Fraud, Waste, and Abuse

fraud waste abuse healthcare compliance

FWA in Healthcare: How to Respond Appropriately to Detected Offenses

Fraud, Waste, and Abuse (FWA) can have serious implications for the healthcare industry, affecting patient care, financial stability, and organizational integrity. Detecting and responding to FWA offenses promptly and appropriately is essential to protect the well-being of patients, uphold ethical standards, and maintain regulatory compliance.

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Unlock the power of employee hotlines: How to create a culture of compliance, transparency, and accountability in healthcare.

Discover the potential of employee hotlines in fostering a culture of compliance, transparency, and accountability within healthcare organizations. Our latest blog delves into the essential questions surrounding employee hotlines, discussing their significance, benefits, and best practices for successful implementation.

Exclusion Screening Requirements for Healthcare Entities: Ensuring Compliance and Protecting Your Organization

Exclusion Screening Requirements for Healthcare Entities: Ensuring Compliance and Protecting Your Organization

One crucial aspect healthcare entities must prioritize in the ever-evolving landscape of healthcare regulations is exclusion screening, which is the process of checking individuals and entities against various exclusion lists to ensure compliance with federal and state regulations. Failing to comply with these requirements can have serious consequences for your organization. Read on to explore the importance of exclusion screening, its benefits, and how partnering with the right experts can help you navigate this critical aspect of healthcare compliance.

Healthcare Assets – How to Preserve and Protect

1st Talk Compliance features attorneys Sean McKenna, Lauren Nelson, and Vincent Aiello of Spencer Fane LLP, on the topic of Healthcare Assets: How to Preserve and Protect. We will discuss the interplay between enforcement and liability proceedings with asset protection, explore how government and private litigation matters can impact healthcare companies, clinicians, and executives, and provide tips and preventative strategies to preserve income and assets prior to such action to ensure business continuity and succession planning. 

FCA - what you need to know

False Claims Act “Hot Areas” – What You Need to Know: Audio Version of the Webinar

Expert presenter, Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX guides us through current trends and tips.
With its roots stemming back to 1863, the False Claims Act continues to be the U.S. Department of Justice’s primary enforcement tool for returning money to the Federal Treasury. It is also considered one of five fundamental fraud, waste, and abuse laws, which potentially impact a provider every time a claim is submitted to Medicare, Medicaid, and other government programs because of the attestation language. The purpose of this webinar is to provide a synopsis of the False Claims Act and the current landscape in relation to coverage determinations and the federal Anti-Kickback Statute.

A Practical Approach to The Safe Harbor Law

1st Talk Compliance features guest Raymond Ribble, CEO and Founder at SPHER, Inc., on the topic of A Practical Approach to The Safe Harbor Law. Ray joins our host Catherine Short to discuss how HIPAA data breach penalties typically get measured in millions of dollars, even following an organization implementing NIST cybersecurity framework measures. However, with the new HIPAA Safe Harbor Law, signed in January 2021, HHS and OCR may consider some penalty mitigation. It is important to understand that the Safe Harbor Law, while offering substantial protection, does not provide a true safe harbor and only offers some protection. This episode will examine what the established security practices for healthcare are, and how to pivot your organization’s security profile to mitigate breach penalties if an event occurs.

Safe Harbor Law 2023

The Safe Harbor Law: A Practical Approach – Audio Version of the Webinar

Raymond Ribble is the CEO and Founder at SPHER, Inc. HIPAA data breach penalties typically get measured in millions of dollars even following an organization implementing NIST cybersecurity framework measures. It is important to understand that the Safe Harbor Law, while offering substantial protection, does not provide a true safe harbor. Our presentation will examine what are the established security practices for healthcare, and how to pivot your organization’s security profile in order to mitigate breach penalties in the event of an event.

DMEPOS – In Compliance with CMS

1st Talk Compliance features guest Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., on the topic “DMEPOS – In Compliance with CMS.” Rachel joins our host Catherine Short to discuss special payment rules associated with durable medical equipment, prosthetics, orthotics and supplies. DMEPOS products must meet quality standards, suppliers need to be accepted by Medicare to participate, similar to providers, and are subject to fraud, waste, and abuse laws. This episode will provide an overview of participation and quality requirements, relay the latest compliance and requirements updates, and discuss the consequences of non-compliance, as well as submitting false and fraudulent claims. 

HIPAA Cybersecurity Criminal Webinar

The Criminal Side of Cybersecurity and HIPAA – Audio Version of the Webinar

Expert presenter, Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX guides us during this important and informative webinar. Breaches and the lack of the requisite technical, administrative, and physical safeguards can have criminal consequences. While most people are familiar with civil cases, there is the potential for HIPAA violations and ransomware attacks to be prosecuted criminally. The purpose of this webinar is to highlight potential areas of criminal liability, give specific examples, and address mitigation techniques – both before and after a government discovery request or grand jury subpoena emerges.