Verisys

AUGUST 31, 2023

Here are seven red flags to look out for and the reasons why: Incomplete or inconsistent application: Missing or conflicting data regarding education, training, work history, licensure, or malpractice history might indicate false information or attempts to conceal relevant details.

Malpractice 52

Malpractice Fraud Medicaid Medicaid 52

Verisys

JULY 20, 2023

This creates the potential for adverse patient outcomes, leading to expensive malpractice lawsuits. However, an even better source is an aggregated dataset such as Verisys’ FACIS (Fraud Abuse Control Information System). Thorough and ongoing provider screening is critical to avoid costly negligent credentialing and malpractice claims.

Due Diligence 52

Due Diligence Malpractice Licensing Hospitals 52

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. The employer may also review any pending and past medical malpractice cases or disciplinary actions. This helps uphold quality healthcare standards and protects against fraud, waste, and abuse.

Licensing 52

Licensing Governance Compliance Fraud 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. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This includes understanding various fraud and abuse laws.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

AIHC

AUGUST 30, 2023

Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM Due to the high volume of fraud schemes involving telemarketing revealed by the Department of Justice (DOJ) over recent years, it is important that providers heed “buyer beware” when engaging with a telemarketing firm. “If If it is too good to be true it probably isn't.”

Compliance 52

Compliance Fraud Medicare Medicare 52

MedTrainer

MARCH 14, 2024

Additionally, the credentialing specialist may request a record of any pending and past medical malpractice cases and disciplinary actions from the appropriate authority. Maintaining compliance helps protect against fraud, waste, and abuse. Upon completion and approval, the provider can begin billing for medical services.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

Verisys

APRIL 27, 2023

Verisys’ proprietary dataset, Fraud Abuse Control Information System (FACIS) , is the largest and most comprehensive dataset for screening allied health and medical providers. As a credentialing verification organization , Verisys has a variety of solutions that can meet your organization’s credentialing needs. With over 5.5

Malpractice 52

Malpractice Licensing Fraud Medicaid 52

Verisys

DECEMBER 5, 2023

The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs. The policy issuer for malpractice insurance verifies insurance coverage. Credentials Verification Organizations to the Rescue?

Governance 52

Governance Licensing Malpractice Medicaid 52

MedTrainer

AUGUST 2, 2023

It involves collecting and reviewing information such as education, training, licensure, certifications, work history, malpractice history, and references — all in pursuit of verifying that providers are who they say they are and qualified to deliver legitimate, safe, and ethical care.

Malpractice 52

Malpractice Due Diligence Compliance Licensing 52

Med Law Blog

MAY 1, 2023

Please note that the potential for ulterior financial motives does not automatically presume that the intent is somehow suspect, in the same way that potential medical malpractice concerns does not legitimately question the clinical motives of all other providers.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

Verisys

MARCH 1, 2022

The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs. The policy issuer for malpractice insurance verifies insurance coverage. Credentials Verification Organizations to the Rescue?

Governance 52

Governance Licensing Malpractice Medicaid 52

Hall Render

MAY 13, 2022

Prism pays $650K to settle Medi-Cal fraud claims filed in San Diego. Judge awards $5 million to NH woman in medical malpractice case. Hospital association sues DHS over pro-union language in Medicaid contracts. Medicaid experts say Utah is hard at work preparing for redeterminations and integrating care under DHHS.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

APRIL 29, 2022

Alabama Medicaid enrollment increases as pandemic requirement continues. California to increase awards in medical malpractice cases. in malpractice case. Doctor overseeing coronavirus testing at BWI accused of health-care fraud. Owners Of Behavioral Health Companies Sentenced For Medicaid Fraud. Here’s why.

COVID-19 40

COVID-19 US Department of Health and Human Services Nursing Homes Nurses 40

Hall Render

DECEMBER 22, 2023

fraud scheme UConn Health is in financial trouble. fraud scheme UConn Health is in financial trouble. health care spending hits $4.5

Nursing Homes 40

Nursing Homes Nurses COVID-19 Hospitals 40

Hall Render

SEPTEMBER 23, 2022

A federal judge schedules a hearing on Florida’s Medicaid transgender rule. million to resolve Medicare fraud claims. Vendor sues to identify mystery owners of shuttered nursing home so it can sue for fraud. fraud scheme. Minnesota health systems doing better financially, but bracing for Medicaid cliff.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

OCTOBER 25, 2024

Million in Tucson Steward Arizona behavioral hospital gets interim manager Former AZ Department of Health employee charged in Medicaid fraud indictment Arizona hospital performs kidney transplant using robotic technology ARKANSAS NIH Director “blown away” by health care efforts in Arkansas Arkansas Gov.

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ biotech mulling sweetened acquisition offer D.C.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

DECEMBER 1, 2023

with more than 5 Magnet designations Four more years: Anthem Blue Cross and Blue Shield, Wellstar re-up contract Hospital fails to dodge $10M malpractice verdict after attempting to pin payment on radiologist New survey reveals insight into Georgia’s maternal health crisis New chief medical officer hired for St.

Nursing Homes 40

Nursing Homes Nurses COVID-19 Ransomware 40

Hall Render

OCTOBER 6, 2023

Tammany Health System create new residency program CHRISTUS nationally recognized for high-quality heart care Behind Ochsner LSU Health’s multimillion-dollar tech upgrades MAINE Millinocket hospital schedules renovation after $3.5M medical school to revamp philanthropic efforts Sage Health opening 3 central Md.

US Department of Health and Human Services 40

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

Hall Render

OCTOBER 6, 2023

Tammany Health System create new residency program CHRISTUS nationally recognized for high-quality heart care Behind Ochsner LSU Health’s multimillion-dollar tech upgrades MAINE Millinocket hospital schedules renovation after $3.5M medical school to revamp philanthropic efforts Sage Health opening 3 central Md.

