MRO Compliance

JANUARY 16, 2025

For payers, investing in interoperability is more than meeting regulatory compliance, it creates a future where patient data follows seamlessly, improving care coordination and reducing administrative burdens. Many claims analysts feel that chasing down overpayments feels like plugging leaks in a sinking boat.

Overpayments 130

Overpayments Overpayment Regulatory Compliance Patient Satisfaction 130

Health Care Law Brief

JUNE 26, 2022

With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability. The Overpayment Rule. The Overpayment Rule, set forth at 42 U.S.C. 29844, 29921 (May 23, 2014). See UnitedHealthcare Insurance Co. 3d 173 (Sep.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

HIT Consultant

SEPTEMBER 27, 2024

Risk adjustment requires constant attention to ensure accurate coding, timely regulatory compliance, and streamlined communications across the payer-provider continuum. billion in overpayments to MA plans with this new audit methodology over the next ten years. In one recent audit, OIG found at least $3.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 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.

Compliance 52

Compliance Due Diligence 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.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Florida Health Care Law Firm

DECEMBER 2, 2021

They believe that good faith disclosure of potential fraud and cooperation with OIG’s review and resolution process are indications of a robust and effective compliance program. The OIG clarified that using the SDP may mitigate potential exposure under Medicare and Medicaid 60-day reporting and returning requirements for overpayments.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40