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Department of Health and HumanServices aims to protect the integrity of federal healthcare programs, in addition to the health of beneficiaries. "We believe health technology should be used in the service of care to achieve better health and value," said VanLandingham.
As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !
Department of Health and HumanServices works to ensure the integrity of federal healthcare programs and to safeguard the health and welfare of those programs' beneficiaries. And I think it's important for us to recognize that we don't know a whole lot right now.
An ineligible Medicaid provider was arrested in Florida for defrauding Medicaid of more than $68,000. According to a MedicaidFraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application. Update policies as necessary.
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.
million scheme to defraud Medicare by billing for services under another doctor’s name after Medicare revoked his privileges to participate in the program. Once the new business was set up, he continued to bill Medicare for services just as he had prior to his revocation, only now exclusively under the name of his partner.
Attendees will gain valuable insights into health information privacy, healthcare cybersecurity, HIPAA enforcement, and a wealth of information to help them maintain HIPAA compliance and take healthcare data privacy and security to the next level. Jillson, JD – Counsel to the Director, Bureau of Consumer Protection, U.S.
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.
A Massachusetts home health aide, who was licensed as a Certified Nursing Assistant (CNA), has been indicted in connection with a home surveillance video showing her abusing an elderly patient, Attorney General Maura Healey announced. The aide was indicted by a grand jury on two charges of assault and battery on an elder by a caretaker.
It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors? Department of Justice (DOJ), the U.S.
USDepartment of Health and HumanServices (HHS) Office of Inspector General Christi A. Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs.
The Office of Inspector General (OIG) for the USDepartment of Health and HumanServices (HHS) has made educational resources available for healthcare providers to comply with federal healthcare laws and regulations. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.
Board Certified by The Florida Bar in Health Law The USDepartment of Health and HumanServices (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). Indest III, J.D., These subpoenas are very broad, usually requiring the production of thousands of pages of documents.
In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and HumanServices’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaidservices. Increased Telehealth Services.
In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and HumanServices’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaidservices. Increased Telehealth Services.
His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”.
Do your hiring managers and Human Resources colleagues know what to look for? Department of Health and HumanServices Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. Provision of unnecessary or substandard services.
Federal payments for healthcare services account for 28% of all healthcare spending in the United States. Payments from Medicare, Medicaid, TRICARE, CHIP, and other federal programs are a significant source of funds for nearly every healthcare organization and provider. There are two types of OIG exclusions : permissive and mandatory.
Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.
Within the USDepartment of Health and HumanServices (HHS), the Centers for Medicare & MedicaidServices (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.
In order to participate in the Medicare, Medicaid, and all federal healthcare programs once the term of exclusion ends, the individual or entity must apply for reinstatement and receive written notice from OIG that reinstatement has been granted. An individual or entity with a defined period of exclusion (e.g., 5 years, 10 years, etc.)
Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Department of Health & HumanServices ( HHS ).
As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. The Social Security Act establishes rules for reimbursement from Medicare, Medicaid, and CHIP. Reimbursement. Healthcare administration.
Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations. It also reduces waste, fraud, and abuse that threaten the efficiency of healthcare delivery and services. name, phone number).
Dive with us as we explore the complexities and necessities of compliance in the healthcare sector. Health Insurance Portability and Accountability Act (HIPAA) HIPAA is a pivotal regulation that focuses on the protection of patient health information, enforced by the U.S. Department of Health and HumanServices (HHS).
Understanding the OIG Work Plan The OIG Work Plan for physicians and health organizations is a dynamic document that lays out the various audits, reviews, and inspections the OIG intends to conduct in relation to healthcare programs and services within a time frame. HIPAA violations alone are incredibly costly to health providers.
Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.
The Office of Inspector General for the Department of Health and HumanServices is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaidfraud.
The Office of Inspector General for the Department of Health and HumanServices is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaidfraud.
David Gray When President Joe Biden recently declared on national television that “the pandemic is over,” he offered a glimpse into the strategy his administration will be using on COVID-19 going forward: We’re ready to move on. What this means for telehealth and connected health policy.
David Gray When President Joe Biden recently declared on national television that “the pandemic is over,” he offered a glimpse into the strategy his administration will be using on COVID-19 going forward: We’re ready to move on. What this means for telehealth and connected health policy.
County Struggles with Income Affect Social Determinants of Health. HHS puts $90 million toward addressing health disparities through data. Nearly half of rural hospitals lose money on childbirth services. Alabama Medicaid enrollment increases as pandemic requirement continues. CMS Proposes $1.6B
Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.” The result?
Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.” The result?
Amazon Pharmacy partners with health plans for discount drugs. Health Policy Brief: Pandemic-Driven Health Policies To Address Social Needs And Health Equity. HHS putting $35 million toward mental health support for children, young adults. How the PE Nursing Home Crackdown Could Affect the Home Health Industry.
HHS Secretary Outlines FY 2023 Mental Health Investments at Senate Hearing. million in ARP funds to train health workers in local communities. million in ARP funds to train health workers in local communities. Patient generated data can be a key factor in reducing health inequity. HHS is giving $226.5 HHS is giving $226.5
NATIONAL 50% of U.S. to buy property. NATIONAL 50% of U.S. to buy property. NATIONAL 50% of U.S. to buy property. The deal fell through, but that won’t solve Bartlett’s budget issues. Kenai Peninsula Borough Assembly considers $38.5M Kenai Peninsula Borough Assembly considers $38.5M
million loss, scraps 145 positions Health systems lock in acquisitions as year draws to a close Kaiser mental health workers’ strike leaves some patients struggling for care Kaiser Permanente Northern California rated highest for quality care MMCC Arranges $4.7M operating margin in Q3 JLL Arranges $13.4M
4 Health Systems Join Provider-Created Data Collective to Improve Care. Full 4th Circuit to tackle Medicaidfraud standard under False Claims Act. Why asking about social determinants of health is so important. Alabama Women’s Health Center Suffers Data Breach, 34K Impacted. Sanders Capital Partners Completes $12.4
million for rural hospital expansion Hospices in Arizona & other states receive scrutiny over concerns of fraud, waste & abuse Phoenix Children’s Building New 44,000-Square Foot Level IV Neonatal Intensive Care Unit Firefighters oppose Banner’s planned $400M hospital There’s a growing nurse shortage in Arizona.
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