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An Overview of Healthcare Compliance Laws and Regulations

Compliancy Group

When you work in healthcare, you must comply with the most rigorous regulations that safeguard patient health and privacy, protect workers, and prevent fraud, waste, and abuse of federal funds. Anyone in this industry should know the healthcare compliance laws and regulations that guide how they do their jobs and provide quality care.

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False Claims Act Settlements Exceed $5.6 Billion in Fiscal Year 2021

Healthcare Compliance Blog

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. In 2009 and 2010, further improvements were made to the False Claims Act and its whistleblower provisions. More than $5.6

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What is HIPAA?

HIPAA Journal

Title II: Preventing health care fraud and abuse; administration simplification; medical liability reform. The provisions related to administrative simplification are discussed below, while the provisions for medical liability reform (of which there are few) only relate to whistle blower protection for reporting fraud and abuse.

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HIPAA Transactions and Code Sets Rules

HIPAA Journal

Indeed, many of the classification systems that would eventually be adopted as the HIPAA transactions and code sets rules were already mandated for use in some federal and state healthcare programs – including Medicare and Medicaid. The post HIPAA Transactions and Code Sets Rules appeared first on The HIPAA Journal.

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The History of Healthcare Compliance

MedTrainer

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance in healthcare began to encompass billing, fraud, and abuse prevention. Compliance efforts shifted toward protecting patient information.

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Zone 5 Program Integrity Contractor (ZPIC) for Medicare and Medicaid Programs is AdvanceMed

The Health Law Firm

AdvanceMed Corporation, an NCI company, was named the Zone 5 Program Integrity Contractor (ZPIC) for the Medicare and Medicaid programs, in December 16, 2009. As the ZPIC for Zone 5, AdvanceMed has been performing benefit integrity activities aimed to reduce fraud, waste and abuse in Medicare and Medicaid data matching programs.

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Editorial: 5 Gaps in HIPAA and How They Are Being Filled

HIPAA Journal

For example, the Administrative Requirements (Part 162) helped reduce insurance fraud and accelerated eligibility inquiries, authorization requests, and claims processing. Only one penalty was issued in each of 2008 and 2009, 2 in 2010, 3 in 2011, and 6 in 2012.

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