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

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

Medicare covers many telebehavioral and telemental health services including audio-only services. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This includes understanding various fraud and abuse laws. This is also called “store-and-forward telemedicine.”

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

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. Government watchdog: Health care giants improperly denied Medicare benefits. 50 doctors urge Schrader to allow Medicare to negotiate drug prices, cease ‘false’ ads. CALIFORNIA.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

APRIL 29, 2022

Hospitals sue HHS over Medicare billing calculation. Permanent telehealth expansion could cost Medicare $25B over 1 decade. California to increase awards in medical malpractice cases. in malpractice case. Doctor overseeing coronavirus testing at BWI accused of health-care fraud. Will hospitalizations follow?

COVID-19 40

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

Hall Render

OCTOBER 25, 2024

Humana sues to reverse cut to Medicare Advantage ratings Karen Lynch steps down as CVS Health CEO Nursing home survey teams don’t always have to include nurses: federal appeals court Senate report: How private equity ‘gutted’ dozens of U.S. health care company acquires three Del.

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Hall Render

OCTOBER 6, 2023

Mary’s ‘modernization’ project UChicago Medicine AdventHealth Bolingbrook Hospital Names New CFO Nurses asks lawmakers for staffing mandates, hospital leaders disagree Loyola Medicine Burr Ridge outpatient medical center trades for $59.95

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

Mary’s ‘modernization’ project UChicago Medicine AdventHealth Bolingbrook Hospital Names New CFO Nurses asks lawmakers for staffing mandates, hospital leaders disagree Loyola Medicine Burr Ridge outpatient medical center trades for $59.95

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 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.’ million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

SEPTEMBER 23, 2022

Colorado senior-care company pauses expansion into Indiana after Medicare audit. million to resolve Medicare fraud claims. Colorado senior-care company pauses expansion into Indiana after Medicare audit. Vendor sues to identify mystery owners of shuttered nursing home so it can sue for fraud. fraud scheme.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

DECEMBER 22, 2023

fraud scheme UConn Health is in financial trouble. health care spending hits $4.5 approval for obstetrics services in Prince George’s County Maryland health system gets state OK for $300M labor, delivery unit Maryland hospitals must pay back millions to poor patients.

Nursing Homes 40

Nursing Homes Nurses COVID-19 Hospitals 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

JUNE 7, 2024

facility Southern Research CEO talks biotech incubator, future of Birmingham medicine ALASKA Juneau’s hospital is bleeding cash. 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

CMS releases Medicare OPPS and ASC proposed rule. cancer, cardio lab fraud. Long Beach Memorial avoids losing Medicare funding after serious patient care lapses. State settles University of Iowa medical malpractice lawsuit for $7.5 10 procedures CMS proposes moving off the inpatient-only list in 2023. CMS proposes 2.7%

COVID-19 40

COVID-19 Nursing Homes Nurses 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. 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

NOVEMBER 27, 2023

Mary’s Hospital accused of negligence and medical malpractice in wrongful death suit. 11 Plan To Slash $1.5B 11 Plan To Slash $1.5B Louis health system strikes deal with southeast Missouri provider St. renovation St.

US Department of Health and Human Services 40

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

Hall Render

JUNE 30, 2023

MedStar Transport Celebrates 40 years of service C.

US Department of Health and Human Services 40

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

Hall Render

NOVEMBER 17, 2023

million Staff shortages hit Medicare Advantage stars, Kaiser exec says Sutter Health slips to 0.1% million Staff shortages hit Medicare Advantage stars, Kaiser exec says Sutter Health slips to 0.1% million patients stolen during ransomware attack MINNESOTA CFO of the Year 2023: Penny Cermak, HealthPartners Inc.

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 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 Nurses COVID-19 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. 5 Things Hawaii: COVID testing profits, Nursing workforce, Medicare physician fees. million over allegations it defrauded Medicare. HHS Awards Over $3.1

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 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

APRIL 1, 2022

Fraud plagues California’s hospice industry, audit finds. Despite malpractice lawsuits, Gainesville hospital stands behind star surgeon. Court sides with HHS in Indiana hospitals’ challenge to Medicare payment calculation. over MassHealth fraud. California nurses begin strike. But they can’t afford it forever.

COVID-19 40

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

Hall Render

DECEMBER 15, 2023

Fitch Revises Outlook on Dartmouth-Hitchcock Health (NH) to Negative; Affirms IDR and Revs at ‘A’ NEW JERSEY 2 nurses, medical resident injured in attack at New Jersey hospital, authorities say New Jersey man convicted in $4M fraud scheme NJ hospitals make progress after crippling cyberattacks According to U.S.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

MARCH 17, 2023

‘Not what we were looking for,’ CEO says Fired CEO files slander, defamation suit against Scotland County Hospital Missouri health system appoints strategy chief Missouri physician pleads guilty to $537K Medicare fraud scheme New Behavioral Health Crisis Center Open in Cape Girardeau St. Roy Cooper’s $32.9

US Department of Health and Human Services 40

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

Hall Render

NOVEMBER 11, 2022

Physician leaders balk at Medicare 4.48% physician fee cut. Bright Health exiting Florida Medicare Advantage market. After record-breaking malpractice award, Coralville clinic files for bankruptcy. Duke LifePoint hospital at risk of losing its Medicare contract — again. Indiana Health Systems Join Forces to get REaL Data.

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

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 3, 2023

million for youth mental health care KENTUCKY Pike County nursing home officials release statement following loss of Medicare agreement Three Humana executives drop $11.2M

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

Hall Render

FEBRUARY 24, 2023

medical workers 4 takeaways from Braselton hospital expansion presentation HAWAII Hawaii Gov. Staff shortages could spur next public health crisis, Baystate Health CEO warns CommonSpirit, Mass General, Moffitt execs to judge telehealth challenge Brigham and Women’s, AI company get $2.5M

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

MAY 26, 2023

Anthony’s Hospital celebrates expansion, renovation project milestone ‘Our voices weren’t being heard’: COVID-19 restrictions rolled back in Metro nursing home Nebraska lawmakers send $10.7

Nursing Homes 40

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