Compliancy Group

OCTOBER 28, 2024

Established in 1976, the Office of Inspector General (OIG) has led the U.S. Health and Human Services (HHS) Department’s efforts to eliminate fraud, waste, and abuse. Its compliance program guidance (CPG) has improved the efficiency and effectiveness of Medicare and many other federal programs.

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Nurses Compliance Nursing Homes Compliance Officers 52

Compliancy Group

FEBRUARY 22, 2024

The healthcare industry faces an ever-increasing number of essential regulations, making developing a reliable compliance strategy crucial. Have you explored the best path to ensure peak healthcare compliance officer training? It’s a role that transcends mere oversight.

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Compliance Officers Compliance Fraud Regulations Compliance 52

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. Accordingly, maintaining compliance has become a key focus for healthcare facilities. HCO Qualifications. Reimbursement.

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

Compliancy Group

NOVEMBER 6, 2024

Importance of Workforce Compliance Compliance with workforce requirements in healthcare involves ensuring the organization and its members comprehend and adhere to laws governing patient safety and privacy, maintaining secure working conditions, and preventing fraud, waste, and abuse.

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Compliance Compliance Officers Fraud Health Insurance 52

Compliancy Group

OCTOBER 4, 2024

Despite your best efforts in meeting healthcare compliance requirements, errors may still occur. Maintaining the security and integrity of sensitive information and preventing waste, fraud, and abuse is essential to quality healthcare and promoting workplace safety.

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MedTrainer

NOVEMBER 2, 2023

This critical responsibility rests on the shoulders of the healthcare compliance officer. Read on if you’ve ever wondered about the unsung heroes as we answer the question: What does a compliance officer do in healthcare? What Is the Primary Role of a Compliance Officer in Healthcare?

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Compliance Officers Compliance HIPAA Regulatory Compliance 52

Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. Some denials result from noncompliance with federal fraud, waste, and abuse laws. Such noncompliance can result in non compliance fines.

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Fraud Compliance Medicare Medicare 52

HIPAA Journal

MARCH 30, 2023

While the seven elements of a compliance program apply to all industries, they originated in the healthcare industry in the 1990s. This was in response to the growing level of healthcare fraud and abuse and an alleged “compliance disconnect” at the executive level in many hospitals and health systems.

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Health Law RX

NOVEMBER 22, 2023

The GCPG has been anticipated since the OIG announced on April 25, 2023, that it planned to modernize the accessibility and usability of its publicly available resources, including the OIG’s Compliance Program Guidance (CPG) documents. Ensure individuals are not deterred from reporting compliance concerns (e.g.,

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Compliance Officers Compliance Medicare Medicare 52

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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YouCompli

MARCH 18, 2025

In the context of the opioid epidemic, the HHS OIGs responsibilities are multi-faceted, including fraud and abuse enforcement, corporate accountability, audits of pharmaceutical practices, and civil and criminal penalties. Healthcare compliance officers must create and enforce policies that prioritize patient health over profits.

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MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. 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. What is a Certified Fraud Examiner?

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Fraud Compliance Governance Compliance Officers 52

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. government or a government contractor.

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AIHC

FEBRUARY 24, 2025

Part 2: When Criminal Behavior Infiltrates Your Audit Program Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) We Recommend Reading Part 1 Fraud Indicators and Red Flags When Audit Managers Knowingly Skew Audit Results as this article is Part 2, the rest of the story.

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Fraud Compliance Governance Compliance Officers 52

Total Medical Compliance Resources

NOVEMBER 11, 2024

Priced at $15.00, this course is invaluable for physicians, dentists, healthcare administrators, IT personnel, compliance officers, and administrative staff, helping them understand the significance of secure PHI and their roles in protecting patient data. link] HIPAA Fraud, Waste, and Abuse Awareness Course $30.00

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ADA HIPAA Compliance Fraud 59

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. To become certified, please visit us at: American Medical Compliance (AMC).

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Fraud Medicare Medicare Compliance 52

Healthicity

SEPTEMBER 26, 2024

CJ Wolf sits down with Rebecca Busch , a healthcare compliance expert with over four decades of experience. From her early days as a trauma nurse to her current role as a sought-after expert witness, Rebecca has seen it all in the ever-evolving world of healthcare compliance and fraud.

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HealthStream

AUGUST 26, 2019

Compliance officers must work to prevent criminal healthcare fraud cases, especially given the expansion of DOJ focus areas for investigating possible fraudulent action.

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Fraud Compliance Compliance Officers 40

Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. Donna Thiel, Chief Compliance Officer at ProviderTrust, said, “It’s an opportunity to promote partnership between HR and compliance.

