Verisys

APRIL 3, 2025

Data inaccuracies: A misspelled name, incorrect license number, or missing documentation might seem minor, but they can lead to license and certification rejections, compliance violations, and delayed insurance reimbursementspotentially causing financial and operational headaches.

US Department of Health and Human Services 52

US Department of Health and Human Services Licensing Compliance Malpractice 52

Medisys Compliance

MARCH 9, 2025

Clinical Social Workers (LCSWs): Licensed to provide mental health services, including psychotherapy and counseling. Licensed Professional Counselors (LPCs) & Licensed Mental Health Counselors (LMHCs): These professionals are increasingly recognized by Medicare.

Medicare 59

Medicare Medicare Medical Billing Medical Billing Services 59

HIPAA Journal

MAY 25, 2022

Social Action Community Health System (SAC Health) has recently notified 149,940 patients that documents containing their protected health information were stolen in a break-in at an off-site storage location where patient records were stored. Notification letters were sent to those individuals on May 3, 2022.

Ransomware 137

Ransomware Fraud HIPAA Licensing 137

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.

Fraud 40

Fraud Compliance Medicaid Medicaid 40

Medisys Compliance

APRIL 19, 2023

The Medicaid program in Florida provides medical services and assistance to low-income individuals and families. To participate in the Medicaid program, healthcare providers must meet several general requirements set forth by the Agency for Health Care Administration (AHCA).

Medicaid 52

Medicaid Medicaid Medical Billing Outsourcing Licensing 52

MedTrainer

MARCH 30, 2024

Step-By-Step Provider Enrollment Process There are many reasons provider enrollments are delayed: incorrect information, missing documents, busy credentialers, and slow-moving payers. However, there are ways to leverage enrollment checklists and technology to ensure everything you need for a smooth application process happens the first time.

Malpractice 98

Malpractice Licensing Medicaid Medicaid 98

Verisys

MARCH 6, 2025

The Centers for Medicare and Medicaid Services (CMS) Regulates reimbursement policies and ensures healthcare organizations adhere to the standards necessary to participate in federal healthcare programs. Credentialing, Licensing, and Education. Failure to comply with regulations can result in the loss of these essential credentials.

Compliance 52

Compliance HIPAA Licensing Governance 52

Healthcare IT News - Telehealth

NOVEMBER 10, 2020

The Centers for Medicare and Medicaid Services (CMS) is expected to issue new rules for telehealth in the release 2021 Physician Fee Schedule later this year. This includes meeting all state-level telehealth, licensing, and credentialling requirements. Ensure licensing and credentialling is in proper order for all providers.

Public Health 161

Public Health Medicare Medicare COVID-19 161

Verisys

MARCH 6, 2025

Preventing documentation from falling through the cracks can help ensure patients receive the medical care they deserve. For example, requiring all names to follow a “Last Name, First Name” format and license numbers to be entered uniformly can prevent mismatches.

Compliance 52

Compliance Licensing Doctors Malpractice 52

MRO Compliance

JUNE 1, 2022

This review is part of the Star rating system, which according to RAC Monitor was developed by the Centers for Medicare & Medicaid Services (CMS) to rate health plan performance for Medicare Advantage programs and Medicare risk adjustment initiatives. Reporting and documentation. HEDIS works as a government rating tool.

Medicare 130

Medicare Medicare Compliance Medicaid 130

Healthcare IT News - Telehealth

OCTOBER 20, 2021

Early on in the pandemic, the Centers for Medicare & Medicaid Services (CMS) extended telehealth waivers that helped bring virtual care services into the mainstream. That is an amalgamation of telehealth, RPM, clinical documentation surveillance and analytics tools in a way that will position you to be reimbursed.

COVID-19 183

COVID-19 Hospitals Telemedicine Licensing 183

HIPAA Journal

JUNE 28, 2023

The total settlement fund has not been disclosed; however, all class members are entitled to claim up to $1,500 as reimbursement for ordinary expenses, which are documented expenses that were incurred as a result of the data breach. A lawsuit – Young, et al. The final approval hearing has been scheduled for Sept.

