Compliancy Group

JANUARY 23, 2025

A classic example is Medicare fraud. Providers who bill Medicare for services they did not actually provide and who present the bill with the knowledge that the service was not performed have committed Medicare fraud. The DOJ has focused much of its anti-fraud efforts on pursuing these cases, litigating several of them in 2024.

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Fraud Medicare Medicare Regulatory Compliance 98

Healthcare IT Today

OCTOBER 26, 2024

Staying a step ahead of this type of fraud requires a proactive approach to real-tine auditing and coding, noted David Lareau at Medicomp Systems. Medication tracking software maker Bluesight acquired Sectyr , a compliance and audit management platform. Read more… It’s Time to Combat “Instafraud” in Medicare Advantage.

Ransomware 95

Ransomware Fraud Licensing Nurses 95

Provider Trust

SEPTEMBER 29, 2022

Mendez, who was a physician assistant at CCI Therapy Counseling Centers International, was working with a suspended medical license. However, despite his suspended medical license, Mendez continued to treat patients at various mental health clinics in Brownsville, Harlingen, and Pharr, TX. How Often Should You Verify Employee Licenses?

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Licensing Fraud Medicaid Medicaid 52

Verisys

NOVEMBER 3, 2023

Healthcare Fraud Crackdown! Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc. to Pay $32.5 to Pay $32.5 Secure your success by choosing Verisys.

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Fraud Compliance Medicare Medicare 52

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

Compliancy Group

FEBRUARY 16, 2024

This month, fraud in the medical industry has been making headlines fairly frequently. In one case, the dentist himself was involved, practicing on a revoked license. We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received.

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Fraud Licensing Medicaid Medicaid 52

Compliancy Group

NOVEMBER 25, 2024

In the healthcare industry specifically, more businesses are using tools and tactics like an OIG LEIE exclusion search to safeguard their hiring choices and automating that search with compliance software solutions.

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Compliance Fraud Medicaid Medicaid 52

MedTrainer

JANUARY 21, 2025

Todays healthcare organizations face mounting pressures to keep impeccable compliance records while managing increasingly complex operations. Proactivity in the form of continuous OIG exclusion list monitoring is key to minimizing risk, maintaining compliance, and avoiding costly mistakes.

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Compliance Fraud Regulatory Compliance Medicare 52

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.

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! Each month we will give a roundup of recent healthcare fraudsters and compliance busters. With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network.

Fraud 52

Fraud Telemedicine Licensing Doctors 52

Verisys

DECEMBER 29, 2024

Healthcare organizations and insurance companies rely on credentialing to ensure patient safety, regulatory compliance, and minimize liability risks. Credentialing services perform this verification by contacting primary sources, such as medical schools and licensing boards, to confirm the physician’s education and qualifications.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

American Medical Compliance

APRIL 6, 2023

Prosecutors stated that if they passed, they would be able to seek licenses and jobs in numerous locations. Incidence of Healthcare Fraud Numerous scammers view this as a method to make quick, yet unlawful, money. Incidence of Healthcare Fraud Numerous scammers view this as a method to make quick, yet unlawful, money.

Fraud 52

Fraud Nurses Licensing Compliance 52

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. 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

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

Provider Trust

AUGUST 6, 2024

Healthcare compliance monitoring has never been easy. So, what makes an effective compliance monitoring program? The compliance spectrum helps organizations of all sizes identify the effectiveness of their compliance monitoring based on three key factors: population, primary sources, and frequency. What about vendors?

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Compliance Licensing Fraud 52

Provider Trust

JUNE 1, 2022

Organizations across the healthcare continuum have experienced several workforce trends that are creating gaps in license monitoring and verifications. In this post, we’ll explore three current challenges impacting the healthcare license and credential verification process.

Licensing 52

Licensing Nurses COVID-19 Compliance 52

Provider Trust

APRIL 18, 2024

This comprehensive program provides healthcare organizations across the continuum of care a roadmap to implement top-tier compliance standards by addressing key population monitoring gaps, prioritizing financial efficiencies, and upholding community healthcare and success.

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Compliance Licensing Fraud Medicaid 52

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

Provider Trust

APRIL 26, 2023

Compliance and HR managers responsible for staffing should stay apprised of events that may have repercussions within the healthcare space. However, this solution comes with its share of compliance risks, especially if interstate licenses are involved. This can spell trouble for everyone involved.

Licensing 52

Licensing Nurses Compliance COVID-19 52

Verisys

FEBRUARY 8, 2024

Verisys can assist pharmaceutical manufacturers in maintaining compliance with OIG guidelines and other regulatory requirements through a multifaceted approach, leveraging its extensive suite of data solutions and compliance services. The post Pharmaceutical Manufacturers Guide to OIG Compliance appeared first on Verisys.

