Verisys

MARCH 6, 2025

Credentialing involves a detailed review of a provider’s qualifications, including their: Education Work experience Certifications Licenses Professional standing This process ensures that patients see professionals who are properly trained and certified to provide the level of care they require.

Licensing 52

Licensing Compliance Nurses Malpractice 52

Verisys

DECEMBER 8, 2022

A professional career can take a provider across state lines, and through an evolution of various license types. In order to see the full picture of an individual, the comprehensive whole of each state licensing board across all license types must be searched. Take the process back another step.

Licensing 52

Licensing Medicaid Medicaid Fraud 52

Verisys

MARCH 6, 2025

The Centers for Medicare and Medicaid Services (CMS) Regulates reimbursement policies and ensures healthcare organizations adhere to the standards necessary to participate in federal healthcare programs. Credentialing, Licensing, and Education. Failure to comply with regulations can result in the loss of these essential credentials.

Compliance 52

Compliance HIPAA Licensing Governance 52

Verisys

APRIL 3, 2025

Data inaccuracies: A misspelled name, incorrect license number, or missing documentation might seem minor, but they can lead to license and certification rejections, compliance violations, and delayed insurance reimbursementspotentially causing financial and operational headaches.

US Department of Health and Human Services 52

US Department of Health and Human Services Licensing Compliance Malpractice 52

Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). for every $1 spent How ProviderTrust Can Help With nearly 80 million individuals covered by Medicaid, every data point counts.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

Verisys

MARCH 6, 2025

For example, requiring all names to follow a “Last Name, First Name” format and license numbers to be entered uniformly can prevent mismatches.

Compliance 52

Compliance Licensing Doctors Malpractice 52

The Health Law Firm Blog

OCTOBER 5, 2023

Board Certified by The Florida Bar in Health Law Do you have a medical, pharmacist, counselor, or nursing license in more than one state? Do you have a license in more than one profession? By George F. Indest III, J.D., Have you been notified that an investigation has been opened against your professional [.]

Licensing 52

Licensing Nurses Medicaid Medicaid 52

The Health Law Firm Blog

JULY 11, 2022

Board Certified by The Florida Bar in Health Law Do you have a medical, pharmacist, counselor, or nursing license in more than one state? Do you have a license in more than one profession? By George F. Indest III, J.D., Have you been notified that an investigation has been opened against your professional [.].

Licensing 52

Licensing Nurses Medicaid Medicaid 52

MedTrainer

MARCH 30, 2024

Built-in Automation Keep the enrollment process moving forward with automated reminders for providers to send documents, notification of recredentialing deadlines, and license expiration. Choose software with dynamic graphs that show application age, average time to complete applications, and number of closed applications per credentialer.

Malpractice 98

Malpractice Licensing Medicaid Medicaid 98

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? But these programs cannot be controlled by Medicaid and Medicare alone. But these programs cannot be controlled by Medicaid and Medicare alone. With this legislation, Medicaid Fraud Control Units (MFCUs) were born.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

Pharmacy Law Blog

MAY 7, 2018

Our attorneys include those who are board certified in health law by The Florida Bar, those who are nurses, and those who are themselves licensed health professionals. The Following is a list of little known facts about state investigations (including DOH investigations) that could save your license: 1.

Licensing 40

Licensing Nurses Medicaid Medicaid 40

Pharmacy Law Blog

MAY 14, 2018

Our attorneys include those who are board certified in health law by The Florida Bar, those who are nurses, and those who are themselves licensed health professionals. The Following is a list of little known facts about state investigations (including DOH investigations) that could save your license: 1.

Licensing 40

Licensing Nurses Medicaid Medicaid 40

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

The Health Law Firm Blog

SEPTEMBER 20, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

AUGUST 24, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

JULY 19, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

JUNE 27, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

MAY 16, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

Healthcare Law Blog

OCTOBER 21, 2022

For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. It can be found here.

Licensing 97

Licensing Medicaid Medicaid Hospitals 97

MRO Compliance

JUNE 1, 2022

This review is part of the Star rating system, which according to RAC Monitor was developed by the Centers for Medicare & Medicaid Services (CMS) to rate health plan performance for Medicare Advantage programs and Medicare risk adjustment initiatives. HEDIS audits are important for Medicare and Medicaid health plans.

Medicare 130

Medicare Medicare Compliance Medicaid 130

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

The Health Law Firm Blog

MAY 12, 2023

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her [.]

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

The Health Law Firm Blog

FEBRUARY 15, 2022

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her.

