MedTrainer

JANUARY 10, 2024

It may seem a little early to do some spring cleaning, but not when it comes to compliance! It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. The OIG is making major investments to systematically detect and prosecute fraud.

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Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

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Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. Update your policies and procedures as needed.

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American Medical Compliance

JULY 9, 2024

The Medicare FWA Compliance Training aims to educate healthcare providers (HCP) on the definitions of fraud, waste, and abuse in the context of Medicare. Additionally, education regarding Medicare FWA is crucial to providing proper care and the prevention of FWA. What Is Medicare? AMA PRA Category 1 Credits.

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Compliancy Group

MARCH 22, 2024

depend on Medicare to get the healthcare they need. Remaining in good standing with Medicare has several advantages. Compliance Program A comprehensive way to avoid Medicare exclusion is to develop an organization-wide compliance program, one of the Centers for Medicare and Medicaid Services (CMS) requirements.

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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. He was also ordered to pay $557,000 in restitution to Indiana Medicaid and Medicare. As such, providers should prioritize billing compliance.

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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.

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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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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.

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

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. This year, 50% of Medicare enrollees are expected to sign up for Medicare Advantage.

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Healthcare IT Today

MAY 10, 2022

Contract Enforcements Tie Cybersecurity to Financial Fraud and Liability The receptionist you yelled at for shopping online could turn you in and get a $900,000 reward. When it comes to compliance, ignoring the contracts you sign – including with Medicare and your insurance policies – can hit you really hard and really fast.

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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.

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Healthcare IT News - Telehealth

AUGUST 11, 2021

In a session at HIMSS21 on Tuesday, two HHS OIG leaders offered a look at the enforcement priorities the agency has in mind these days, and some hints about the compliance responsibilities healthcare organizations should be prioritizing in the coming months. They're not submitting a telehealth claim to Medicare.

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Innovaare Compliance

JULY 19, 2024

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

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Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

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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

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.

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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.

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Med-Net Compliance

AUGUST 25, 2022

A Texas physician and his employee were charged for their roles in a healthcare fraud scheme involving the submission of more than $3.5 million in claims to Medicare. The physician allegedly paid kickbacks to various adult day care companies to gain Medicare beneficiary information under the guise of providing medical services.

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McBrayer Law Blog

SEPTEMBER 28, 2021

Posted In COVID-19 , Health Care Fraud , Healthcare Regulation , Telehealth The shift to telemedicine in the United States predates the pandemic, but COVID-19 has accelerated its widespread use.

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Healthcare Compliance Blog

FEBRUARY 22, 2022

Two women, one from Colorado and the other from Houston, have been sentenced in federal court for their roles a multi-million dollar Medicare Fraud Scheme. Each woman pled guilty to one count of conspiracy to commit healthcare fraud. The post Two Women Sentenced for Conspiracy to Commit Healthcare Fraud appeared first on.

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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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Total Medical ComplianceHIPAA

APRIL 12, 2024

As healthcare providers navigate the complex web of rules and regulations in compliance, one aspect that needs more attention is exclusion screening of those working with federally funded healthcare programs. Non-compliance with these requirements could result in financial penalties and jeopardize participation in Federal healthcare programs.

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Compliancy Group

DECEMBER 15, 2023

Unfortunately, some Medicare and Medicaid funds are lost to fraudulent and wasteful behaviors. Knowing how to detect, report, and prevent inappropriate use of funds associated with the Centers for Medicare and Medicaid Services (CMS) is essential. What is Healthcare Fraud? taxpayers over $100 billion annually.

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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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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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Compliancy Group

OCTOBER 28, 2024

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. Established in 1976, the Office of Inspector General (OIG) has led the U.S.

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Healthcare IT News - Telehealth

JULY 2, 2020

Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma to provide a written plan for permanent changes to Medicare, Medicaid and Children’s Health Insurance Program rules around telehealth.

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American Medical Compliance

MARCH 13, 2023

The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. Many of these individuals targeted elderly patients who receive Medicare benefits. The Centers for Medicare & Medicaid Services investigates these cases and prioritizes protecting patients. course today.

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Med-Net Compliance

SEPTEMBER 20, 2022

million scheme to defraud Medicare by billing for services under another doctor’s name after Medicare revoked his privileges to participate in the program. According to court documents and evidence presented at trial, the podiatrist was revoked from participating in the Medicare program in January 2015.

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Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. As part of the settlement, the doctor will pay a total of more than $9.48

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Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. In March 2020 she pleaded guilty to one count of healthcare fraud, one count of wire fraud, and one count of theft of government funds. Provide periodic retraining to members of the compliance and ethics committee as well.

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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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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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Verisys

JANUARY 8, 2024

OIG compliance refers to adherence to the guidelines and regulations set forth by the Office of Inspector General (OIG) of the U.S. The OIG is responsible for combating fraud, waste, and abuse in health and human services programs, including Medicare and Medicaid. The post What is OIG Compliance?

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HIPAA Journal

JANUARY 11, 2024

OIG in healthcare stands for the Department of Health and Human Services (HHS) Office of Inspector General (OIG) – the Office within the HHS responsible for reducing waste, fraud, and abuse in HHS programs and improving efficiency.

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