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Fraud US Department of Health and Human Services Licensing Nurses 52

AIHC

JUNE 14, 2024

Financial exploitation refers to 2 types of financial crimes committed against older adults: Financial abuse (committed by someone you know) Financial fraud (committed by a stranger) Both result in serious financial, physical, and emotional harm to older adults. Call the Elder Fraud Hotline at 1-833-372-8311 (Monday-Friday, 10:00 a.m.-6:00

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Fraud Elder Abuse Governance Compliance 52

Healthcare IT Today

MARCH 27, 2025

Additionally, AI-based healthcare billing and coding automation could also inadvertently perpetuate fraud or errors if the models are not adequately trained and monitored. AI-driven systems present additional vulnerabilities, such as adversarial attacks that manipulate machine-learning models to produce incorrect results.

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Governance Compliance HIPAA Regulatory Compliance 64

Health Care Performance

JULY 20, 2022

Compliance lesson: Enforcement agencies are actively using data analytics to identify, investigate and prosecute providers with unusual billing activity – and so should you. Mole billing fraud scheme totals $4.1 It is impossible to draft policies and train staff on for every possible compliance risk scenario. L earn more.

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Fraud Compliance Medicaid Medicaid 52

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

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Fraud Medicare Medicare Compliance 52

Healthicity

FEBRUARY 3, 2025

A psychiatrist and mental health clinic in Philadelphia recently paid $900,000 to resolve allegations for committing Medicaid billing fraud.

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Fraud Medicaid Medicaid Compliance Officers 52

Verisys

MARCH 6, 2025

Identifying Compliance Risks in Real Time AI-powered surveillance tools work around the clock, scanning data to catch red flags or suspicious patterns that indicate: Fraud Security threats Regulatory violations Credential discrepancies Take electronic health records (EHRs), for example.

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

MedTrainer

AUGUST 8, 2024

The training covers the seven core compliance program requirements mandated by CMS, including written policies and procedures, designation of a compliance officer, effective training and education, and procedures for prompt response to compliance issues.

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MedTrainer

JANUARY 10, 2024

Review Recent Compliance Changes There is a major shift in compliance priorities toward addressing health inequities and improving access to quality healthcare services. The OIG is making major investments to systematically detect and prosecute fraud. We all should be a LOT more prepared!

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Compliance Fraud HIPAA Compliance Officers 94

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. But what exactly is considered fraud, waste, and abuse? These complaints can trigger an audit. Data Analysis and Trends.

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Healthcare IT Today

NOVEMBER 19, 2020

The following is a guest article by Donna Thiel, Chief Compliance Officer at ProviderTrust. Although there may be numerous benefits to using telehealth services, patients and providers should also consider the substantial telehealth risks involved.

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YouCompli

MAY 11, 2022

The doctor will be sentenced in July for multiple counts of healthcare fraud. Compliance officers should watch for: Follow the money. If a practice is billing millions of dollars for allergies services, that code or set of codes is likely to stand out as an outlier to compliance programs monitoring all their billing data.

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Compliance Officers Fraud Compliance Medicare 52

AIHC

SEPTEMBER 25, 2024

Reviewing the Office of Inspector General's (OIG) enforcement actions is important for compliance officers because it can help them understand the OIG's focus and priorities, and how to comply with federal health care laws and regulations. Register for online training to certify in various areas of compliance.

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Fraud Compliance Compliance Officers Licensing 52

Compliancy Group

AUGUST 9, 2024

Importance of Compliance Documents to Your Healthcare Organization Besides enabling various compliance activities, readily available compliance documents can make a significant difference in maintaining your entity’s reputation. Examples include confidentiality agreements, business associate agreements , copyrights, and patents.

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Compliance Compliance Officers Regulations Compliance HIPAA 72

Healthcare Compliance Blog

FEBRUARY 15, 2022

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. The government paid $237 million in fiscal year 2021 to whistleblowers who exposed fraud and false claims. More than $5.6

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Fraud Governance Compliance Medicare 59

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. Such an ongoing auditing system is crucial to a healthcare organization’s compliance program.

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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].

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Compliance Compliance Officers Fraud Medicare 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. 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.

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Fraud Compliance Officers Compliance Medicare 52

Healthcare IT Today

DECEMBER 26, 2024

Recent incidents involving fake video calls and voice cloning demonstrate the technology’s potential for sophisticated fraud. Deepfake technology presents another critical threat, with AI-generated video and voice content enabling unprecedented impersonation attacks.

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