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This includes verifying education, residency, employment history, malpractice insurance, hospital privileges, and board certifications. It plays a key role in reducing malpractice risks, preventing fraud, and verifying that healthcare professionals have the necessary training and clinical experience to perform their duties.
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. This ensures that medical facilities are not engaging in malpractice and following program rules and regulations.
This includes verifying education, residency, employment history, malpractice insurance, hospital privileges, and board certifications. It plays a key role in reducing malpractice risks, preventing fraud, and verifying that healthcare professionals have the necessary training and clinical experience to perform their duties.
In this quick guide, we’ll explore the importance of including NPDB monitoring in your routine license and exclusion monitoring to protect your organization and the patients you serve from fraud, waste, and abuse. Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S.
Start with quality data As a first step, pre-screening all applicants ensures that only viable applicants are presented to the credentials committee for review. Verisys’ proprietary dataset, Fraud Abuse Control Information System (FACIS) , is the largest and most comprehensive dataset for screening allied health and medical providers.
As you might expect from a federal investigation, conducted by politicians with media present, the tone of the meeting was more hostile rather than supportive. In March 2023, the House Ways and Means Committee hosted an investigative hearing on “private equity’s expanded role in the US healthcare system”.
The lack of multistate licensure presents a barrier to telehealth because providers must obtain and uphold licensure (and the associated medical education and financial obligations) in multiple states. This includes understanding various fraud and abuse laws.
Many healthcare employers utilize FACIS (Fraud Abuse Control Information System), offered by Verisys, to screen for any sanctions, exclusions, or disciplinary actions at the federal and state levels. While essential for ensuring patient safety and regulatory compliance, it often presents several hurdles.
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The goal of this requirement is to eliminate fraud and abuse. For instance, Arizona demands a 10-year history of any sanctions on a provider’s license, while others ask about past malpractice suits. While this may seem straightforward, the implementation is far from simple.
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Apparently, a fraudulent foreign-trained “doctor” treated the plaintiffs, none of whom claimed malpractice or any physical injury whatsoever. The unfortunate truth is that ECFMG was also a victim of this fake doctor’s fraud. Typically overblown MDL claims for “fraud” and “conspiracy” also failed. 4th 259 (3d Cir.
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