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Fighting fraud, waste and abuse continues to be the focus of the Department of Health and Human Services (HHS) and the Office of the Inspector General (OIG). Almost 80 percent of HHS’ budget is spent on Medicare, Medicaid and CHIP totaling near $985 M for FY 2015. The ongoing goal for Center for Medicare and […]
Compliance in healthcare is comprised of complex laws and regulations. This complexity often leads to confusion. It’s not surprising that a few common myths exist. If you’re responsible for compliance and would like to separate fact from fiction, keep reading. Myth #1: We’re a small organization and there’s no way we can be expected […]
On April 16, 2016, the Office of Inspector General of the Department of Health and Human Services (OIG) issued a revised policy statement updating its criteria on excluding individuals/entities from participation in Medicare, Medicaid, and all other Federal healthcare programs. This policy statement is an update to the 1997 statement and provides insight into the OIG’s […]
Covered entities should be very concerned about the possibility of a major breach of protected health information (PHI) originating from a Business Associate (BA). According to the Health and Human Services’ Wall of Shame, a single breach in 2015 by a BA in Indiana affected more than 3.9 million individuals which is more than all […]
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 […]
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 […]
As the end of the year approaches, keep in mind that all breaches of unsecured protected health information involving less than 500 individuals must be reported to the Secretary at the Department of Health and Human Services (HHS) within 60 days of the end of the calendar year. If the organization already reported a breach […]
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 […]
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, […]
October 2015
