YouCompli

AUGUST 22, 2023

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs.

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Medicare Medicare US Department of Health and Human Services Compliance 52

Compliancy Group

MARCH 19, 2024

Hospitals and private practices aren’t the only enterprises with compliance obligations within this sector. Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations. name, phone number).

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

MedTrainer

OCTOBER 16, 2023

This is the essence of corporate compliance in healthcare. Just as every piece of the puzzle must fit perfectly, every compliance element in healthcare needs precise integration to ensure seamless, ethical, and effective operations. Dive with us as we explore the complexities and necessities of compliance in the healthcare sector.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Medicaid 52

Provider Trust

MARCH 21, 2023

US Department of Health and Human Services (HHS) Office of Inspector General Christi A. 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.

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Fraud Medicare Medicare US Department of Health and Human Services 52

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 52

Medisys Compliance

JULY 25, 2022

Recently published watchdog report found that private Medicare plans routinely rejected claims that should have been paid and denied services that reviewers found to be medically necessary. For detailed understanding we shared observations of OIG where they found that some of the claims were wrongly denied by private Medicare plans.

Medicare 52

Medicare Medicare US Department of Health and Human Services Medical Billing Outsourcing 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.

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US Department of Health and Human Services HIPAA Compliance Medicaid 85

YouCompli

NOVEMBER 30, 2022

How to use the SBAR Framework. The same tool nurses use to communicate about health emergencies – can help you secure investment in your compliance department. . Over the past few years, I’ve helped many of our clients demonstrate the value of investing in compliance with an?SBAR. Explain your assessment.

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

YouCompli

SEPTEMBER 6, 2023

But very quickly, as a compliance officer, I realized that I was managing multiple projects every day. I was responsible for allocating financial, human, and physical resources to accomplish certain tasks.   Conducting annual compliance training is a project.   Was “project manager” in your current or previous job descriptions?

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

YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. The CCR is determined by a hospital’s cost report that is reconciled with the local Medicare contractor.

Compliance 52

Compliance US Department of Health and Human Services Overpayment Overpayments 52

Compliancy Group

JULY 24, 2024

Ensuring compliance with healthcare regulations is critical for any healthcare organization. One of the most significant regulatory bodies is the Centers for Medicare & Medicaid Services (CMS), which conducts rigorous inspections to ensure that healthcare providers meet required standards.

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US Department of Health and Human Services Compliance Medicaid Medicaid 59

YouCompli

NOVEMBER 18, 2023

Most of us have had the experience of preparing for an important conversation or interaction, only to leave it feeling defeated, misunderstood, and not even really heard. In this article, we will examine four essential listening skills that help compliance officers be more effective within their organizations.

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

Healthcare Compliance Blog

MAY 9, 2022

A home health services company headquartered in Kentucky, and its related entities, paid $2.1 million to the United States government to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida.

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US Department of Health and Human Services Medicare Medicare Compliance 59

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff.

US Department of Health and Human Services 52

US Department of Health and Human Services Nursing Homes COVID-19 Medicare 52

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff.

US Department of Health and Human Services 52

US Department of Health and Human Services COVID-19 Nursing Homes Medicare 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. Training employees on compliance issues.

Compliance Officers 52

Compliance Officers Compliance US Department of Health and Human Services Governance 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. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

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

Healthcare IT Today

MAY 16, 2024

Mike Semel, President and Chief Security Officer of Semel Consulting The Ascension health system data breach can’t be easily separated from the United Healthcare Change Health breach that recently caused a huge financial and medical impact across the healthcare sector and may have breached the personal information for a third of Americans.

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Ransomware US Department of Health and Human Services Hospitals Compliance 120

Med-Net Compliance

AUGUST 18, 2022

An Indiana provider of skilled nursing and long-term care services has agreed to pay $5,591,044.66 to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program. The complaint alleged that the provider had engaged in conduct to defraud the Medicare program. to the United States.

Nursing Homes 59

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

Healthcare Compliance Blog

MAY 19, 2022

million to settle allegations that it violated the False Claims Act by submitting false claims to Medicare. Following an internal review and audit, the hospital discovered irregularities regarding its billing of certain services, and proactively contacted the United States to self-disclose the issues.?The to resolve the claims.

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US Department of Health and Human Services Hospitals Medicare Medicare 59

Healthcare Compliance Blog

APRIL 26, 2022

The Office of Inspector General (OIG) for the US Department of Health and Human Services (HHS) has made educational resources available for healthcare providers to comply with federal healthcare laws and regulations. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.

