide spectrum of medical services, from fertility clinics to neonatal care, primary care to cardiology, hospices, and everything in between. The consequence?

Health Insurance 52

Health Insurance Medicaid Medicaid Governance 52

AIHC

MAY 31, 2022

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. You exert significant influence over what services your patients get.

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Fraud Compliance Officers Compliance Medicare 52

MedTrainer

MARCH 8, 2024

Healthcare professionals should frequently learn, re-train, and refresh their knowledge of new concepts and best practices. Specific topic areas include: HIPAA: The Health Insurance Portability and Accountability Act is a federal law that governs the privacy and security of patient health information.

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Compliance Fraud Governance HIPAA 52

Hall Render

FEBRUARY 27, 2023

billion in False Claims Act (“FCA”) related settlements and judgments in the federal fiscal year 2022. Unnecessary Services. DOJ also exercised enforcement action against providers who billed for services that were not medically necessary. While this is less than half of the previous year’s recovery of $5.6

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

Med-Net Compliance

SEPTEMBER 23, 2022

A physician pleaded guilty in federal court to falsely certifying that products and tests were medically necessary for more than 2,000 Medicare and Medicaid patients in Missouri whom he never met or examined. Accordingly, he knew his false and fraudulent statements and documents were untrue when he made them.

Fraud 59

Fraud Medicaid Medicaid Telemedicine 59

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. HCOs create systems within the practice to ensure that compliance with healthcare regulations is a smoothly administered routine.

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

Hall Render

JANUARY 4, 2023

Mayo Alao (Denver/Indianapolis offices) practices in the area of health care law with a focus on hospital and health system matters, regulatory and compliance issues, corporate transactions and hospital/physician alignment. James Junger (Milwaukee office) focuses his practice on pharmacy and health care compliance issues.

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Fraud Compliance Hospitals 40

Health Law RX

MARCH 27, 2023

an online mental health counseling service, to resolve alleged violations of the Federal Trade Commission Act (FTC Act) related to the company’s collection, use, and sharing of customers’ health information. Earlier this month the FTC announced a consent order with BetterHelp, Inc. ,

HIPAA 52

HIPAA Compliance Health Insurance Governance 52

MedTrainer

JANUARY 31, 2024

It upholds healthcare organizations and professionals to standards and guidelines that protect patient safety, data privacy, and medical practices. By ensuring accurate billing and coding practices, compliance programs protect healthcare organizations from legal and financial repercussions.

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Compliance Compliance Officers Governance Fraud 52

AIHC

APRIL 5, 2022

Only appeal claims when you have evidence and supporting documentation to substantiate your right to payment. Read Part 1 entitled “ Managing Denials Is Important to Good A/R Hygiene ” posted March 22, 2022, and Part 2 entitled “ Understanding How Payers Deny Claims. Place of Service (POS) can be a “trigger” for an investigation.

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Fraud Compliance Medicare Medicare 52

Provider Trust

MAY 17, 2022

Following Sections 1128 and 1156 of the Social Security Act, the HHS Office of Inspector General Exclusions Program mandates that healthcare organizations refrain from doing business with “excluded or sanctioned” individuals or entities. Vendor Z provides contract janitorial services. What is considered a healthcare vendor?

Compliance 52

Compliance Medicare Medicare Due Diligence 52

Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”). All other providers were required to update practice locations within 90 days.

Medicare 40

Medicare Medicare Licensing Malpractice 40

Health Law Advisor

AUGUST 14, 2023

During the COVID-19 PHE, CMS issued temporary waivers, including a waiver of the “location requirement” of the In-Office Ancillary Services (“IOAS”) exception. The IOAS exception requires, among other things, that both: (1) the practice be a “group practice” (as defined in the Stark Law regulations), and (2) the furnishing of the DHS (e.g.,

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COVID-19 Medicare Medicare Public Health 52