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Fraud, Waste, and Abuse

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Healthcare Fraud, Waste, and Abuse by the Numbers

July 2017 marked the largest healthcare fraud takedown in history. We're bringing you more details about the takedown and important information about the hotline that helped make it happen.

DOJ’s Commitment to Holding Executives Accountable for Healthcare Fraud

Last year, the Department of Justice (DOJ) released a policy memorandum, titled “Individual Accountability for Corporate Wrongdoing,” also known as the “Yates Memo." The DOJ shifted its approach to fighting corporate fraud and misconduct by focusing its investigative efforts on those individuals within a corporation who perpetrated wrongdoing. The policy guidelines were discussed in this

Penalties Doubled in August 2016: False Claims Act and OSHA

August 2016 was an important month, with penalties increasing for violations of the False Claims Act and OSHA. Review our infographic to familiarize yourself with the changes.   As of August 1st, 2016, there are new penalties for the False Claims Act.  The Department of Justice will nearly double the statutory penalties under the False Claims

Exposed: National Health Care Fraud Takedown 2016

In light of the historic health care fraud takedown announced by the DOJ and OIG on June 22nd, we've put together an infographic highlighting the important facts.

Risk Score Fraud in Medicare Advantage Plans

Medicare Advantage (MA) plans may be doing just what the name says- taking advantage of Medicare.  It is highly unlikely that this was the intention in 2003 when MA plans were created by nongovernment entities using a capitated managed care reimbursement approach. The amount of Medicare reimbursement to the MA plan is fixed and calculated

CMS Enrollment Screening Will Prioritize Fraud Prevention

Protecting the integrity of the Medicare program is a top priority.  Fortunately, the Affordable Care Act has allotted significant funding for task forces to root out fraud, waste and abuse. Up until now, the task forces have focused recovery efforts on funds already paid to the providers and suppliers.  The new focus is on prevention

Stark Law and Strict Liability

The genesis of the Stark Law, also known as the Physician Self-Referral Law [42 U.S.C. § 1395nn], occurred in 1988 when a congressman named Pete Stark proposed the law to prevent medical doctors from sending Medicare and Medicaid patients to any healthcare entity to which the doctor, or an immediate family member, has a financial

Overpayments: Reporting and Returning Deadline

The long awaited ruling on reporting and returning overpayments is now in the Federal Register and will become effective on March 14, 2016. As stated in §401.303, an overpayment is any fund that a person has received or retained under Title XVIII of the Social Security Act to which the person, after applicable reconciliation, is

Compliance Program: What is the Value?

The value placed on a compliance program varies greatly with perspective and remains difficult to define. Obviously, the purpose of a compliance program is to prevent and deter wrongdoing. A strong program preempts problems. However, it is difficult to know what might happen in the future or what could have gone wrong in the past.

Jumpstart Your Compliance Program

The beginning of the New Year is a popular time for new initiatives. Many healthcare organizations are looking for ways to improve quality and reduce risk. A compliance program is an effective way to detect, deter and prevent wrongdoing in the healthcare setting and an ongoing system assures conformity with governing laws and regulations. An