MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

Healthcare Law Blog

FEBRUARY 3, 2023

New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1]

Medicaid 52

Medicaid Medicaid Compliance Overpayments 52

Verisys

APRIL 3, 2025

Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Compliance and Legal Considerations The NPDB is governed by strict federal regulations that impact both healthcare organizations and individual providers.

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

Compliancy Group

MARCH 12, 2025

With such a wide range of potential noncompliance incidents, more compliance officers are exploring ways to combat these penalties so they can respond proactively instead of reactively. The False Claims Act prohibits the knowing submission of a false or fraudulent claim to the federal government.

Fraud 52

Fraud Compliance Medicare Medicare 52

Verisys

MARCH 6, 2025

Healthcare executives and compliance officers must consistently update and verify provider data to enhance patient care, adhere to regulatory standards, and streamline administrative tasks. Similarly, insurance companies that process thousands of claims daily require up-to-date provider information to avoid claims delays and denials.

Compliance 52

Compliance Licensing Doctors Malpractice 52

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. Part 521, make several important changes that will affect all Medicaid Providers’ compliance programs throughout New York State. New York Social Services Law § 363-d.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

Verisys

MARCH 6, 2025

Healthcare administrators and compliance officers must be prepared to navigate these obstacles to maintain a seamless, efficient process. This process helps guarantee that providers stay in line with state and federal regulations, keeping healthcare organizations in good standing with insurers, regulators, and other key players.

Licensing 52

Licensing Compliance Nurses Malpractice 52

Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. Toolkits: The OIG has created several toolkits to help providers ensure they are in compliance with healthcare laws.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Compliance Medicaid 59

AIHC

MAY 31, 2022

When the federal government covers items or services rendered to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply. Government programs, such as the Centers for Medicare & Medicaid Services (CMS), find the investment in their audit and monitoring programs are effective.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

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

Compliancy Group

APRIL 17, 2024

For example, the OIG has focused on billing and coding, quality of care, data security and privacy, and Medicare compliance. Compliance officers and other healthcare leaders should stay updated on these focus areas and be able to anticipate annual changes in audit policy. Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

HIPAA Journal

JANUARY 30, 2023

The National HIPAA Summit is the leading forum on healthcare EDI, privacy, breach notification, confidentiality, data security, and HIPAA compliance, and the deadline for registration for the Virtual 40th National HIPAA Summit is fast approaching.

US Department of Health and Human Services 81

US Department of Health and Human Services HIPAA Compliance Medicaid 81

C&M Health Law

DECEMBER 18, 2023

Compliance policies should be developed under the direction and supervision of the compliance officer and compliance committee and should address the implementation and operation of an entity’s compliance program and processes. OIG’s updated take on the seven elements is briefly summarized below. (1)

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

YouCompli

JUNE 29, 2022

With it, compliance officers have guided their healthcare organizations in complying with changing documentation, coding, and confidentiality requirements. As virtual care requirements for telehealth evolve, we explore how compliance officers can support patient care and help their organizations stay up to date.

Compliance Officers 52

Compliance Officers Compliance Telemedicine COVID-19 52

Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. What is an effective healthcare compliance program?

Compliance 52

Compliance Compliance Officers ADA Governance 52

MedTrainer

APRIL 22, 2024

A healthcare compliance committee is a cross-functional team that monitors compliance at a strategic level. An influential healthcare compliance committee supports the compliance officer in promoting ethical practices, mitigating risks, and advising on compliance program operations.

Compliance 52

Compliance Compliance Officers Governance Medicaid 52

MedTrainer

JUNE 28, 2023

The primary goal of a Certified Fraud Examiner in healthcare is to safeguard the integrity of healthcare systems and protect patients, insurance providers, and government programs from financial losses due to fraudulent activities. Typically, that means looking at the five main Federal laws governing healthcare fraud : False Claims Act (FCA).

Fraud 52

Fraud Compliance Governance Compliance Officers 52

MedTrainer

DECEMBER 7, 2023

All healthcare organizations, along with their providers and compliance officers, must understand the requirements of each regulatory state agency that provides oversight. This article offers a summary of essential aspects of healthcare compliance specific to Hawaii.

Compliance 52

Compliance Compliance Officers Licensing Medicaid 52

Verisys

MARCH 23, 2023

Abuse of government healthcare programs is a federal offense with severe penalties. government or a government contractor. The Most Common False Claims The FCA primarily combats healthcare fraud and abuse associated with Medicare and Medicaid.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Medisys Compliance

JANUARY 30, 2023

The medical billing industry is a complex and ever-changing field, and it is crucial for healthcare providers and billing companies to stay compliant with government regulations. Violations of the False Claims Act can result in significant financial penalties, including fines and exclusion from government healthcare programs.

