Compliancy Group

FEBRUARY 9, 2024

One crucial tool that helps healthcare organizations achieve this is compliance program guidance documents. These comprehensive guidelines are designed to assist various healthcare settings in implementing effective compliance programs, ensuring that they operate within legal boundaries while providing quality care to patients.

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Compliance Fraud Hospitals 52

Bill of Health

OCTOBER 30, 2023

In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. The use of emojis in healthcare documents would align with the idea of legal design. Finally, emojis raise legal issues as a new form of data subject to HIPAA compliance, as well as accessibility concerns for the visually impaired.

Doctors 290

Doctors Hospitals Fraud Health Insurance 290

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

Med-Net Compliance

JUNE 13, 2022

Three independent clinical laboratories, their owner and holding company, an additional independent clinical laboratory and its owner, two laboratory marketing companies, and a Massachusetts physician have been charged in connection with Medicaid fraud, money laundering, and kickbacks involving urine drug tests?that

Fraud 105

Fraud Medicaid Medicaid 105

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. Case documents revealed that Dr. Farley’s billing practices included false claims for extended, complex patient visits that did not occur.

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Fraud Compliance Medicaid Medicaid 40

Compliancy Group

APRIL 25, 2024

Maintaining Medicare compliance and avoiding legal and financial repercussions requires Medicare compliance training for employees at all organizational levels. Examples of Medicare fraud include billing for unrendered services and using a billing code or a service that’s more expensive than what a patient received.

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Fraud Medicare Medicare Compliance 59

Healthcare It News

DECEMBER 5, 2022

" Community also said that the investigation has not found evidence that misuse or fraud has occurred as a result of the breach, and it "cannot say with certainty what information was involved."

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Fraud HIPAA Compliance Hospitals 299

American Medical Compliance

AUGUST 7, 2024

Notably, many of these incidents are preventable and could have been avoided with proper compliance measures. Compliance with healthcare regulations is crucial not only for avoiding legal repercussions but also for ensuring high standards of patient care and safety. It ensures its confidentiality and maintains security.

Compliance 81

Compliance HIPAA Medicaid Medicaid 81

HIT Consultant

AUGUST 17, 2023

Erin Rutzler, VP of Fraud, Waste, and Abuse at Cotiviti As behavioral health claim volumes continue to increase, there’s a growing need for health plans to be vigilant in spotting fraud, waste and abuse. But not every plan has access to a large SIU to combat fraud, waste and abuse in behavioral health.

Fraud 98

Fraud COVID-19 Medicare Medicare 98

American Medical Compliance

JANUARY 9, 2024

The following Documentation and Provider Standards Training educates healthcare providers on the significance of documentation compliance in healthcare. It also provides an introduction to all things related to healthcare compliance, which is important for all healthcare facilities to know about.

Fraud 52

Fraud Compliance HIPAA Health Insurance 52

Healthcare Blog

NOVEMBER 9, 2023

An effective healthcare compliance program is a crucial aspect of any healthcare organization. These documents should serve as a roadmap for employees. Healthcare organizations should clearly define their expectations and the consequences for non-compliance. Patient safety and consistent quality care will maintain priority.

Compliance 98

Compliance Compliance Officers ACA Patient Satisfaction 98

Med-Net Compliance

JULY 11, 2022

The report says that in FY 2021 the DOJ opened 831 new criminal healthcare fraud investigations. Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, and a total of 312 defendants were convicted of healthcare fraud related crimes during the year. 2,947 investigations were pending at the end of FY 2021.

Fraud 59

Fraud Compliance Medicaid Medicaid 59

Med-Net Compliance

JULY 20, 2022

According to court documents and evidence presented at trial, the doctor billed Medicare and Medicaid for an incision procedure of the external ear for hundreds of patients, when in fact all he actually performed was an ear exam or ear wax removal. He was convicted of one count of healthcare fraud and one count of making a false claim.

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Fraud Doctors Medicare Medicare 59

Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas. The psychologist was convicted of four counts of healthcare fraud.

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Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Compliancy Group

JULY 10, 2024

Compliance with healthcare regulations protects patients, safeguards employee safety, and maintains the security of electronic medical records (EMRs) and cyber networks. Ensuring compliance with critical regulations falls on the compliance officer. What Does a Compliance Officer Do?

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Compliance Officers Compliance Fraud Electronic Medical Records 64

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

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Fraud Medicaid Medicaid Compliance 59

Compliancy Group

JUNE 27, 2024

Completing compliance incident reports is crucial to reducing the number of accidents in the future and understanding why they occur. Understanding what incidents need reporting and how to complete an incident report can help providers, compliance officers, and other personnel maintain the highest safety standards.

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Compliance Compliance Officers Fraud Nurses 64

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. In 2021, a U.S.

Fraud 72

Fraud Medicare Medicare Overpayment 72

Compliancy Group

DECEMBER 15, 2023

Differentiating Fraud, Abuse, and Waste Detecting and stopping fraud, abuse, and waste rely on distinguishing these behaviors in the healthcare context. What is Healthcare Fraud? Providers commit Medicare and Medicaid fraud when they knowingly submit or contribute to the submission of a false claim for financial gain.