US Department of Health and Human Services 40

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

Hall Render

JUNE 7, 2024

million bird flu shots to U.S. million bird flu shots to U.S. million bird flu shots to U.S.

US Department of Health and Human Services 40

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

Hall Render

JULY 22, 2022

cancer, cardio lab fraud. Delaware Adds Centene Plan to Medicaid Managed Care Offerings. Key advocates reflect on Hawaii postpartum Medicaid coverage extension. State settles University of Iowa medical malpractice lawsuit for $7.5 Hospital System Says It’s Hurt by Lack of Medicaid Expansion. MISSISSIPPI.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M

US Department of Health and Human Services 40

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

Hall Render

NOVEMBER 27, 2023

11 Plan To Slash $1.5B face growing challenges to stay open KENTUCKY BehaVR merges with New York City-based Fern Health For years, a powerful Louisville hospital sued people for unpaid bills.

US Department of Health and Human Services 40

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

Hall Render

OCTOBER 11, 2024

New mental health clinic in Rexburg accepts Medicaid and Medicare ILLINOIS 3 IL Children’s Hospitals Among Nation’s Best: U.S. NATIONAL 92% Of U.S. Here is what it will involve. billion on hospital acquisitions Wolfson Children’s Hospital ranked among best in 4 specialties, per U.S. Now, it’s against funding clinics missing standards.

US Department of Health and Human Services 40

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

Hall Render

APRIL 14, 2023

But hospitals say they can’t afford to pay California hospital nurses to receive raises of up to 30% California pharmacist pleads guilty to multi-year Medicare fraud scheme Carmichael-based Eskaton pays $5.5

Nursing Homes 40

Nursing Homes US Department of Health and Human Services COVID-19 Nurses 40

Hall Render

NOVEMBER 17, 2023

Million Individuals Affected by MOVEit Hack MARYLAND Adventist HealthCare, Montgomery College form partnership to address need for qualified nursing workforce Harford Memorial Hospital closing set for Feb. million patients stolen during ransomware attack MINNESOTA CFO of the Year 2023: Penny Cermak, HealthPartners Inc. Many more are waiting.

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Hall Render

AUGUST 12, 2022

Doctor loses at least four homes, sentenced to federal prison for healthcare fraud amounting to $38M. million in restitution in complex telemedicine fraud scheme. QC dermatologist to pay $1.66M for fraud claim. Mississippi awards 3 Medicaid contracts. Hospitals holding up NC Medicaid deal, Gov. NORTH CAROLINA.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

DECEMBER 15, 2023

s Vanda Pharmaceuticals pays $100M for commercial rights to Johnson & Johnson company’s drug Hundreds of DC’s Medicaid nursing home patients sent to Maryland Medical facility in DC’s Ward 8 gets $22.5M

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

APRIL 1, 2022

Fraud plagues California’s hospice industry, audit finds. Lawmakers not giving up on bill to expand Medicaid to undocumented kids. Despite malpractice lawsuits, Gainesville hospital stands behind star surgeon. over MassHealth fraud. Rural healthcare providers feel the pain of North Carolina’s “Medicaid gap”.

COVID-19 40

COVID-19 US Department of Health and Human Services Nursing Homes Nurses 40

Hall Render

SEPTEMBER 27, 2024

Jaya Raj fosters relatable health care ARKANSAS 5 ASC legal cases, controversies in 1 month UAMS Report Shows Financials Improved in Fiscal Year 2023 Clinical Transaction Checks In at $1.5M Million Settlement with L.A. Million Settlement with L.A. headcount among top 10 biopharma employers shrinks New Mass.

Nurses 40

Nurses Hospitals Nursing Homes Medicare 40

Hall Render

MARCH 17, 2023

Francis Hospital-Interquest Progresses In Colorado Colorado’s wealthiest hospitals favored in $1.2 in Indiana aging-in-place work.

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nursing Homes Nurses 40

Hall Render

MARCH 3, 2023

Businesses set to profit from medical marijuana in Mississippi Missouri, Mississippi Advance Bills To Expand Postpartum Medicaid Benefits MISSOURI Missouri, Mississippi Advance Bills To Expand Postpartum Medicaid Benefits Missouri congressman seeks a lifeline for rural hospitals New St.

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

NOVEMBER 11, 2022

Supreme Court Weighs Whether Medicaid Residents Can Sue State-Owned Nursing Homes. Arkansas governor announces rural health coverage with Medicaid program. CMS Approves Arkansas Medicaid Waiver to Address SDOH. Supreme Court to hear Indiana nursing home case involving Medicaid benefits. attorney general urges HCA probe.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes COVID-19 Nurses 40

Hall Render

JANUARY 19, 2024

Francis emergency room KENTUCKY Apollo’s 220-hospital ‘stranglehold’ harms patients and workers, report alleges Humana cuts ‘small’ number of jobs in multiple locations LMU School of Nursing will open Lexington site at CHI Saint Joseph Health Mercy Health announces acquisition of orthopedic center in Paducah, Ky.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

FEBRUARY 24, 2023

Dunleavy adds $9M to budget to address food stamp, Medicaid backlog New study provides snapshot of increase in maternal deaths in Alaska Mental Health Trust Grants $1.6M Dunleavy adds $9M to budget to address food stamp, Medicaid backlog New study provides snapshot of increase in maternal deaths in Alaska Mental Health Trust Grants $1.6M

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

NOVEMBER 10, 2023

California physician convicted of healthcare fraud, kickbacks California’s healthcare minimum wage boost to cost $4B City Council upholds approval of Hollywood Presbyterian medical offices at 1321 N. Will it survive the next few years?

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40