Compliance 52

Compliance Medical Billing Medical Billing Outsourcing HIPAA 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. Government agencies expect your organization to stay informed.

Fraud 52

Fraud Compliance Compliance Officers Licensing 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. For staff, compliance officers should support annual online FWA compliance training.

US Department of Health and Human Services 52

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

MedTrainer

JULY 29, 2024

Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Corporate compliance training software helps healthcare executives and compliance officers mitigate legal and financial risks while fostering a culture of ethical behavior. monitorship or reporting obligations).”

Compliance 52

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

Compliancy Group

AUGUST 30, 2024

We suggest incorporating them into an annual compliance checklist for companies across the healthcare sector. HIPAA The Health Insurance Portability and Accountability Act (HIPAA) of 1996 governs how healthcare organizations handle protected health information (PHI). Under the direction of the U.S.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 52

MedTrainer

OCTOBER 11, 2024

As you may have discovered (hopefully not the hard way), meeting the basic requirements set forth by the Centers for Medicare and Medicaid (CMS) and OSHA should be a bare minimum. I’ve identified the five most valuable based on feedback from healthcare compliance officers. Before I share those tools, let’s start with the basics.

Compliance Officers 52

Compliance Officers Compliance Medicaid Medicaid 52

MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the Bureau of Facility Standards , provide oversight with certain standards, adding a layer of complexity to successfully managing healthcare compliance in Idaho. Continue reading this overview for key aspects of healthcare compliance specific to the state of Idaho.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

MedTrainer

NOVEMBER 27, 2023

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. Routine audits should be conducted, and the results of the audits should be reported at the compliance and ethics committee meetings and in reports to the governing body.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

AIHC

FEBRUARY 17, 2025

There are also self-reporting mechanisms in place to report overpayments on the OIG website ( Self-Disclosure ) and Self-Referral Disclosure for voluntary self-reporting of overpayments on the Centers for Medicare and Medicaid Services (CMS) website. But is the oversight of the audits manipulated to achieve particular performance goals?

Fraud 52

Fraud Compliance Overpayments Overpayment 52

MedTrainer

AUGUST 30, 2023

Medicaid Managed Care. Some state Medicaid programs contract with managed care organizations to provide healthcare services to eligible beneficiaries. These plans follow managed care principles to control costs and improve care coordination for Medicaid recipients. Quality of Care Standards.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

MedTrainer

DECEMBER 4, 2023

This article gives a clear and detailed look at the important things you need to know about following healthcare laws in Kentucky, especially for those who provide healthcare and manage compliance. Regulations Unique to Kentucky To meet the standards of healthcare compliance in Kentucky , there are a few additional regulations.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. Let’s delve into the importance of healthcare compliance laws and regulations, their impact on providers and organizations, and the guidelines governing their implementation.

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Compliance Compliance Officers Fraud Compliance Framework 52

HIT Consultant

JULY 24, 2024

The company’s AI practices are guided by standards from the Centers for Medicare & Medicaid Services (CMS) and the National Institutes of Standards and Technology (NIST). Led by Michael Rodio (General Manager of AI) and Katie McCrudden (AI Project Manager), in collaboration with Nikole Benders-Hadi, M.D.

Regulatory Compliance 52

Regulatory Compliance Compliance Officers Compliance Medicaid 52

MedTrainer

NOVEMBER 30, 2023

Like other regions in the United States, Wisconsin is characterized by its unique blend of rules and mandates that govern healthcare compliance within the state. This post sheds light on certain aspects of healthcare compliance in Wisconsin, with tips for effectively managing your healthcare organization.

Compliance 52

Compliance Medicaid Medicaid Licensing 52

MedTrainer

NOVEMBER 30, 2023

This article provides a concise overview of Missouri’s healthcare compliance, highlighting the state-specific requirements to be aware of. Regulations Unique to Missouri To meet the standards of healthcare compliance in Missouri , there are a few additional regulations.

Compliance 52

Compliance Compliance Officers Hospitals Public Health 52

MedTrainer

MAY 21, 2024

With the odds of a person entering your healthcare facility dealing with a behavioral or mental health issue at about 20% , new and existing clinical providers must receive behavioral health compliance training to ensure patients receive the highest quality care.

Compliance 52

Compliance Medicaid Medicaid HIPAA 52

MedTrainer

FEBRUARY 1, 2024

Meet Government Requirements: Some government programs and payers, such as the Centers for Medicare & Medicaid Services (CMS) , require healthcare facilities to have compliance programs as a condition for participation. Compliance Officer: Have a designated individual responsible for overseeing the compliance program.

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Compliance Fraud Regulatory Compliance Regulations Compliance 52