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Ongoing License Monitoring Critical to Prevent Healthcare Fraud

Provider Trust

Mendez, who was a physician assistant at CCI Therapy Counseling Centers International, was working with a suspended medical license. However, despite his suspended medical license, Mendez continued to treat patients at various mental health clinics in Brownsville, Harlingen, and Pharr, TX. How Often Should You Verify Employee Licenses?

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Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know

HIT Consultant

What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Licensed Clinical Social Worker. For more information, download the full report here.

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How To Prepare for an OIG Inspection

MedTrainer

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. Download “Compliance Reports You Can’t Live Without” for OIG reporting templates and tips. What Prompts an OIG Inspection?

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An Overview of the New York OMIG Exclusion List

Provider Trust

In 2006, New York’s Office of the Medicaid Inspector General (OMIG) was established as an independent office within New York State’s Department of Health to combat fraud and abuse in New York State’s Medicaid program. The second option offers multiple downloadable formats that offer full access to the exclusion list.

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Everything You Need To Know About NPI Numbers

Verisys

The NPI does not replace other identification numbers such as a provider’s taxpayer identification number (TIN), Drug Enforcement Administration registration, license number, or Social Security number. Tracking actions to a standardized identifier provides transparency that can identify and impede fraud.

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Preventing Unlicensed Individuals and Subsequent Fraudulent Claims Submission

Provider Trust

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. According to the U.S.

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Navigating the Maze of Who Regulates Healthcare Compliance

MedTrainer

Department of Health and Human Services focuses on preventing fraud, abuse, and waste in federal healthcare programs. Regulatory agencies have the authority to impose monetary sanctions, revoke licenses, or exclude providers from federal healthcare programs as punitive measures.