Verisys

MAY 13, 2024

April 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. The post April 2024 Bad Actors Roundup appeared first on Verisys. Secure your success by choosing Verisys.

Fraud 52

Fraud COVID-19 Doctors Licensing 52

Verisys

MARCH 8, 2024

February 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M Peters Physician Pleads Guilty to False Statements, Resulting in $1.4

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Verisys

APRIL 2, 2024

March 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3

Fraud 52

Fraud Telemedicine Licensing Doctors 52

Verisys

FEBRUARY 9, 2024

January 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 The post January 2024 Bad Actors Roundup appeared first on Verisys.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

JANUARY 10, 2024

It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. The OIG is making major investments to systematically detect and prosecute fraud. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024.

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Compliance Fraud HIPAA Compliance Officers 94

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] By George F. Indest III, J.D.,

Nursing Homes 52

Nursing Homes Nurses Fraud Medicare 52

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] By George F. Indest III, J.D.,

Nursing Homes 52

Nursing Homes Nurses Fraud Medicare 52

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

The Health Law Firm Blog

MARCH 4, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] By George F. Indest III, J.D.,

Nursing Homes 52

Nursing Homes Nurses Fraud Medicare 52

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. HHS’s suspension and debarment programs are vital to upholding integrity in Federal grants and contracts.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

AIHC

SEPTEMBER 3, 2024

On February 21, 2024 the OIG stated that the first two industry segment-specific CPGs (ICPGs) will address Medicare Advantage and nursing facilities. OIG intends to publish these guidance documents in 2024, but as of September 2024, we are still waiting for more ICPG information.

Compliance Officers 52

Compliance Officers Compliance Fraud Medicare 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. 79452 (2022)). 405.902). .

Medicare 52

Medicare Medicare Overpayments Overpayment 52

HIPAA Journal

JANUARY 11, 2024

OIG in healthcare stands for the Department of Health and Human Services (HHS) Office of Inspector General (OIG) – the Office within the HHS responsible for reducing waste, fraud, and abuse in HHS programs and improving efficiency. The post What is OIG in Healthcare? appeared first on HIPAA Journal.

Fraud 81

Fraud HIPAA Compliance Medicare 81

Provider Trust

OCTOBER 19, 2023

8, 2023 | 12pm CST Reserve Your Spot With new regulations and a changing payer demographic—marked by health plans entering new contracts such as Medicare Advantage—the demands for credentialing support can quickly outpace an organization’s available resources. Wednesday, Nov. A PDF report of the survey Sign up today!

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Fraud Medicare Medicare Licensing 52

Healthcare IT Today

MARCH 24, 2024

DrFirst released TrueRx , a prescription monitoring product that provides standardized alerts to protect against prescriber identity and prescription fraud. Wellth launched Wellth Northstar to support Medicare Advantage plans aiming to motivate change in hard-to-reach members.

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Medicare Medicare Fraud Nurses 109

HIT Consultant

MAY 20, 2022

. – LifeChain will leverage blockchain technology to solve healthcare’s biggest problems, including fraud, inefficiency in payments and antiquated processes. LifeChain will be developed by MSP Recovery and Tokenology as a fully tokenized Medicare, Medicaid and commercial claims recovery system protected by biometric security.

Fraud 94

Fraud Medicaid Medicaid Medicare 94

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). This is just the beginning.

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Compliance US Department of Health and Human Services Fraud Medicare 52

Hall Render

AUGUST 1, 2024

On July 3, 2024, a federal court in Texas (“the Court”) issued a stay related to certain provisions of CMS’s Contract Year 2025 Medicare Advantage and Part D (“MAPD”) Final Rule (“2025 Final Rule”), which would change how agents and brokers are paid by Medicare Advantage (“MA”) and Part D plans.

Medicare 40

Medicare Medicare Fraud Governance 40

Healthicity

AUGUST 6, 2024

This eBrief covers new OIG efforts on clinical laboratory tests, overpaid DMEPOS claims, Medicaid managed care, Medicaid managed care capitation payments.

Medicaid 52

Medicaid Medicaid Fraud Medicare 52

Compliancy Group

MAY 15, 2024

As we move deeper into 2024, hospitals must increasingly focus on compliance with regulations set forth by the Office of Inspector General (OIG). Understanding OIG Compliance Program for Hospitals The OIG compliance program for hospitals intends to prevent fraud, waste, and abuse while ensuring high-quality care.