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US Department of Health and Human Services Fraud Compliance Medicaid 59

MedTrainer

FEBRUARY 29, 2024

The World Health Organization (WHO) defines a near miss as “an error that has the potential to cause an adverse event [patient harm] but fails to do so because of chance or because it is intercepted.” More than three-fourths (77%) were due to emergency department overcrowding and medication administration errors.

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US Department of Health and Human Services Compliance Nurses World Health 52

Med-Net Compliance

OCTOBER 19, 2022

The settlement resolves allegations that between 2013 and 2020, the company paid remuneration to its home health medical directors in Oklahoma and Texas for the purpose of inducing referrals of Medicare and TRICARE home health patients. The corporate officers were previously the CEO and COO of the company.

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US Department of Health and Human Services Medicare Medicare Medicaid 59

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.

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

Healthcare IT Today

AUGUST 28, 2023

Stephen Sofoul, SVP, Data & Decision Science Services at MultiPlan A critical challenge lies in the shortage of experienced financial analysts or data analysts capable of effectively analyzing the wealth of information that the healthcare industry holds. However, with healthcare being ever-evolving our regulations are also ever evolving.

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US Department of Health and Human Services Telemedicine Hospitals Compliance 122

Compliancy Group

JANUARY 17, 2024

The OIG Work Plan, sometimes referred to as “the Work Plan” or “the Plan,” is an essential tool in securing and maintaining healthcare regulatory compliance for patient safety, privacy, and quality care. The OIG Compliance Work Plan identifies significant risks and areas that require attention within the healthcare system.

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

Healthcare IT News - Telehealth

NOVEMBER 25, 2020

Department of Health and Human Services' final rules regarding the Physician Self-Referral Law (also known as the Stark Law) and the Federal Anti-Kickback Statute. The American Telemedicine Association this week issued a statement in response to the U.S. WHY IT MATTERS.

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US Department of Health and Human Services Telemedicine Medicaid Medicaid 185

Healthcare Compliance Blog

JUNE 9, 2022

His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription. Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare.

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US Department of Health and Human Services Overpayment Overpayments Medicare 59

Healthcare IT News - Telehealth

AUGUST 11, 2021

Department of Health and Human Services works to ensure the integrity of federal healthcare programs and to safeguard the health and welfare of those programs' beneficiaries. And I think it's important for us to recognize that we don't know a whole lot right now.

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US Department of Health and Human Services Fraud Medicare Medicare 159

YouCompli

DECEMBER 7, 2022

Do your hiring managers and Human Resources colleagues know what to look for? Department of Health and Human Services Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. Provision of unnecessary or substandard services.

Fraud 52

Fraud US Department of Health and Human Services Compliance Medicaid 52

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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Fraud US Department of Health and Human Services Medicare Medicare 59

Healthcare IT Today

SEPTEMBER 17, 2024

An ongoing lawsuit between two health IT companies raises questions that call for more discussion. has led independent observers to predict a shake-up in health care and the potential for future lawsuits. Department of Health & Human Services should be applied. PointClickCare Technologies, Inc. )

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US Department of Health and Human Services Nurses Health Care Reform Hospitals 70

Med-Net Compliance

JUNE 22, 2022

Investigation of the case was conducted by the US Department of Veterans Affairs-Office of Inspector General (VA-OIG), VA Police Detroit and the Medicare Fraud Strike Force (MFSF) partners, a partnership among the Criminal Division, US Attorney’s Offices, and US Health and Human Services-Office of Inspector General (HHS-OIG).

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

Med-Net Compliance

NOVEMBER 8, 2022

On November 3, 2022, the OIG released the results of a recent inspection of a nursing home by the Texas Health and Human Services (HHS) Office of Inspector General Audit and Inspections Division (OIG Inspections).

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

Innovaare Compliance

JUNE 21, 2023

The Inflation Reduction Act of 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they are administered in the provider’s office (Part B) or used in the ambulatory setting (Part D). Part B drugs have had the fastest spending growth for drugs for Medicare. percent annually.

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Medval Compliance Blog

MARCH 10, 2022

by Frank Fairchok, Vice President of Medicare Reporting Services. Last week, the Centers for Medicare & Medicaid Services (CMS) advanced the rulemaking process in two long-awaited areas. 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047).

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US Department of Health and Human Services Medicare Medicare Medicaid 52

AIHC

NOVEMBER 15, 2022

Written by Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, COCAS, CORCM, OHCC, ICDCT-CM/PCS The Federal Hospital Price Transparency Rule helps Americans know the cost of a hospital item or service before receiving it. Compliance is mandatory. So, exactly what is this all about? Consequences of Noncompliance?

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Hospitals US Department of Health and Human Services Compliance Governance 52