Remove Fraud Remove Licensing Remove Regulatory Compliance
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2024 DOJ False Claims Act Settlements in Healthcare Recover $1.67B

Compliancy Group

A classic example is Medicare fraud. Providers who bill Medicare for services they did not actually provide and who present the bill with the knowledge that the service was not performed have committed Medicare fraud. The DOJ has focused much of its anti-fraud efforts on pursuing these cases, litigating several of them in 2024.

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The Role of AI in Healthcare Compliance

Verisys

What Is AI in Healthcare Compliance? Imagine having a tireless assistant who handles the nitty-gritty of regulatory compliance so healthcare teams can focus on what matters mostpatient care and privacy. AI in healthcare compliance taps into the power of machine learning, natural language processing, and automation.

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What Is Physician Credentialing?

Verisys

Healthcare organizations and insurance companies rely on credentialing to ensure patient safety, regulatory compliance, and minimize liability risks. Primary Source Verification Healthcare organizations contact educational institutions, licensing boards, and past employers to verify the accuracy of submitted documents.

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A Guide to the National Practitioner Data Bank (NPDB)

Verisys

As a centralized hub of critical practitioner data, the NPDB serves as a powerful ally in provider credentialing , helping hospitals, medical boards, and institutions verify backgrounds, track malpractice claims, and ensure regulatory compliance. What Is the National Practitioner Data Bank (NPDB)?

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Best Practices for Continuous OIG Exclusion List Monitoring in Healthcare

MedTrainer

Mandatory exclusions result from serious convictions, including Medicare fraud, patient abuse, and felony healthcare fraud. Permissive exclusions stem from less severe violations, such as defaulting on student loans or losing a healthcare license. The impact extends to organizational reputation and stakeholder relationships.

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Streamlining Nurse Credentialing Processes

Verisys

By thoroughly evaluating a nurse’s credentials, healthcare organizations can: Minimize the risk of medical errors Ensure compliance with regulatory requirements Maintain a high level of patient trust Credentialing also serves as a mechanism for ongoing professional development.

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What is FACIS and Why is it the Gold Standard

Verisys

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. Excluded from one means excluded from all, and the fines for non-compliance will likely be in the hundreds of thousands. License Verification & Monitoring. Credentialing.