YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Compliance officers can help protect revenue and reduce the risk of penalties by collaborating with the Finance and Reimbursement departments to navigate the dynamics of outlier payments and prospective repayment.

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Compliance US Department of Health and Human Services Overpayments Overpayment 52

YouCompli

OCTOBER 26, 2022

Helping our clinical colleagues feel the urgency of compliance monitoring can be a huge challenge. And the Compliance team simply doesn’t have the clinical expertise to own the monitoring of these requirements. That’s a 41% error rate with an extrapolated overpayment of?$269 Don’t let processes overwhelm clinical colleagues.

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Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

NOVEMBER 1, 2023

As compliance officers, we are continually placed in a position to influence the actions of others and help shape our organization’s compliance culture. One way to change that perception is to avoid creating “gotcha” moments when you’re working on a compliance-related matter. Here are four tips that will help.

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

C&M Health Law

DECEMBER 18, 2023

Department of Health and Human Services (HHS) published the General Compliance Program Guidance (GCPG) on November 6, 2023. The GCPG provides updated descriptions of the seven elements of an effective compliance program that health care entities have long relied upon. The Office of the Inspector General (OIG) of the U.S.

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Compliance Compliance Officers Governance Overpayments 52

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. The DOJ Announcement stresses the importance of investing in strong compliance programs for both the buyers and sellers in business transactions.

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Compliance Due Diligence Fraud Governance 52

AIHC

SEPTEMBER 30, 2024

Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS Does your compliance program include auditing and monitoring documentation and coding related to risk adjustments and your value-based care reimbursement? The OIG made the following recommendations to Humana: Refund to the Federal Government the $6.8

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Overpayment Overpayments Compliance Medicare 52

Health Law RX

MARCH 30, 2023

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. This is the reality for a medical company in Minnesota.

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Overpayments Overpayment Fraud Governance 52

Hall Render

NOVEMBER 25, 2024

Department of Health and Human Services (“HHS”) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (“Nursing Facility ICPG”) for nursing home members of the health care compliance community. On November 20, 2024, the Office of Inspector General (“OIG”) for the U.S.

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Nurses Compliance Compliance Officers Medicare 40

Hall Render

DECEMBER 11, 2024

OIGs new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community emphasizes the importance of staff screening and exclusion checks. Information about the LEIE may be found on the OIGs Exclusions page. Under 42 CFR Sec.

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Compliance Licensing Nurses Medicaid 40

Healthcare Compliance Blog

MARCH 16, 2022

Erskine stated, “Nursing home facilities provide important services to our elderly; however, those facilities must uphold the trust placed in them by billing the government only for reasonable and necessary services. Periodically audit to ensure that skilled rehabilitation services being provided to residents are reasonable and necessary.

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Nursing Homes Nurses Overpayment Overpayments 59

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. As a result, the OIG is not seeking to exclude them from those programs or to require a CIA.

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Fraud Compliance Medicare Medicare 59

Health Law Blog

MAY 22, 2018

The government had accused the two owners of paying illegal kickbacks/bribes to “sober homes” in exchange for the referral of the sober homes’ insured residents to treatment program. If the allegations made by the government are to be believed, the treatment center is an illustration of exactly what intentional fraud looks like.

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Fraud Overpayments Overpayment Licensing 52

Florida Health Care Law Firm

DECEMBER 2, 2021

As described on the OIG website, “Self-disclosures give persons the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”. Any overpayment retained after this period may create liability under the Civil Monetary Penalties Law and the False Claims Act.

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Overpayments Overpayment Fraud Medicare 40

YouCompli

SEPTEMBER 27, 2023

Two of the most significant healthcare compliance risks are medical coding and billing. Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. In essence, they routinely double-billed for certain aspects of patients’ care. She

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Compliance Overpayments Overpayment Medicare 52

Innovaare Compliance

MARCH 1, 2022

6] Improper payments can be overpayments and underpayments. Overpayments put an MAO at risk in a bid and a one-third financial audit while underpayments consume valuable staff time in resolving provider disputes and can also be a jeopardy in a one-third financial audit.

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Medicare Medicare Overpayments Overpayment 52

Innovaare Compliance

MARCH 24, 2024

Poor dispute resolution could lead to compliance risks, reputational damage, and even loss of key providers. Inovaare’s comprehensive suite of HIPAA-compliant software solutions features best-practice regulatory processes to help healthcare organizations sustain audit readiness, reduce non-compliance risks, and lower operating costs.

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Fraud Compliance Health Insurance Medicaid 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. 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.

US Department of Health and Human Services 52

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

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance.

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Hospitals Compliance Officers Compliance Overpayments 52

AIHC

OCTOBER 23, 2024

Internal audits can be an integral part of your corporate compliance program and used as an effective management system, whether it is focused on quality, safety or any other business element. The American Institute of Healthcare Compliance (AIHC) provides comprehensive training to certify healthcare auditors.

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Compliance Overpayments Overpayment Medicaid 52

Innovaare Compliance

MARCH 24, 2024

Poor dispute resolution could lead to compliance risks, reputational damage, and even loss of key providers. Inovaare’s comprehensive suite of HIPAA-compliant software solutions features best-practice regulatory processes to help healthcare organizations sustain audit readiness, reduce non-compliance risks, and lower operating costs.

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Fraud Health Insurance Medicaid Medicaid 52

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. This requirement can sometimes apply to specific types of professionals when located in law or regulations governing their profession.

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AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back. If in doubt, check it out.

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Fraud Medicare Medicare Compliance 52

Healthcare IT Today

MAY 5, 2023

The surge in genetic testing claims comes with a rise in fraud, waste and abuse across government and commercial payers. Common schemes include: Code stacking. This occurs when multiple CPT codes are used to delineate different phases in the genetic testing process—a process often rife with error.

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AIHC

MARCH 28, 2022

Government Accountability Office (GAO), improper payments have been estimated to total almost $1.7 trillion government-wide from fiscal years 2003 through 2019. Auditing and denying claims after the claims have been paid is “big money” for the government. According to the U.S.

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Medicare Medicare Compliance Governance 52

Healthcare Law Blog

JANUARY 5, 2023

The Proposed Rule includes changes on an array of topics including: Star Ratings, medication therapy management, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, behavioral health services, identification of overpayments , requirements for valid contract applications, and formulary changes.

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Hall Render

MARCH 22, 2024

Nevada Medicaid must cover abortion services, judge rules Clark County health rankings improve, but physicians per capita still well below U.S. Nevada Medicaid must cover abortion services, judge rules Clark County health rankings improve, but physicians per capita still well below U.S.

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Nursing Homes US Department of Health and Human Services Nurses Hospitals 40