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

The Health Law Firm

OCTOBER 7, 2022

Board Certified by The Florida Bar in Health Law The US Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). These subpoenas are very broad, usually requiring the production of thousands of pages of documents. Indest III, J.D.,

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US Department of Health and Human Services Fraud Medicaid Medicaid 52

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

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 According to court documents and evidence presented at trial, the podiatrist was revoked from participating in the Medicare program in January 2015.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 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

Compliancy Group

JUNE 6, 2024

Many compliance violations in healthcare arise from financial conflicts of interest, particularly when providers get kickbacks or achieve financial gain from their referral services. Department of Health and Human Services, enforces the Stark Law. CMS Updates in 2023 : Voluntary self-referral disclosure laws.

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Compliance Officers Compliance US Department of Health and Human Services 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. Department of Health and Human Services (hhs.gov).

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US Department of Health and Human Services Fraud Compliance Medicaid 59

Compliancy Group

JULY 24, 2024

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. Understanding CMS Inspections CMS is a federal agency within the United States Department of Health and Human Services.

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US Department of Health and Human Services Compliance Medicaid Medicaid 59

HIT Consultant

NOVEMBER 13, 2023

hours entering electronic health records (EHR data), and managing patient loads of 2,000 or more. These healthcare organizations (HCOs) will deploy task-oriented and domain-specific models that build on large-language models (LLMs), using reinforcement learning and knowledge graphs to deliver relevant, accurate, and stable data outputs.

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US Department of Health and Human Services COVID-19 Fraud Nurses 111

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.

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

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

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

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

Healthcare Law Blog

MARCH 7, 2023

The Centers for Medicare & Medicaid Services (“CMS”), on behalf of the U.S. Department of Health and Human Services (“HHS”), recently issued a proposed rule to adopt standards under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) for “health care attachment” transactions (the “Proposed Rule”).

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US Department of Health and Human Services HIPAA Medicaid Medicaid 52

The Health Law Firm

JULY 16, 2015

Board Certified by The Florida Bar in Health Law The House Committee on Energy and Commerce and the Senate Committee on Finance both recently sent a letter to Secretary Burwell urging the US Department of Health and Human Services (HHS) to actually issue the Medicaid Equal Access regulations.

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US Department of Health and Human Services Medicaid Medicaid Medicare 40

Healthcare Compliance Blog

MAY 10, 2022

The provider had created a business to provide home and community-based services to Medicaid recipients. The provider had created a business to provide home and community-based services to Medicaid recipients. An ineligible Medicaid provider was arrested in Florida for defrauding Medicaid of more than $68,000.

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Medicaid Medicaid US Department of Health and Human Services Fraud 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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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. An individual or entity with a defined period of exclusion (e.g., 5 years, 10 years, etc.)

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US Department of Health and Human Services Licensing Medicare Medicare 59

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

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Compliance US Department of Health and Human Services Fraud Medicare 52

C&M Health Law

JANUARY 20, 2023

This builds on the HIPAA Transactions Rule standards for financial and administrative transactions among health care providers and health plans and aligns with Department of Health and Human Services (HHS) interoperability regulations.

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HIPAA US Department of Health and Human Services Compliance Health Insurance 52

Med-Net Compliance

JULY 25, 2022

The Office for Civil Rights (OCR) at the US Department of Health and Human Services (HHS) announced the resolution of eleven investigations in its Health Insurance Portability and Accountability Act (HIPAA) Right of Access Initiative, bringing the total number of these enforcement actions to thirty-eight since the initiative began.

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

YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). The inflated charges resulted in inappropriate outlier payments from Medicare.

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Compliance US Department of Health and Human Services Overpayments Overpayment 52

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

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US Department of Health and Human Services Medicare Medicare Medicaid 52

Compliancy Group

JANUARY 17, 2024

Understanding the OIG Work Plan The OIG Work Plan for physicians and health organizations is a dynamic document that lays out the various audits, reviews, and inspections the OIG intends to conduct in relation to healthcare programs and services within a time frame. OIG in healthcare , functioning as an arm of the U.S.

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

Compliancy Group

MARCH 19, 2024

Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations. It also reduces waste, fraud, and abuse that threaten the efficiency of healthcare delivery and services. name, phone number).

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

YouCompli

SEPTEMBER 6, 2023

I was responsible for allocating financial, human, and physical resources to accomplish certain tasks.   By doing so, you and your project team will be excellent stewards of the human and physical resources needed to complete the project. Was “project manager” in your current or previous job descriptions? Agree to due dates.

Compliance 52

Compliance US Department of Health and Human Services Compliance Officers 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. Ensuring proper creation, maintenance, distribution, and storage of documentation. Reimbursement. Healthcare administration.

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Compliance Officers Compliance US Department of Health and Human Services Governance 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. In the US, hospital prices vary widely but are not visible to patients or the public.

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Hospitals US Department of Health and Human Services Compliance Governance 52

Physician Credentialing Company

OCTOBER 17, 2024

In the healthcare sector, healthcare organizations and practitioners provide medical services to patients and ask for reimbursement in return from the insurers. There are many codes assigned for the service provided to the patients, and CPT code 99214 is very important for billing office or outpatient medical patient visits.

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US Department of Health and Human Services Medical Billing Medicare Medicare 40

Innovaare Compliance

SEPTEMBER 24, 2020

Medicare Appeals Best Practices. How can health plans improve their Medicare appeals processes? For many health plans serving the Medicare population, they will have to automate more and more of their processes to capitalize on the growing demand for services. According to the U.S. Allow me to explain.

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US Department of Health and Human Services Medicare Medicare Compliance 40

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.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

MedTrainer

FEBRUARY 13, 2022

During the credentialing procedure, a candidate’s documentation is sent back to the institution that first issued them, such as a university to confirm their legitimacy. After all, there is a bit of a loophole under the Incident-to rule that allows a non credentialed physician to bill under a credentialed physician for services.

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US Department of Health and Human Services Medical Billing Hospitals Compliance 40

MedTrainer

AUGUST 8, 2022

During the credentialing procedure, a candidate’s documentation is sent back to the institution that first issued them, such as a university to confirm their legitimacy. After all, there is a bit of a loophole under the Incident-to rule that allows a non credentialed physician to bill under a credentialed physician for services.

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US Department of Health and Human Services Medical Billing Hospitals Compliance 40

Healthcare IT News - Telehealth

JUNE 4, 2021

But for health IT, things sped up. When new technologies were needed to solve fast-moving healthcare challenges, hospitals and health systems could not afford to wait the time it normally took to stand up IT. This is the ninth installment in Healthcare IT News ' Health IT Lessons Learned in the COVID-19 Era feature story series.

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US Department of Health and Human Services COVID-19 Doctors COVID-19 Vaccine 190

The Health Law Firm

JANUARY 28, 2013

Board Certified by The Florida Bar in Health Law. A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. Drug Enforcement Administration (DEA) agents removed boxes of documents and computers from the pharmacy, according to Naples News.

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US Department of Health and Human Services Medicare Medicare Fraud 40

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. Cobra breeders killed the majority of the cobras and redeemed them for money while they continued to breed more cobras.

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Compliance US Department of Health and Human Services COVID-19 Hospitals 52