AIHC

FEBRUARY 17, 2025

When Audit Managers Knowingly Skew Audit Results Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. on fraud detection and prevention in healthcare.

Fraud 52

Fraud Compliance Overpayments Overpayment 52

Healthcare IT News - Telehealth

SEPTEMBER 27, 2021

The brief, which examined oversight efforts as of January and February 2020, stemmed from a survey of Medicaid directors from 37 states, as well as structured interviews with relevant stakeholders. Conduct monitoring for fraud, waste and abuse, and support state efforts to oversee telehealth for behavioral health services.

COVID-19 215

COVID-19 Fraud Medicaid Medicaid 215

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4 million, and $6.4

Medicaid 102

Medicaid Medicaid Medicare Medicare 102

Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

Fraud 98

Fraud Nurses Medicare Medicare 98

American Medical Compliance

JUNE 21, 2024

The Department of Health and Human Services (HHS) estimated that improper payments in the Medicare and Medicaid programs exceeded $100 billion from 2016 to 2023. Unlike fraud, waste is not necessarily intentional but results from inefficiencies.

Fraud 105

Fraud Compliance Medicaid Medicaid 105

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. Why Are Medicare Swing Bed Rules So Important to Follow? Prevent fraud and abuse of Medicare funds.

Medicare 52

Medicare Medicare Compliance Nurses 52

HIPAA Journal

APRIL 27, 2023

The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.

Medicare 114

Medicare Medicare Medicaid Medicaid 114

MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

Medicare 93

Medicare Medicare Compliance Medicaid 93

Compliancy Group

APRIL 25, 2024

Maintaining Medicare compliance and avoiding legal and financial repercussions requires Medicare compliance training for employees at all organizational levels. Examples of Medicare fraud include billing for unrendered services and using a billing code or a service that’s more expensive than what a patient received.

Fraud 59

Fraud Medicare Medicare Compliance 59

HIT Consultant

OCTOBER 18, 2021

Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud. The second type, indirect fraud, involves several bad actors that coordinate their efforts.

Fraud 98

Fraud COVID-19 Public Health Medicare 98

Fierce Healthcare

APRIL 11, 2024

Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid Services (CMS) said Thursday that the | Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid (..)

Fraud 112

Fraud Medicaid Medicaid Medicare 112

HIPAA Journal

MARCH 6, 2023

The Department of Justice has announced one of its first prosecutions under the Medicare Access and CHIP Reauthorization Act of 2015 in a case involving the theft and sale of Medicare Beneficiary Identifiers. MACRA also made it illegal to buy, sell, or distribute Medicare Beneficiary Identifiers without proper authority.

Medicare 103

Medicare Medicare Fraud Medicaid 103

Health Law Checkup

JANUARY 20, 2022

Can a whistleblower successfully allege Medicaid/Medicare fraud if the whistleblower lacked direct access to records related to the alleged fraud? While the appellate circuits are still split on this issue, we look at recent decisions that indicate a possible shift in the Seventh Circuit’s pleading standard.

Fraud 95

Fraud Medicaid Medicaid Medicare 95

Fierce Healthcare

OCTOBER 4, 2024

A proposed rule from the Centers for Medicare & Medicaid Services (CMS) released Oct. | CMS is looking to shake up the risk adjustment model and wants the ability to suspend shady brokers from the insurance marketplace, the agency wrote among other updates in a new proposed rule.

Fraud 105

Fraud Medicaid Medicaid Medicare 105

American Medical Compliance

OCTOBER 25, 2024

Audits serve as a critical defense against fraud and inefficiency while fostering trust in your practice. It could target several key areas, such as patient privacy and security to ensure compliance with HIPAA guidelines, or billing and coding accuracy to prevent fraud and abuse under CMS regulations.

Compliance 105

Compliance Fraud HIPAA Compliance Framework 105

Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. To avoid running afoul of potential civil or criminal liability, organizations must ensure that Medicare claim reporting is accurate.

Fraud 52

Fraud Compliance Medicare Medicare 52

Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Hall Render

MARCH 11, 2025

Background Following a whistleblower lawsuit alleging fraudulent Medicare billing, a jury found that HCAT submitted 21,844 false claims, causing $2,753,641.86 Government fraud enforcement remains aggressive : Despite this ruling, health care providers should continue prioritizing compliance with Medicare and Medicaid billing regulations.

