MedTrainer

JANUARY 21, 2025

Understanding the OIG Exclusion List The OIG maintains the List of Excluded Individuals/Entities (LEIE), which provides comprehensive information to the healthcare industry on those currently excluded from participating in Medicare, Medicaid, and any other federal healthcare programs.

Compliance 52

Compliance Fraud Regulatory Compliance Medicare 52

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. organizations that receive any funds from Medicare, Medicaid, TRICARE, or other federal programs cannot afford to employ individuals or entities excluded from even one program. Medicare opt out.

Medicare 52

Medicare Medicare Regulatory Compliance Medicaid 52

Compliancy Group

OCTOBER 16, 2024

Some compliance officers turn to free resources like the Department of Health and Human Services (HHS) risk assessment tool to assess their organizational compliance and risk, while others use spreadsheets or software. Risk management refers to identifying, avoiding, and mitigating the factors contributing to healthcare non-compliance.

Compliance 52

Compliance Compliance Officers Fraud Regulatory Compliance 52

MedTrainer

JULY 29, 2024

These tools make it easier for healthcare organizations to maintain a culture of compliance, adapt to evolving industry standards, and ensure that all staff members are consistently informed and compliant. Corporate Compliance vs. Regulatory Compliance Corporate compliance and regulatory compliance are not the same thing.

Compliance 52

Compliance US Department of Health and Human Services Regulatory Compliance Compliance Officers 52

Total Medical ComplianceHIPAA

JANUARY 11, 2024

These screenings search through various databases containing records of individuals or organizations barred from participating in Medicaid, Medicare, or other federal/state healthcare programs due to fraud, abuse, or other offenses. Why is Sanction Screening Vital Under HIPAA?

HIPAA 52

HIPAA Malpractice Regulatory Compliance Compliance 52

Compliancy Group

MAY 15, 2024

The healthcare landscape is fraught with complexities, and staying compliant involves understanding the OIG’s specific targets for hospital audits and crafting your OIG compliance program for your hospital with those in mind. Billing Integrity Hospitals must ensure that all billing practices adhere to federal laws and regulations.

Compliance 52

Compliance Hospitals Fraud Regulatory Compliance 52

MedTrainer

AUGUST 30, 2023

Medicare Advantage (Part C). Medicare Advantage plans are managed care plans offered by private insurance companies as an alternative to traditional Medicare (Parts A and B). Some key compliance elements for managed care organizations include: Legal and Regulatory Compliance. Quality of Care Standards.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Verisys

JANUARY 8, 2024

This type of audit is essential in the healthcare industry for several reasons: Regulatory Compliance It ensures that the healthcare organization complies with various federal and state laws and regulations. Compliance with state-specific healthcare laws and regulations is also assessed.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes are significant and will have a major impact on Medicare and Medicaid plans. Plans will be required to provide more information about their quality improvement activities.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

MedTrainer

FEBRUARY 1, 2024

A corporate compliance program in healthcare is a comprehensive set of policies, procedures, and practices that healthcare organizations establish and maintain to ensure that they operate compliant with all applicable laws, regulations, and ethical standards. Why do healthcare facilities use corporate compliance programs?

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

Compliancy Group

JANUARY 17, 2024

The OIG Work Plan, sometimes referred to as “the Work Plan” or “the Plan,” is an essential tool in securing and maintaining healthcare regulatory compliance for patient safety, privacy, and quality care. OIG in healthcare , functioning as an arm of the U.S.

US Department of Health and Human Services 52

US Department of Health and Human Services Regulatory Compliance Compliance Regulations Compliance 52

Compliancy Group

OCTOBER 4, 2024

Maintaining the security and integrity of sensitive information and preventing waste, fraud, and abuse is essential to quality healthcare and promoting workplace safety. We also discuss how compliance software can help ensure regulatory compliance and maximize efficiency and accuracy in all your compliance activities.

Compliance Officers 59

Compliance Officers Compliance Regulatory Compliance Fraud 59

Healthcare IT Today

JUNE 29, 2023

However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid. ASCs must also meet Medicare’s Conditions for Coverage.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

Verisys

DECEMBER 29, 2024

Healthcare organizations and insurance companies rely on credentialing to ensure patient safety, regulatory compliance, and minimize liability risks. Without proper credentialing, physicians cannot apply for privileges, bill for services, or receive reimbursement from Medicare and other payers.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

Verisys

FEBRUARY 14, 2024

Mitigating Provider Risk: Verisys’ solutions, such as FACIS® (Fraud Abuse Control Information System) , provide in-depth screening and continuous monitoring of healthcare professionals against the largest dataset of disciplinary actions and exclusions. How does Verisys help with healthcare compliance?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

MedTrainer

NOVEMBER 2, 2023

Most compliance officers possess a bachelor’s degree, often in healthcare administration, law, or a related field. Additionally, hands-on experience in healthcare or regulatory compliance provides a foundation for this role.

