Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

Medicare 52

Medicare Medicare Due Diligence Health Insurance 52

Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

Medicare 40

Medicare Medicare Due Diligence Health Insurance 40

HIPAA Journal

DECEMBER 28, 2022

It is also the case that, regardless of the level of effort put in to comply specifically with HIPAA, most hospitals already comply with HIPAA to some degree due to the measures implemented in order to participate in Medicare. It is also important to be aware patients´ rights under HIPAA go much further than Medicare.

HIPAA 83

HIPAA Compliance Hospitals Medicare 83

HIPAA Journal

DECEMBER 31, 2022

Two of the HIPAA violation categories are designated for Covered Entities and Business Associates that can demonstrate reasonable due diligence, whereas the other two are for entities guilty of willful neglect. What are the 3 types of HIPAA violations? The three types of HIPAA violations are administrative, civil, and criminal.

HIPAA 133

HIPAA Due Diligence Compliance Fraud 133

HIT Consultant

JANUARY 3, 2023

This trend is likely to continue for the foreseeable future as Medicare Advantage plans increasingly move to value-based models. Working with a third-party advisor can give you an edge by having a team ready to perform buy-side due diligence and provide guidance throughout the transaction quickly and efficiently.

Due Diligence 52

Due Diligence Medicare Medicare 52

HIT Consultant

FEBRUARY 5, 2024

Therefore, due diligence requires background checks to identify both current and historical adverse actions to be performed. Hospitals and health systems will be held accountable for a physician’s omission. Mistake No. 7: Failing to report adverse actions to the National Practitioners Data Bank (NPDB).

Malpractice 96

Malpractice Licensing Due Diligence Hospitals 96

Verisys

JULY 20, 2023

3: Allowing a physician to treat patients before credentialing is completed Courts have held hospitals liable when a physician falsifies credentials, and the hospital fails to do its due diligence in verifying them. Therefore, due diligence requires background checks to identify current and historical adverse actions.

Due Diligence 52

Due Diligence Malpractice Licensing Hospitals 52

HIPAA Journal

MARCH 30, 2023

Importantly, in the original seven elements of a compliance program, OIG notes that the continual retraining of personnel at all levels (emphasis added) is a significant element of an effective compliance training program.

Compliance 111

Compliance Compliance Officers Fraud HIPAA 111

Provider Trust

MAY 17, 2022

Federal regulators such as the HHS-OIG, the Department of Justice (DOJ), the Centers for Medicare and Medicaid Services (CMS), and others have regulations and guidelines regarding the prohibition of reimbursements of federal healthcare dollars (Medicaid, Medicare, CHIPS, TriCare, and others) to excluded vendors.

Compliance 52

Compliance Medicare Medicare Due Diligence 52

HIPAA Journal

JANUARY 21, 2024

Disaster Recovery and Emergency Mode Operation Most healthcare providers have to implement measures for disaster recovery and emergency mode operation as a condition of participating in Medicare.

HIPAA 75

HIPAA Compliance Due Diligence Medicare 75

HIPAA Journal

MARCH 20, 2025

These data highlight the importance of securing the supply chain, conducting due diligence on vendors before their products and services are used, and monitoring existing vendors for HIPAA Security Rule compliance and cybersecurity. Dominion National Insurance Company, and Dominion Dental Services USA, Inc.

HIPAA 111

HIPAA Ransomware Compliance Hospitals 111

Verisys

NOVEMBER 30, 2023

Therefore, due diligence requires background checks to identify both current and historical adverse actions be performed. Hospital and health systems will be held accountable for a physician’s omission. Mistake No. 7: Failing to report adverse actions to the National Practitioners Data Bank (NPDB).

Malpractice 52

Malpractice Licensing Due Diligence Hospitals 52

Verisys

FEBRUARY 4, 2022

Therefore, due diligence requires background checks to identify both current and historical adverse actions be performed. Exclusions from participation in a federal or state healthcare program including Medicare and Medicaid exclusions. Hospital and health systems will be held accountable for a physician’s omission. Mistake No.

Malpractice 52

Malpractice Licensing Due Diligence Hospitals 52

Provider Trust

MAY 18, 2022

Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. Recent cases of OIG enforcement and other fines, penalties related to vendors.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

MedTrainer

AUGUST 2, 2023

Insurance Reimbursement Insurance companies — along with government programs like Medicare and Medicaid — require providers to be credentialed to ensure they meet specific standards and qualifications. Selecting a credentialing provider takes a fair amount of due diligence; however, it’s time and energy that pay for themselves in short order.

Malpractice 52

Malpractice Due Diligence Compliance Licensing 52

Healthcare Law Blog

MAY 2, 2023

On April 12, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released a final rule updating key regulations pertaining to Programs of All-Inclusive Care for the Elderly (“PACE”) (the “ Final Rule ”). Overall, these changes, summarized below, will offer significant administrative and operational flexibilities.

Due Diligence 52

Due Diligence Medicaid Medicaid Medicare 52

Health Care Law Brief

NOVEMBER 9, 2021

Additionally, the Part II Rule provides that providers or facilities who act in good faith and with reasonable due diligence will not fail to comply with these requirements upon making an error in a good faith estimate, provided that they correct the information as soon as practicable. 2] See 86 Fed.

Medical Billing 75

Medical Billing Due Diligence Compliance Patient Satisfaction 75

HIPAA Journal

JANUARY 31, 2024

CA Healthcare Provider 2,364,359 Hackers hack access to its network between August 30, 2023, and September 1, 2023 Centers for Medicare & Medicaid Services MD Health Plan 2,342,357 MOVEit Transfer vulnerability exploited at Maximus Inc.

Ransomware 128

Ransomware HIPAA Hospitals Compliance 128

Hall Render

JANUARY 11, 2023

For example, reimbursement under Medicare and Medicaid for certain telemedicine services was significantly increased due to the COVID-19 pandemic.

Compliance 40

Compliance HIPAA FDA Due Diligence 40

AIHC

JUNE 22, 2022

If the provider is not enrolled in the plan, you will not be able to bill for services rendered, ESPECIALLY with Medicare and Medicaid. Code of Federal Regulations (CFR) have, as a result, become the best standard for due diligence. CFR regulations (U.S.

Medicaid 52

Medicaid Medicaid Due Diligence Medicare 52

HIPAA Journal

MAY 29, 2023

Risk management processes also need to be extended to third parties – business associates – which means performing due diligence on vendors throughout the supply chain and implementing processes to identify, assess, and manage vendor risk at each stage of the vendor life cycle – onboarding, ongoing, and offboarding.

HIPAA 107

HIPAA Compliance Due Diligence COVID-19 107