Medicare 52

Medicare Medicare Governance Fraud 52

Medisys Compliance

JANUARY 16, 2025

The Centers for Medicare & Medicaid Services (CMS) provides comprehensive behavioral health billing guidelines, which can be overwhelming due to their technical nature and breadth. Providers must ensure that these services meet Medicares criteria for medical necessity.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Fraud 59

Healthcare IT News - Telehealth

DECEMBER 13, 2021

The bill, the Telehealth Extension Act , would also end geographic and site restrictions on approved telemedicine services for Medicare beneficiaries. Despite being broadly popular on both sides of the aisle , the geographic- and site-related Medicare provisions the new bill would establish have yet to be enshrined by Congress.

COVID-19 171

COVID-19 Telemedicine Fraud Medicare 171

Healthcare IT News - Telehealth

AUGUST 11, 2021

Andrew Vanlandingham, senior counselor for Medicaid Policy and acting health IT lead at OIG, called attention to recent revisions to safe harbors under the Anti-Kickback Statute and Civil Monetary Penalty Rules around coordinated care. They're not submitting a telehealth claim to Medicare. billion, with a B, of alleged fraud.

US Department of Health and Human Services 167

US Department of Health and Human Services Fraud Medicare Medicare 167

Healthcare IT News - Telehealth

JULY 2, 2020

Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma to provide a written plan for permanent changes to Medicare, Medicaid and Children’s Health Insurance Program rules around telehealth.

COVID-19 180

COVID-19 Medicare Medicare Medicaid 180

Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). for every $1 spent How ProviderTrust Can Help With nearly 80 million individuals covered by Medicaid, every data point counts.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

Compliancy Group

OCTOBER 28, 2024

Health and Human Services (HHS) Department’s efforts to eliminate fraud, waste, and abuse. Its compliance program guidance (CPG) has improved the efficiency and effectiveness of Medicare and many other federal programs. Established in 1976, the Office of Inspector General (OIG) has led the U.S.

Nurses 52

Nurses Compliance Nursing Homes Compliance Officers 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

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? Among other provisions, the act would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare.

COVID-19 179

COVID-19 Medicare Medicare Governance 179

Electronic Health Reporter

OCTOBER 6, 2022

The Centers for Medicare and Medicaid Services (CMS) has made no secret of its intentions to crack down on fraud, abuse, and waste, throwing more budget dollars into audits, heightening program […]. This article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited.

Fraud 113

Fraud Medicaid Medicaid Medicare 113

Compliancy Group

NOVEMBER 1, 2024

When you work in healthcare, you must comply with the most rigorous regulations that safeguard patient health and privacy, protect workers, and prevent fraud, waste, and abuse of federal funds. Anyone in this industry should know the healthcare compliance laws and regulations that guide how they do their jobs and provide quality care.

Compliance 52

Compliance HIPAA Electronic Medical Records Fraud 52

Compliancy Group

FEBRUARY 5, 2025

The individuals and entities on the list are excluded from participation in federal healthcare programs because they have committed a crime, such as Medicare or Medicaid fraud, or have engaged in other misconduct. States maintain their own exclusion lists for their Medicaid programs.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Modern Healthcare

JULY 28, 2023

The Centers for Medicare and Medicaid Services gave hospice providers a reimbursement bump for next year, along with a warning about fraud and waste.

Medicare 69

Medicare Medicare Fraud Medicaid 69

Kaiser Health News

NOVEMBER 11, 2021

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. “You’re not from Medicare,” Heimer told her.

Medicare 145

Medicare Medicare Doctors Fraud 145

Healthcare IT Today

OCTOBER 22, 2020

The US Department of Justice has filed charges against 345 defendants, including more than 100 medical professionals, accusing them of engaging in healthcare fraud schemes. The […].

Fraud 86

Fraud COVID-19 Medicaid Medicaid 86

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 IT News - Telehealth

SEPTEMBER 2, 2021

Department of Justice announced this week that a Florida laboratory owner had pleaded guilty for his role in a $73 million Medicare kickback scheme. Although these changes were intended to safeguard access to care for Medicare beneficiaries, DOJ says some fraudsters have used them for their own benefit. THE LARGER TREND. ON THE RECORD.

COVID-19 165

COVID-19 Medicare Medicare Public Health 165

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. The psychologist was convicted of four counts of healthcare fraud.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52