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 GCPG provides voluntary, non-binding guidance to assist all individuals and entities in the healthcare industry to develop and maintain a successful compliance program.

Compliance 52

Compliance Due Diligence Fraud Governance 52

Health Law Advisor

AUGUST 25, 2023

In July 2022, the New York State Office of the Medicaid Inspector General (“OMIG”) proposed extensive modifications to the regulatory requirements governing compliance programs for entities receiving “significant” Medicaid revenue (increased by these regulations from a threshold of $500,000 to $1 million). Lines of Communication.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

Fraud 52

Fraud Overpayments Overpayment Governance 52

Florida Health Care Law Firm

DECEMBER 2, 2021

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The OIG recognized that there are benefits to disclose potential fraud.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Compliance Health Insurance Medicaid 52

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. Excluded individuals and entities are listed in the OIG’s exclusions database.

Fraud 59

Fraud Compliance Medicare Medicare 59

AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse.

Fraud 52

Fraud Medicare Medicare Compliance 52

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

Medisys Compliance

NOVEMBER 26, 2024

SNF billing compliance refers to the adherence to federal and state regulations governing billing processes for skilled nursing facilities. These regulations are designed to ensure accurate claims, prevent fraud, and promote proper reimbursement for services rendered to patients. What is SNF Billing Compliance?

Compliance 52

Compliance Medical Billing Outsourcing Medicare Medicare 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Fraud Compliance 52

Healthcare Law Blog

FEBRUARY 9, 2024

Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance. Million To Resolve Health Care Fraud Allegations | United States Department of Justice [3] See Defs.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Hall Render

DECEMBER 11, 2024

The Proposed Rule would revise the section governing exclusions under section 1128(b)(14) of the Act based on an individual’s default on a health education loan or scholarship obligation.

Compliance 40

Compliance Licensing Nurses Medicaid 40

AIHC

MARCH 28, 2022

Government Accountability Office (GAO), improper payments have been estimated to total almost $1.7 trillion government-wide from fiscal years 2003 through 2019. Auditing and denying claims after the claims have been paid is “big money” for the government. According to the U.S.

Medicare 52

Medicare Medicare Compliance Governance 52

C&M Health Law

DECEMBER 18, 2023

OIG also specifically calls out the growing presence of private equity and other forms of private investment in health care and recommends that such investors scrutinize their operations and oversight to ensure compliance with fraud and abuse laws and the delivery of high-quality care for patients.

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

AIHC

OCTOBER 23, 2024

Defined Criteria” are standards identified in advance and approved for use in a specific audit, generally set by government rules, regulations or government agencies, such as CMS or pre-approved by the governing board of your organization. Corrective action includes refunding overpayments revealed during the audit.

Compliance 52

Compliance Overpayments Overpayment Medicaid 52

AIHC

SEPTEMBER 5, 2023

Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. This requirement can sometimes apply to specific types of professionals when located in law or regulations governing their profession.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

Hall Render

NOVEMBER 25, 2024

Quality of Care and Quality of Life OIG identified that beyond the Requirements of Participation for Long Term Care Facilities in 42 CFR 483 , the failure to provide quality care and promote quality of life poses a risk of fraud and abuse for nursing facilities.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Health Policy Commission still missing key document in Steward sale to Optum Local obesity drug developer lands deal worth up to $600M with Novo Nordisk Mass.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

HIPAA Journal

MARCH 30, 2022

Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. However, when HIPAA was passed, the standards governing health care data, patients´ rights, and the flow of information were still several years away. In March 1996, Rep.

HIPAA 130

HIPAA Fraud Health Insurance Health Care Reform 130

Hall Render

APRIL 26, 2024

New California rule aims to limit health care cost increases to 3% annually UC San Diego Health operations deal with California hospital slows to crawl Kaiser reports data breach affecting 13.4M health dept. processed 1.5

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Medicaid 40

Hall Render

JANUARY 19, 2024

in costs, report finds Pennsylvania hospital staff vote for union removal St.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

MARCH 22, 2024

Banner Health to expand clinical AI to 33 hospitals, 6 states Banner reports $282.8M family sues hospital over life-altering injuries Calif. Nevada Medicaid must cover abortion services, judge rules Clark County health rankings improve, but physicians per capita still well below U.S.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40

Kaiser Health News

OCTOBER 13, 2022

For the first time, Medicare Advantage plans are poised to enroll more than half of the Medicare population despite allegations that many of the largest insurers are getting billions of dollars in overpayments from the federal government.

ACA 75

ACA Medicare Medicare Governance 75

Med League

MARCH 23, 2022

Med League Support Services provides medical billing expert witness to review medical billing fraud cases. million fraud scheme against payers and patients. Dr. Rosen was part of this large fraud scheme where physician prescribes expensive drugs through network of pharmacists who then pay bribes to fill the order.

Medical Billing 40

Medical Billing Fraud Overpayments Overpayment 40