Hall Render

AUGUST 1, 2024

Background The FCA allows private individuals (relators) to bring qui tam lawsuits for fraudulent claims resulting in federal overpayments. Hall Render blog posts and articles are intended for informational purposes only. This ruling is expected to have significant and lasting effects on FCA cases and the imposition of treble damages.

Overpayments 40

Overpayments Overpayment Governance 40

Hall Render

AUGUST 1, 2024

Background The FCA allows private individuals (relators) to bring qui tam lawsuits for fraudulent claims resulting in federal overpayments. Hall Render blog posts and articles are intended for informational purposes only. This ruling is expected to have significant and lasting effects on FCA cases and the imposition of treble damages.

Overpayments 40

Overpayments Overpayment Governance 40

YouCompli

SEPTEMBER 27, 2023

Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid.  She also claimed the hospital failed to reimburse payors for overpayment stemming from these improperly coded claims. The hospital ultimately settled and agreed to pay $3.3

Compliance 52

Compliance Overpayments Overpayment Medicare 52

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

Fraud 72

Fraud Medicare Medicare Overpayments 72

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. This is the final article in a 3-part series on denials and appeals management. The government's primary civil tool for addressing healthcare fraud is the False Claims Act (FCA).

Fraud 52

Fraud Medicare Medicare Compliance 52

YouCompli

OCTOBER 26, 2022

The net of it is this: Our Compliance Department performed a compliance audit related to sleep studies that resulted in a significant payback to the federal government that could have been avoided if monitoring was being performed by the Sleep Center Clinical leadership. That’s a 41% error rate with an extrapolated overpayment of?$269

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

NOVEMBER 1, 2023

As a result, the department now has to refund several thousand dollars in overpayments and implement a corrective action plan. In tackling the countless regulatory and operational issues for these diverse organization types, he has developed a deep understanding of the business of healthcare and the regulations governing the industry.

Compliance 52

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

AIHC

MARCH 28, 2022

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. This information is not all-inclusive and the article is a truncated version of Lesson 3 from our Certified Outpatient Clinical Appeals Specialist (COCAS SM ) training program.

Medicare 52

Medicare Medicare Compliance Governance 52

AIHC

OCTOBER 23, 2024

The information provided in this article is not comprehensive and not intended as consulting or legal advice. Corrective action includes refunding overpayments revealed during the audit. Federal law requires entities repay any overpayments received from Medicare or a State Medicaid program within 60 days after identification.

Compliance 52

Compliance Overpayments Overpayment Medicaid 52

Healthcare Law Blog

FEBRUARY 9, 2024

Sherman himself had submitted disclosure logs to the OIG), Sherman alleges that it failed to adequately report the arrangements it had with Neonatology Associates or any other private physician groups, or return any alleged overpayments. The article refers to all entities as ChristianaCare consistent with Defendants’ briefing. [2]

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

YouCompli

SEPTEMBER 13, 2023

Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic. Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals.

US Department of Health and Human Services 52

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

AIHC

SEPTEMBER 5, 2023

This article is not intended as legal or consulting advice. If your practice is currently using a telebehavioral health approach for patient treatment, or if you organization is considering implementing this approach, we hope this article will give some food-for-thought on the topic.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

Hall Render

DECEMBER 11, 2024

The Proposed Rule would revise the section governing exclusions under section 1128(b)(14) of the Act based on an individual’s default on a health education loan or scholarship obligation. Hall Render blog posts and articles are intended for informational purposes only.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Hall Render

NOVEMBER 25, 2024

The Nursing Facility ICPG provides that, even if an entity makes an isolated billing error, the entity still has an obligation to repay the overpayment to the government to avoid False Claims Act liability, as explained in the GCPG. Hall Render blog posts and articles are intended for informational purposes only.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

HIPAA Journal

MARCH 30, 2022

Articles discussing the 3 major things addressed in the HIPAA law often tend to focus on the Administrative, Physical, and Technical Safeguards of the Security Rule. However, when HIPAA was passed, the standards governing health care data, patients´ rights, and the flow of information were still several years away.

HIPAA 137

HIPAA Fraud Health Insurance Health Care Reform 137

Healthcare IT Today

JANUARY 13, 2025

With the HSCC’s collaboration between government agencies and over 400 industry participants, healthcare has an opportunity to set the standard for how to harden a critical sector to these threats. As AI capabilities evolve, regulatory frameworks will need to catch up, demanding proactive AI governance to maintain compliance.

Compliance 99

Compliance Compliance Framework HIPAA Governance 99

HIT Consultant

MARCH 1, 2022

In Ohio, unemployment overpayments reached $3.86 billion on their MES and eligibility and enrollment systems, according to a 2020 report by the Government Accountability Office (GAO). billion during the pandemic. Consider more CMS oversight : Between 2008 and 2018, states spent a total of $44.1 billion of that amount.

Medicaid 52

Medicaid Medicaid COVID-19 Overpayments 52

Hall Render

JANUARY 19, 2024

NATIONAL 13 major health systems partner with high schools in $250M Bloomberg initiative Acute Hospital Care at Home data released AI can help identify social determinants of health American Hospital Association Sues Over Updated HIPAA Guidance Bill aims to push price transparency to ASCs Billing for patient messages to clinicians is increasing, study (..)

Nursing Homes 40

Nursing Homes Nurses COVID-19 Hospitals 40