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Compliance Licensing Fraud 52

MedTrainer

FEBRUARY 27, 2025

This list includes individuals convicted of healthcare fraud, patient abuse, or other serious violations. Hiring or contracting with excluded parties can damage an organizations compliance status and lead to reputational damage and severe financial penalties. Exclusion Monitoring Same concept, different strategy, different outcomes.

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Compliance Malpractice Fraud Licensing 52

Provider Trust

MARCH 13, 2023

State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment. In Delaware, 26 nursing licenses were revoked when the nurses’ credentials were tied to the scheme. Are you in Florida? What are your pre-hire practices?

Fraud 52

Fraud US Department of Health and Human Services Licensing Nurses 52

HIPAA Journal

APRIL 25, 2024

The exposed and stolen data included contact information, Social Security numbers, driver’s license numbers, financial information, health insurance information, medical records, medical histories, diagnoses/conditions, and health insurance information. During that time, files containing patient data were exfiltrated from its network.

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Fraud Health Insurance HIPAA Licensing 120

Healthcare IT Today

DECEMBER 20, 2022

Five former employees of Methodist Hospital in Memphis, TN, including a recently-licensed Registered Nurse, were indicted by a federal grand jury for allegedly selling medical information about car accident victims to personal injury attorneys and chiropractors. Mike Semel is the President and Chief Compliance Officer at Semel Consulting.

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HIPAA Nurses Licensing Hospitals 111

MedTrainer

APRIL 22, 2024

Creating and using a supplier compliance checklist ensures vendors meet regulatory requirements and are trusted partners in managing sensitive information. In this article, I’ll discuss why supplier compliance is as critical as legal and regulatory adherence for healthcare organization employees.

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Compliance HIPAA Licensing Fraud 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is serious business for regulators. In this blog post, we’ll outline who regulates healthcare compliance, how rules are enforced, and why organizations need a robust compliance platform to stay in the good graces of regulators. What is Healthcare Compliance? Who Regulates Healthcare Compliance?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

MedTrainer

FEBRUARY 12, 2024

Failing to report healthcare non-compliance is a lot like failing to tell your parents you got sent to the principal’s office. In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare.

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Compliance Licensing Governance Fraud 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

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Fraud Medicaid Medicaid Nurses 52

Verisys

MAY 9, 2023

Data Compliance: 3 Focus Areas for Mitigating Organizational Risk A three-part compliance series that focuses on using technology to help you achieve your compliance goals. There is no question that healthcare organizations should have an effective healthcare compliance program.

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Compliance Fraud Governance Licensing 52

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. Compliance Assessment Ensuring compliance with applicable laws and regulations is fundamental to any healthcare audit.

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Compliance Fraud Regulatory Compliance HIPAA 52

MedTrainer

JULY 31, 2024

Meeting Tennessee training requirements for compliance is critical to maintain this level of excellence. What Is Required for Tennessee Compliance Training? Healthcare compliance training is not a one-size-fits-all solution. Provide required and often hard-to-find CE courses for licensed employees.

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MedTrainer

JUNE 11, 2024

What Is Required for Texas Compliance Training? Healthcare compliance training is not a one-size-fits-all solution. Here’s what you should look for when selecting healthcare compliance courses: Healthcare-Specific Content: Scenario-based training is required in many states and it is also one of the most effective ways to learn.

Compliance 52

Compliance HIPAA Compliance Framework ADA 52

MedTrainer

JULY 30, 2024

What Is Required for Wisconsin Compliance Training? Healthcare compliance training is not a one-size-fits-all solution. Here’s what you should look for when selecting healthcare compliance courses: Healthcare-Specific Content: Scenario-based training is required in many states and it is also one of the most effective ways to learn.

Compliance 52

Compliance HIPAA Compliance Framework ADA 52

Verisys

MARCH 1, 2024

As the healthcare industry is increasingly targeted for data theft and fraud, information security has emerged as a top priority for healthcare institutions. Governance, risk management, and compliance programs can all be automated, providing significant benefits to healthcare organizations.

Governance 52

Governance Compliance Fraud HIPAA 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. Nine Responsibilities of Healthcare Compliance Officers.

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

MedTrainer

JANUARY 12, 2024

At its core, healthcare compliance ensures the quality of care, patient safety, and integrity of healthcare systems. Over the years, healthcare compliance has evolved significantly, driven by changing regulations, advances in technology, and a growing emphasis on patient-centric care. What is Healthcare Compliance?

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MedTrainer

AUGUST 31, 2023

Yet, navigating the intricacies of healthcare compliance can be daunting. It’s why we’ve compiled a series of the most common healthcare compliance FAQs and their answers. Any healthcare professional curious about compliance practices will find these answers helpful, insightful, and empowering. What Is Healthcare Compliance?

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