Fraud Archives | First Healthcare Compliance

The Biggest Recent Health Care Scams & How to Avoid Being a Target

Catherine Short speaks with Stephen Bittinger, Health Care Reimbursement Partner at K&L Gates, about the topic of “The Biggest Recent Health Care Scams & How to Avoid Being a Target.” We will be learning the mechanics of some of the largest recent health care fraud scams, how many providers became victims of these scams, and how to avoid these types of risks in the future. We will study the mechanics of health care fraud scams and the impact on providers caught in them, discover how to identify health care fraud scams and discuss resources for providers to educate themselves, and learn from other providers' mistakes on how to avoid health care fraud scams and decrease risk to revenue cycle.

By Catherine Short|June 10th, 2020|Abuse, Anti-Kickback Statute, compliance program, Compliance Tips, effective compliance program, False Claim Act, false claims act, FCA, Fraud, Fraud, Waste, and Abuse, General Compliance, Healthcare Compliance, Podcasts, Waste|

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

Is Your Compliance Program Effective?

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

Beware of Individual Liability: Yates Memo

On September 9, 2015, the Department of Justice (DOJ) Deputy Attorney General Sally Yates released a policy memorandum, titled “Individual Accountability for Corporate Wrongdoing,” also known as the “Yates Memo.” To read the full contents of the Yates Memo, click here. Essentially, the Yates Memo shifts the DOJ’s approach to fighting corporate fraud and misconduct

By Sheba Vine, JD, CPCO|November 16th, 2015|1st Healthcare Compliance, Abuse, Anti-Kickback Statute, Audit Zone, Corporate Integrity Agreement, DOJ, Fraud, Individual Accountability, OIG, Overutilizaton, physician self-referral law, Quarterly Zone, Uncategorized, Waste, Whistleblower, Wrongdoing, Yates Memo|

OIG WORKPLAN 2016

The Office of the Inspector General (OIG) is responsible for protecting the integrity of the programs in Health and Human Services against fraud, waste and abuse as well as recommending improvements to the system that would promote efficiency and efficacy within the limits of the health care laws. Although OIG oversight includes programs such as

Overview of a Corporate Integrity Agreement (CIA)

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,

Are You Prepared for the HIPAA Phase 2 Audits?

After reviewing the HIPAA Privacy case investigations from 2009-2011, the Office of the Inspector General sent a strong message to the Office of Civil Rights in regard to the administration and enforcement of the HIPAA Privacy Rule. The OIG recommendation is clear in the September 2015 executive summary, “OCR Should Strengthen Its Oversight of Covered

By First Healthcare Compliance Staff|October 29th, 2015|1st Healthcare Compliance, ACA, Affordable Care Act, Audit Zone, Breach, Business Associate, CMS, Covered Entity, Fraud, Healthcare, HHS, HIPAA, HIPAA Zone, HITECH, Medicare, Medicare Rules, OCR, OIG, security breach, Uncategorized, Vendor Zone|

Billing Care Plan Oversight Risks

Care Plan Oversight describes the physician or other healthcare professional’s supervision of patients in hospice, nursing facilities or those receiving care through home health agencies. CPO reimbursement covers initial certification, any re-certifications and care plan supervision. However, only physicians can bill for initial certification and re-certification and only one physician can bill per month. The

By First Healthcare Compliance Staff|October 7th, 2015|1st Healthcare Compliance, Abuse, Audit Zone, Care Plan Oversight, CMS, false claims act, FCA, Fraud, ICD-10, Medicare, Medicare Rules, physician self-referral law, Uncategorized, Waste|

Are You Aware of the Whistleblower Provisions of the False Claim Act ?

The whistleblower provisions of the False Claims Act have lead to several newsworthy cases in recent years. Just a few days ago, the Justice Department announced that KMART Corporation (Kmart) will pay $1.4 Million to resolve False Claims Act allegations for knowingly providing coupons to Medicare beneficiaries to waive or reduce co-pays for purchasing more

By First Healthcare Compliance Staff|September 3rd, 2015|1st Healthcare Compliance, Abuse, CMS, Dashboard Zone, false claims act, FCA, Fraud, Healthcare, Medicare, Medicare Rules, Quarterly Zone, Uncategorized, Whistleblower|

Complying with Stark Law: Can you bill Medicare when treating your family members?

The treatment of family members falls under General Exclusions from Coverage under Medicare. No payment will be made for items or services for a family member when the charge is from an immediately related provider, any of their associates or their professional corporations. As part of Stark I in 1989, self-referrals for clinical laboratory services

By First Healthcare Compliance Staff|August 26th, 2015|1st Healthcare Compliance, Abuse, ACA, Affordable Care Act, Audit Zone, CMS, false claims act, Fraud, Healthcare, Medicare, Medicare Rules, physician self-referral law, Physician-patient Relationship, Quarterly Zone, Stark Law, Uncategorized|

12 Next

Neil S. Kalin, MDKalin Eye Associates, Newark, DE
I’d been searching for a compliance plan for many years. The First Healthcare Compliance solution is cost-effective and efficient. All of the compliance materials are in one place.
Dr. Marc D. Grobman, DO FACPInternal Medicine & Primary Care, Wilmington, DE
Using this solution, I am confident that I am meeting the guidelines or that I can seek help for areas in which I cannot perform the requirements on my own.
Mary Ann Tyler, Practice AdministratorSinclair Retina Associates, PC, Media, PA
Compliance in all areas always seemed to take a back seat to day to day operations. First Healthcare Compliance has developed a solution that easily brings any size office into compliance. It gives me peace of mind.
Paul Smiley, NHAAdministrator, Gilpin Hall
The First Healthcare Compliance solution offers a simple and effective centralized system to access and assemble our compliance data with minimal effort and maximum return. I highly recommend it!
Kris Jones-Bartley, CPCPresident,
Healthcare Management System
The First Healthcare Compliance solution allows our business and our clients to save time and money, and mitigate compliance risks. I highly recommend it to other healthcare billing companies.
R.K. Conell, Practice ManagerAlexiou Hearing and Sinus Center, PLC and Harrisonburg Dermatology, PLC, Harrisonburg, VA
The First Healthcare Compliance solution has everything you need to get started. It helps a practice become compliant on a very timely basis. Without this, it would have been a very extensive and intensive process.
Anne Elkin, EsquirePractice Manager, Boothwyn Medical Associates
The solution has been a great help to our practice. We can now organize all our compliance data in one place.
Robert Henry, PA-C, CEOAmbient Care, Seaford, DE
In an era of ever changing regulations, First Healthcare Compliance has given us the tools to seamlessly and efficiently stay on top of our compliance requirements. This allows us more time to focus on patient care and other aspects of practice management.