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Fraud Medicaid Medicaid Medicare 52

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?

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Med-Net Compliance

JUNE 22, 2022

A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud.

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COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

Med-Net Compliance

JUNE 15, 2022

Division of Medi-Cal Fraud and Elder Abuse (DMFEA) and the US Attorney’s Office for the Eastern District of California intervened in the? During the course of the investigation, documentation from his office revealed five categories of medical services which were the focus of the fraudulent billing schemes. prison term?of

Fraud 59

Fraud Doctors Elder Abuse Medicare 59

Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. As healthcare providers navigate the complexities of SNF billing, maintaining compliance is essential to avoid penalties, denials, and financial losses.

Compliance 52

Compliance Medical Billing Outsourcing Medicare Medicare 52

Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

Fraud 59

Fraud COVID-19 Health Insurance Compliance 59

Compliancy Group

JULY 29, 2024

In 2024, home health agencies face stringent new compliance requirements as outlined by the Office of Inspector General (OIG). This guide provides an overview of the OIG compliance program guidance for home health agencies and practical steps for staying compliant.

Compliance 59

Compliance Regulations Compliance Fraud HIPAA 59

American Medical Compliance

FEBRUARY 9, 2024

Compliance officers’ responsibilities extend far beyond merely checking boxes and ticking off regulatory requirements. In fact, 61% of the compliance teams from a Thomson Reuters report also work on long-range strategies for their companies by putting regulatory and legislative changes as a top priority.

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Compliance Officers Compliance Patient Advocacy Regulatory Compliance 71

Healthcare IT News - Telehealth

JANUARY 30, 2023

" The audit found that it did not require key implementation decisions and plans to be documented. It also did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, before implementing the temporary and permanent MBS telehealth items.

COVID-19 162

COVID-19 Governance Medicare Medicare 162

Med-Net Compliance

AUGUST 16, 2022

Five individuals and two for-profit skilled nursing facilities (SNFs) in Pennsylvania were indicted on charges of conspiracy to defraud the United States and related healthcare fraud charges. Also review your policies and procedures for accurate billing that is supported by documentation detailing provision of services.

Fraud 59

Fraud Nurses Medicaid Medicaid 59

AIHC

SEPTEMBER 3, 2024

Celebrating the Healthcare Compliance Officer The American Institute of Healthcare Compliance is recognizing healthcare Compliance Officers – hats off to you! The primary goal of a compliance officer is to mitigate risk. This involves investigating complaints and conducting internal auditing and monitoring for compliance.

Compliance Officers 52

Compliance Officers Compliance Fraud Medicare 52

MedTrainer

FEBRUARY 1, 2024

Those early ethical standards paved the way for how medical compliance plans to limit liability for healthcare organizations today. Here’s how these plans help limit liability: Prevent Fraud and Abuse: Compliance plans include measures to prevent fraud and abuse within the healthcare organization.

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Compliance Malpractice Fraud HIPAA 52

Med-Net Compliance

SEPTEMBER 20, 2022

The defendant was also convicted for falsification of records designed to prevent detection of this fraud and aggravated identity theft for falsely corresponding with Medicare under the name of another physician. Document that the trainings occurred and file the signed document in each employee’s education file.

Fraud 59

Fraud US Department of Health and Human Services Medicare Medicare 59

Compliancy Group

FEBRUARY 28, 2024

Many industries have compliance rules and regulations to meet and follow, but few would argue that healthcare is one of the most stringent. Privacy and security – Compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient privacy and data security is crucial.

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Compliance US Department of Health and Human Services Fraud 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. That mean, maintaining compliance standards, efficient reporting, and conducting thorough internal audits are vital.

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Fraud Compliance Medicaid Medicaid 98

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. What is an Audit in Healthcare?

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Compliance Officers Compliance Regulatory Compliance Fraud 59

Compliancy Group

JANUARY 22, 2024

Critical Components of a Healthcare Compliance Audit Checklist There are several necessary components in a comprehensive healthcare compliance audit checklist that help maintain adherence to regulatory standards. Documentation Review The first step in any healthcare audit is thoroughly reviewing all required documentation.

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Compliance Fraud Regulatory Compliance HIPAA 52

Compliancy Group

DECEMBER 13, 2024

Maintaining healthcare compliance includes being vigilant for warning signs of potential waste, abuse, and fraud due to identity theft. The term red flag refers to warning signs of fraud, waste, and abuse due to identity theft and other unlawful acts. Specific indications or red flags can tip you off to nefarious activities.

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Compliance Officers Compliance Electronic Medical Records Fraud 52

Total Medical Compliance Resources

MAY 11, 2023

trillion is spent on healthcare in the United States, of which an estimated $60 billion is attributable to fraud and abuse. In order to combat this, HIPAA established the Healthcare Fraud and Abuse Control Program (HCFAC). Criminal Health Care Fraud Statute – 18 U.S.C. Every year a minimum of $4.3

Fraud 59

Fraud HIPAA Medicare Medicare 59