Hospitals 101

Hospitals Fraud Licensing HIPAA 101

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? But these programs cannot be controlled by Medicaid and Medicare alone. But these programs cannot be controlled by Medicaid and Medicare alone. With this legislation, Medicaid Fraud Control Units (MFCUs) were born.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

HIPAA Journal

MARCH 6, 2023

The types of information exposed varied from individual to individual and may have included names, addresses, medical information, health insurance information, Medicaid identification numbers, driver’s licenses, account and routing numbers, and Social Security numbers.

Electronic Medical Records 100

Electronic Medical Records HIPAA Licensing Nurses 100

Healthcare IT News - Telehealth

AUGUST 30, 2021

In doing so, Trinity also hoped to receive readmission incentives from the Centers for Medicare and Medicaid Services, avoid penalties, and reduce costs as it transitioned to value-based care reimbursement. "Document all of this essential information in a scope statement. "Select measures of success," she continued.

Patient Satisfaction 195

Patient Satisfaction Nurses Medicare Medicare 195

HIPAA Journal

MAY 16, 2022

Upon discovery of the breach, an investigation was launched to determine the nature and scope of the attack, and a comprehensive review was then conducted of all documents that were potentially accessed.

Health Insurance 117

Health Insurance Ransomware HIPAA Licensing 117

AIHC

DECEMBER 27, 2024

These laws should mandate detailed discussions of these tasks during the informed consent process and require written documentation of patient agreement. Medical boards, institutions, facilities, and universities must be held accountable for violations, with penalties such as fines, suspensions, or revocation of licenses.

Informed Consent 98

Informed Consent Bioethics ADA Nurses 98

Med-Net Compliance

SEPTEMBER 7, 2022

A 49-year-old Texas physician assistant was arrested and charged for his role in a scheme to defraud Medicaid by working with a suspended medical license. On July 20, 2021, the Texas Medical Board allegedly ordered the immediate suspension of his physician assistant license, deeming him to be a “continuing threat to public welfare.”

Medicaid 59

Medicaid Medicaid Licensing Medical Personnel 59

HIPAA Journal

OCTOBER 18, 2022

Many healthcare organizations wait until the document review is completed before announcing a breach, which could be several months after data has been stolen. Lifespire said it is unaware of any instances of misuse of patient data but has offered affected individuals free access to credit monitoring and identity protection services.

HIPAA 122

HIPAA Health Insurance Licensing Medicaid 122

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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Healthcare IT Today

JANUARY 8, 2025

Outsourcing will pivot to a more surgical, targeted strategy, focusing on high-impact, specialized areas like revenue integrity, underpayment recovery, and the more commonplace out-of-state Medicaid and small balance recovery work where RCM outsourcing supplements streamlined, automation-empowered teams instead of replacing them.

Hospitals 87

Hospitals Payment Systems Licensing Medicaid 87

HIPAA Journal

APRIL 25, 2023

TRPHD said the document review was completed on March 15, 2023, and notifications were mailed to affected individuals on April 14, 2023. The email account breach was detected on February 13, 2023, and the forensic investigation confirmed the email account was accessed between June 16, 2022, and July 18, 2022.

Health Insurance 106

Health Insurance Public Health Ransomware Fraud 106

Health Care Law Brief

MAY 11, 2022

No bonus amount may be paid to any worker who has been suspended or excluded under the Medicaid program during the vesting period and at the time an employer submits a claim. Covered employers will be required to retain records of claims and substantiating documentation for a period of no less than six years. Covered Employers.

Medicaid 97

Medicaid Medicaid Overpayments Overpayment 97

Med-Net Compliance

SEPTEMBER 14, 2022

A Massachusetts home health aide, who was licensed as a Certified Nursing Assistant (CNA), has been indicted in connection with a home surveillance video showing her abusing an elderly patient, Attorney General Maura Healey announced. Document that the training occurred, and record in each employee’s education file.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Medicaid Medicaid 59

Medisys Compliance

AUGUST 20, 2024

Psychologists: Licensed psychologists can provide psychotherapy, psychological testing, and assessments but cannot prescribe medications. Licensed Clinical Social Workers (LCSWs): LCSWs provide therapy, counseling, and support for patients dealing with mental health issues, particularly in community settings.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Licensing Medical Billing Informed Consent 59

Med-Net Compliance

JULY 19, 2022

In order to participate in the Medicare, Medicaid, and all federal healthcare programs once the term of exclusion ends, the individual or entity must apply for reinstatement and receive written notice from OIG that reinstatement has been granted. OIG maintains a list of all currently excluded individuals and entities called the?

