First Healthcare Compliance hosted an informative webinar with Cristina Loayza, Product Manager of Precheck, titled “What Healthcare Employers Should Know About Exclusion Screening.” Click here to view the webinar. As a recap, Cristina Loayza answers the three most common questions regarding exclusion screening. Q: What is exclusion screening? Healthcare service providers who receive federal healthcare funds
Protecting patients and promoting quality in healthcare are generally accepted goals for providers and employers. However, even with the positive purpose and intent behind exclusion screening, complicated decisions must be made to achieve appropriate allocation of resources. Stakes are high due to the potential impact on patient care, individual employees, and the entire organization, so
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.
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
Having a compliance program in place is a start but having an effective compliance program is the goal. Proactively assessing the effectiveness of one’s own compliance program is better than the Department of Justice making a determination of the adequacy as a result of an investigation for alleged misconduct. To set benchmarks for an effective
Health care fraud recoveries for fiscal years 2009- 2014 exceeded previous records with five straight years of more than $2 billion in annual recovery from cases involving fraud and false claims against federal health care programs such as Medicare and Medicaid. Most healthcare providers are aware of significant civil liability due to recent enforcement. However,
The Exclusions Statute is one of five major federal fraud and abuse laws. Exclusion is an administrative remedy that is in the form of a penalty imposed on a provider. You may have never heard of it or have only recently become aware of it, but Congress first mandated exclusion of practitioners convicted of program
According to the OIG’s “Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse”, the OIG is legally required to exclude individuals and entities from all Federal healthcare programs who have been convicted of the following criminal offenses: 1. Medicare or Medicaid fraud or offenses related to delivery of items or services under Medicare