Compliancy Group

APRIL 25, 2024

Components of Medicare Fraud, Waste, and Abuse Training One of the most important elements of CMS Medicare fraud, waste, and abuse training is defining and differentiating these three terms : Fraud is the deliberate attempt to obtain financial gain through deceptive means, such as providing false information. See how it works!

Fraud 59

Fraud Medicare Medicare Compliance 59

Hall Render

MARCH 12, 2025

Background of the Case Relator Rosales filed a qui tam action in June 2020 against a hospice care provider and its subsidiaries, alleging fraudulent conduct aimed at securing payments from Medicare and Medicaid. Instead, courts must review all properly filed claims and assess each claim individually.

Fraud 52

Fraud Governance Medicaid Medicaid 52

Healthicity

OCTOBER 5, 2022

The Office of Inspector General recently made Work Plan updates that impact price transparency rules, Medicaid fraud referrals, and inpatient rehabilitation. If you support compliance for hospitals or hospital systems, listen up! Have you heard? Our latest eBrief covers the updates you need to know.

Fraud 98

Fraud Medicaid Medicaid Compliance 98

Compliancy Group

OCTOBER 28, 2024

Health and Human Services (HHS) Department’s efforts to eliminate fraud, waste, and abuse. While the CPG applies to all hospitals, practices, suppliers, and other healthcare entities, the ICPGs address the salient risk factors in each specific sector. Established in 1976, the Office of Inspector General (OIG) has led the U.S.

Nurses 52

Nurses Compliance Nursing Homes Compliance Officers 52

Healthcare IT News - Telehealth

DECEMBER 13, 2021

"This forward-looking bill, based on expert, independent recommendations, provides clarity, certainty, and a foundation for building a telemedicine system that expands access, preserves patient choice, and includes basic safeguards against fraud and exploitation," said Doggett. WHY IT MATTERS.

COVID-19 171

COVID-19 Telemedicine Fraud Medicare 171

Healthcare IT News - Telehealth

JULY 16, 2020

Now, the question becomes : How many of those changes, particularly regarding temporary waivers issued by the Centers for Medicare and Medicaid Services, will become permanent? Federal policymakers enacted dozens of changes throughout the crisis to ease access to telehealth. "We anticipate a lot of discussion around that."

COVID-19 183

COVID-19 Medicare Medicare Governance 183

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. government or a government contractor.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

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

MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Compliancy Group

DECEMBER 20, 2024

In May of 2015, the NYPD informed Montefiore Medical Center that there was evidence that patient information had been stolen from the hospitals database – leading Montefiore to investigate and discover that the theft had taken place two years earlier. OCR then proposed a civil monetary penalty of $548,265.

Ransomware 98

Ransomware HIPAA Fraud Electronic Medical Records 98

Healthcare Law Blog

DECEMBER 1, 2023

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released its “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2022 ” (the “Report”), highlighting continued enforcement and recovery actions under the Health Care Fraud and Abuse Control Program (HCFAC).

COVID-19 52

COVID-19 Fraud Telemedicine Medicaid 52

Healthcare Law Blog

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

Medicaid 52

Medicaid Medicaid Compliance Overpayment 52

Innovaare Compliance

JULY 19, 2024

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare Blog

JANUARY 19, 2025

CMS Medicare Swing Bed Rules and Regulations for Critical Access Hospitals (CAHs) Critical Access Hospitals (CAHs) are the backbone of rural healthcare, providing essential services to underserved communities. This flexibility benefits both the hospital and the patient. Prevent fraud and abuse of Medicare funds.

Medicare 52

Medicare Medicare Compliance Nurses 52

MedTrainer

SEPTEMBER 20, 2023

If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Certification.

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Medicaid Medicaid Medicare Medicare 97

Kaiser Health News

NOVEMBER 11, 2021

In response, the Centers for Medicare & Medicaid Services has threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers. She told the woman she had reported the calls to CMS, the AARP Fraud Watch Network Helpline and the FTC.

Medicare 145

Medicare Medicare Doctors Fraud 145

Healthcare IT News - Telehealth

JANUARY 26, 2022

Ain Shams University Virtual Hospital (ASUVH) in Cairo, Egypt, employs a model of care where they reach patients throughout the continent by connecting with local clinics. Further, telehealth providers can help reduce the chance for fraud, waste and abuse by implementing risk-management policies and mechanisms.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

C&M Health Law

APRIL 21, 2022

Department of Justice (DOJ) to resolve allegations that it had made donations in order to improperly inflate the funding four of its hospitals received from the federal Medicaid program. Florida Medicaid is administered by the state but jointly funded by both the state and federal governments.