US Department of Health and Human Services 59

US Department of Health and Human Services Licensing Medicare Medicare 59

MedTrainer

MAY 10, 2024

1, 2024 , mental health counselors can enroll with Medicare as part of The Centers for Medicare and Medicaid Services ( CMS ) plan to bring approximately 400,000 marriage and family therapists (MFT) and mental health counselors (MHC) into their network. Effective Jan. This is where it gets complex.

Licensing 52

Licensing ACA Medicare Medicare 52

MedTrainer

JANUARY 21, 2025

Understanding the OIG Exclusion List The OIG maintains the List of Excluded Individuals/Entities (LEIE), which provides comprehensive information to the healthcare industry on those currently excluded from participating in Medicare, Medicaid, and any other federal healthcare programs.

Compliance 52

Compliance Fraud Regulatory Compliance Medicare 52

MedTrainer

DECEMBER 20, 2023

Both licensing and credentialing processes are pivotal in upholding the integrity and safety of healthcare delivery in the state of New Jersey. The New Jersey State Board of Medical Examiners oversees medical credentialing and licensing within the state. Primary Source Verification. Payers in New Jersey have specific requirements.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

Med-Net Compliance

NOVEMBER 8, 2022

The inspection objective was to determine whether the direct care licensed nursing hours recorded at the nursing home supported the hours submitted to the US Centers for Medicare & Medicaid Services (CMS) in compliance with federal requirements. Train appropriate staff to accurately document and report direct care hours worked.

Nursing Homes 59

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

MedTrainer

DECEMBER 4, 2023

The Kentucky Cabinet for Health and Family Services (CHFS), Department for Medicaid Services administers the state’s Medicaid program, ensuring access to essential health care services for eligible low-income individuals and families in Kentucky.

Compliance 52

Compliance Licensing Medicaid Medicaid 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.

Nursing Homes 59

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

HIPAA Journal

MAY 23, 2023

The unauthorized individual was discovered to have accessed documents in the account that included the full names, internal patient identification numbers, and insurance providers of 50 patients. Additional security measures have been implemented and further training has been provided to the workforce.

Licensing 120

Licensing Health Insurance Medicaid Medicaid 120

HIPAA Journal

JUNE 8, 2023

The security breach was detected on February 5, 2023, and the forensic investigation confirmed there had been unauthorized access to documents on its systems between January 7, 2023, and February 5, 2023.

Ransomware 107

Ransomware HIPAA Licensing Health Insurance 107

MedTrainer

NOVEMBER 27, 2023

The Division of Health Benefits administers the state’s Medicaid program, which provides essential healthcare coverage to eligible individuals and families. Providers must be licensed in North Carolina, except under certain conditions, and must ensure that services align with their scope of practice. Medicaid expansion under H.B.

Compliance 52

Compliance Licensing Telemedicine Medicaid 52

MedTrainer

MAY 29, 2024

One of the newest changes that impacts medical credentialing services in Oklahoma is a major change to SoonerCare, the state’s Medicaid program. Controlled Dangerous Substance (CDS) Required The Oklahoma State Bureau of Narcotics and Dangerous Drugs Control requires registration as well as a controlled dangerous substance (CDS) license.

Licensing 52

Licensing Medicaid Medicaid Malpractice 52

C&M Health Law

SEPTEMBER 11, 2023

Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (“CMS”) issued a much anticipated and contested proposed rule that seeks to establish minimum staffing level requirements for nursing homes. HPRD from licensed practical nurses, and 2.38 On September 1, 2023, the U.S. HPRD consisted of 0.75

Nursing Homes 98

Nursing Homes Nurses Medicaid Medicaid 98