Compliance Officers 52

Compliance Officers Compliance HIPAA Regulatory Compliance 52

Florida Health Care Law Firm

DECEMBER 2, 2021

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The OIG recognized that there are benefits to disclose potential fraud.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40

Florida Health Care Law Firm

FEBRUARY 22, 2022

In yet another take-down of an illicit scheme to defraud the Medicare Program and ChampVA, as well as other insurers, Patsy Truglia has been sentenced to 15 years in federal prison. He has also had assets forfeited since these assets were acquired with money from his ill-gotten fraud scheme. million being paid to Truglia and company.

Telemedicine 40

Telemedicine Medicare Medicare Fraud 40

Health Care Law Brief

APRIL 11, 2022

Notwithstanding these streams of remuneration taking the form of cash equivalents and not being protected by an AKS regulatory safe harbor or by an exception to the Beneficiary Inducements CMP, the OIG still concluded that the Arrangement presented a minimal risk of fraud and abuse based on a totality of the underlying facts and circumstances.

Fraud 52

Fraud Medicare Medicare Compliance 52

Hall Render

NOVEMBER 25, 2024

Quality of Care and Quality of Life OIG identified that beyond the Requirements of Participation for Long Term Care Facilities in 42 CFR 483 , the failure to provide quality care and promote quality of life poses a risk of fraud and abuse for nursing facilities. Competency-Based Training.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Health Care Law Brief

JUNE 2, 2022

Similarly, with respect to Medicare, Congress extended certain Medicare telehealth flexibilities for 151 days following the conclusion of the PHE, as part of the Fiscal Year 2022 Omnibus appropriations bill. If so, how will patient fees be structured to comport with these restrictions? Provider Licenses.

Public Health 52

Public Health Compliance COVID-19 Licensing 52

MedTrainer

AUGUST 2, 2023

Listen to a candid discussion on lessons learned from the 2023 federal investigation that uncovered fraudulent medical practice nationwide in this on-demand webinar: Moving Forward From the Nursing Fraud Scheme.

Malpractice 52

Malpractice Due Diligence Compliance Licensing 52

AIHC

MAY 30, 2024

Advancing RCM Operations Every year, more than five billion medical claims are processed by Payers in the United States for reimbursement, according to the Centers for Medicare & Medicaid Service, CMS.gov. Compliance and Risk Management : Fraud Detection : AI systems can identify unusual patterns that may indicate fraudulent activities.

Compliance 52

Compliance HIPAA Regulatory Compliance Medical Billing 52

Health Care Law Brief

NOVEMBER 30, 2021

However, the OIG noted that bona fide employment in which a professional reassigns billing rights in exchange for compensation is “a commonplace practice in the health care industry, explicitly authorized by … the Medicare program.”

Medicare 40

Medicare Medicare Regulatory Compliance Fraud 40

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

HIT Consultant

DECEMBER 6, 2022

trillion Consolidated Appropriations Act of 2022, which extended Medicare coverage related to telemedicine practices. As within many areas of health care, however, expansion and innovation contributed to a higher risk of fraud and resulted in an increase in enforcement activity.

Compliance 98

Compliance COVID-19 Medicaid Medicaid 98

Health Care Law Brief

MARCH 8, 2022

On February 24, 2022, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), announced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, which will begin January 1, 2023, and replace the Global and Professional Direct Contracting (GPDC) Model.

Medicare 52

Medicare Medicare Fraud Compliance 52

MedTrainer

JANUARY 16, 2025

MedTrainer Live: Upcoming NCQA Credentialing Changes Watch Now DEA Registrant Validation: In 2024, the DEA changed registrant validation to avoid fraud. This will include expiration date tracking, shorter verification times, and expanded exclusions to include SAM.gov and are all required every 30 days.

Compliance 52

Compliance Regulatory Compliance COVID-19 HIPAA 52

Drug & Device Law

DECEMBER 29, 2023

2023) (rejecting any express anti-preemption presumption in Medicare case) ( here ); Baker v. 2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. Negligence requires an evaluation of a defendant’s reasonableness, and all relevant NC authority includes relevant regulatory compliance in that mix.

FDA 105

FDA US Department of Health and Human Services COVID-19 COVID-19 Vaccine 105