Medicaid 52

Medicaid Medicaid Governance Fraud 52

Compliancy Group

MAY 15, 2024

As we move deeper into 2024, hospitals must increasingly focus on compliance with regulations set forth by the Office of Inspector General (OIG). This guide outlines the OIG’s hospital compliance priorities and provides actionable advice on ensuring your hospital meets these rigorous standards.

Compliance 52

Compliance Hospitals Fraud Regulatory Compliance 52

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.

Compliance 52

Compliance HIPAA Licensing Governance 52

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The post CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance appeared first on Inovaare.

Fraud 52

Fraud Medicare Medicare Medicaid 52

MedTrainer

AUGUST 8, 2024

In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Fraud, Waste, and Abuse (FWA) Training Fraud, Waste, and Abuse (FWA) training is designed to help healthcare professionals detect, prevent, correct, and report fraudulent, wasteful, and abusive practices within the Medicare system.

Medicare 93

Medicare Medicare Compliance Medicaid 93

Healthcare IT Today

DECEMBER 30, 2024

Bethany Robertson, Clinical Executive at Wolters Kluwer Health During the third quarter of 2024, there were 27 announced hospital mergers and acquisitions, representing $13.3 This API-first approach will be driven by health plans needing to perform with Medicare Advantage and managed Medicaid.

US Department of Health and Human Services 91

US Department of Health and Human Services Nurses Medicare Medicare 91

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicare Medicare Governance 40

Healthcare IT Today

MAY 10, 2022

Contract Enforcements Tie Cybersecurity to Financial Fraud and Liability The receptionist you yelled at for shopping online could turn you in and get a $900,000 reward. When it comes to compliance, ignoring the contracts you sign – including with Medicare and your insurance policies – can hit you really hard and really fast.

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Fraud Medicare Medicare Compliance 115

HIPAA Journal

JULY 4, 2023

As a precaution against identity theft and fraud, affected individuals have been offered 24 months of complimentary credit monitoring services. MMC said it rebuilt its network and has implemented advanced security features to prevent similar breaches in the future, and said the attack appeared not to have resulted in any loss of data.

Medicaid 97

Medicaid Medicaid Health Insurance Licensing 97

Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 52

American Medical Compliance

AUGUST 7, 2024

These regulations protect patient privacy, ensure quality care, and prevent fraud and abuse. CMS (Centers for Medicare & Medicaid Services) These regulations provide essential guidelines for healthcare providers participating in Medicare and Medicaid programs.

Compliance 105

Compliance HIPAA Medicaid Medicaid 105

Healthcare IT Today

FEBRUARY 17, 2023

government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. They expect to recoup 4.7

Overpayment 89

Overpayment Overpayments COVID-19 Medicare 89

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

Fraud 52

Fraud Compliance Medicare Medicare 52

AIHC

SEPTEMBER 25, 2024

There is value in learning from another organization’s lessons publicly posted by a government authority, such as the Department of Justice (DOJ), Centers for Medicare & Medicaid Services (CMS), the HIPAA enforcement agency, the Office of Civil Rights (OCR) or the Federal Bureau of Investigations (FBI).

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Compliancy Group

MAY 27, 2022

The complaint further alleges that the affected patients have suffered anxiety and loss of time and now face a substantial risk of fraud and identity theft due to this data breach. South Shore Hospital (Chicago). The lawsuits allege that the hospital failed to protect patient data adequately. .

HIPAA 98

HIPAA Ransomware Hospitals Health Insurance 98

Hall Render

MARCH 4, 2025

Although liability under the AKS depends in part on a partys intent, it is incumbent on nursing facilities to identify arrangements with referral sources and referral recipients that present a potential for fraud and abuse under the AKS.

Compliance 52

Compliance Nursing Homes Nurses Medicare 52

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Moderated by David S.

Fraud 52

Fraud COVID-19 Compliance Medicaid 52

Healthcare IT Today

AUGUST 14, 2024

Healthcare professionals’ role in collecting and maintaining this data, including providers’ names, practice addresses, office hours, specialties, sanctions and hospital affiliations, is critical but also invaluable. However, much of this provider data has a short shelf life.

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Fraud Hospitals Medicaid Medicaid 80