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

Verisys

NOVEMBER 8, 2023

The NPI improves the Medicare and Medicaid programs, other federal and private health programs, and the overall effectiveness and efficiency of the healthcare industry by simplifying administration and enabling the efficient electronic transmission of health information. Learn More About NPIs When Did NPI Numbers Begin?

Fraud 97

Fraud HIPAA Medicare Medicare 97

MedTrainer

MAY 7, 2024

This blog will highlight how credentialers can navigate UnitedHealthcare provider enrollment. Completing UnitedHealthcare provider enrollment is no different. Credentialers understand the importance of working with insurance payers to ensure smooth and timely reimbursement. It’s a challenge.

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

Nurses 52

Nurses Licensing Fraud Medicaid 52

The Health Law Firm Blog

SEPTEMBER 8, 2022

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law I am often contacted by clients who are health professionals or own businesses in the health care industry who have been approached by government agents or investigators regarding possible complaints or charges. In many cases, the individuals involved [.].

Licensing 52

Licensing Governance Health Care Lawyers Medicaid 52

The Health Law Firm Blog

SEPTEMBER 8, 2022

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law I am often contacted by clients who are health professionals or own businesses in the health care industry who have been approached by government agents or investigators regarding possible complaints or charges. In many cases, the individuals involved [.].

Licensing 52

Licensing Governance Health Care Lawyers Medicaid 52

Provider Trust

SEPTEMBER 12, 2022

In 2006, New York’s Office of the Medicaid Inspector General (OMIG) was established as an independent office within New York State’s Department of Health to combat fraud and abuse in New York State’s Medicaid program. No payments will be for medical care, services and supplies furnished, prescribed, or ordered by an excluded party.

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

MedTrainer

APRIL 11, 2024

This blog will discuss potential healthcare credentialing challenges, strategies to prevent these problems, and how credentialing software makes the process efficient and effective. Noncompliance: Providers must maintain specific licenses and certifications to provide patient care services. What Is Healthcare Credentialing?

Licensing 52

Licensing Medicaid Medicaid Medicare 52

Healthcare Compliance Blog

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. Additionally, the LPN’s nursing license was suspended for an unspecified period of time. Discussion Points: Review your policies and procedures on CPR. Update as needed.

Nurses 59

Nurses Nursing Homes Licensing Fraud 59

MedTrainer

JANUARY 21, 2025

Understanding the OIG Exclusion List The OIG maintains the List of Excluded Individuals/Entities (LEIE), which provides comprehensive information to the healthcare industry on those currently excluded from participating in Medicare, Medicaid, and any other federal healthcare programs.

Compliance 52

Compliance Fraud Regulatory Compliance Medicare 52

YouCompli

APRIL 27, 2022

The Nurse Licensure Compact (NLC) is an interstate agreement allowing nurses to practice in multiple states with one multistate license issued from their home state. The compact enables nurses to provide nursing services to patients located in other NLC states via telehealth without obtaining additional licenses.

Compliance Officers 52

Compliance Officers Licensing Nurses Compliance 52

MedTrainer

FEBRUARY 27, 2025

OIG exclusion list monitoring is vital in maintaining compliance with Centers for Medicare & Medicaid Services (CMS) regulations, as well as National Committee for Quality Assurance (NCQA) credentialing standards , among other federal healthcare provisions. Exclusion Monitoring Same concept, different strategy, different outcomes.

Compliance 52

Compliance Malpractice Fraud Licensing 52

Verisys

OCTOBER 8, 2024

Starting August 26, 2024, out-of-state physicians who have received a license from a compact state and a corresponding letter of qualification can apply to the IMLC to designate Pennsylvania as a state where the physician wants to practice and apply for expedited licensure from the relevant state licensing board.

Regulatory Compliance 52

Regulatory Compliance Compliance Licensing Medicaid 52

Verisys

OCTOBER 8, 2024

Starting August 26, 2024, out-of-state physicians who have received a license from a compact state and a corresponding “letter of qualification” can apply to the IMLC to designate Pennsylvania as a state where the physician wants to practice and apply for expedited licensure from the relevant state licensing board.

Regulatory Compliance 52

Regulatory Compliance Compliance Licensing Medicaid 52

Verisys

OCTOBER 8, 2024

Starting August 26, 2024, out-of-state physicians who have received a license from a compact state and a corresponding “letter of qualification” can apply to the IMLC to designate Pennsylvania as a state where the physician wants to practice and apply for expedited licensure from the relevant state licensing board.

Regulatory Compliance 52

Regulatory Compliance Compliance Licensing Medicaid 52