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Compliance Hospitals Fraud Regulatory Compliance 52

Healthcare Law Blog

MAY 11, 2023

ICPGs are expected to be published in 2024, and the OIG has announced the first two likely ICPGs will be for Medicare Advantage plans and skilled nursing facilities. Healthcare industry stakeholders are encouraged to incorporate the OIG’s CPG into the implementation and operation of their compliance programs.

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Compliance Fraud Nurses Medicare 52

Provider Trust

MAY 16, 2024

MAY 15, 2024 Contact: Morgan Smith , Director of Brand Strategy NASHVILLE, TN – ProviderTrust, the healthcare industry’s leading data and technology company for automated exclusion list monitoring and primary source verifications, is now monitoring more than 10,000,000 individuals and entities on an ongoing basis.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

Hall Render

AUGUST 1, 2024

On July 3, 2024, a federal court in Texas (“the Court”) issued a stay related to certain provisions of CMS’s Contract Year 2025 Medicare Advantage and Part D (“MAPD”) Final Rule (“2025 Final Rule”), which would change how agents and brokers are paid by Medicare Advantage (“MA”) and Part D plans.

Medicare 40

Medicare Medicare Fraud Governance 40

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

MedTrainer

JANUARY 31, 2024

It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. These laws require healthcare providers to establish internal controls and compliance programs to prevent fraud and abuse in the healthcare system. Who started the first healthcare compliance program?

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Compliance Fraud Governance ACA 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Compliancy Group

JULY 18, 2024

The OIG’s purpose is to fight incidents of fraud, waste, and abuse , and any company that acts as an intermediary between patients and practitioners faces a variety of challenges, from maintaining confidentiality and integrity to having high levels of risk awareness.

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Medical Billing Compliance Fraud Compliance Officers 52

Healthcare Law Blog

NOVEMBER 9, 2023

Thereafter, OIG said it planned to update existing industry-specific compliance program guidance (ICPG), which would include tailoring each to address fraud and abuse risk areas specific to a particular industry and describing the compliance measures that industry could take to reduce these risks [2].

Compliance 52

Compliance Compliance Officers Fraud Medicare 52

Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Hall Render

JUNE 21, 2024

To Settle Telehealth Fraud Accusations State Health Dept, Hospital Association Honor Yale New Haven Hospital D.C. Supreme Court weighs future of ER abortions Flinn Foundation report identifies bioscience growth areas for Phoenix metro Medical center office building in Chandler sells for $7.3

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Medisys Compliance

AUGUST 21, 2024

In 2024, the Centers for Medicare & Medicaid Services (CMS) introduced several crucial updates to radiation oncology billing guidelines. In 2024, CMS has updated several areas to reflect changes in medical practices and technological advancements in radiation therapy.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Compliance Medicaid Medicaid 59

MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

Medicare 52

Medicare Medicare Compliance Medicaid 52

Hall Render

APRIL 19, 2024

to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M healthcare?

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. This standard was interpreted and applied differently by various Medicare contractors and was difficult to review/audit.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

AIHC

MAY 7, 2024

Payers are already implementing AI as a solution to deny inappropriately coded claims and detect potential fraud and abuse. Medicare NCCI FAQ Library | CMS. Artificial Intelligence (AI) Automation and Claims Processing Algorithms for coding, billing, and payments are designed to reduce billing errors and maximize revenue recovery.

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Compliance Compliance Officers Fraud Doctors 52

AIHC

MAY 30, 2024

Advancing RCM Operations Every year, more than five billion medical claims are processed by Payers in the United States for reimbursement, according to the Centers for Medicare & Medicaid Service, CMS.gov. Compliance and Risk Management : Fraud Detection : AI systems can identify unusual patterns that may indicate fraudulent activities.

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Compliance HIPAA Regulatory Compliance Medical Billing 52

Hall Render

JULY 12, 2023

If a deemed hospice fails to meet the Medicare requirements or shows continued condition-level noncompliance, deemed status is generally removed and oversight is placed under the SA. Selected hospices either successfully complete the SFP program or are terminated from the Medicare program. of hospice providers reported data.

Medicare 40

Medicare Medicare Nursing Homes Fraud 40