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Read the latest news that impacts the healthcare compliance profession.
The investigation before qui tam
On the topic of human ambition, Ecclesiastes 1:9 is credited with the saying: “What has been will be again, what has been done will be...
PERM pearls: What CMS’ Payment Error Rate Measurement data offers
Medicaid program integrity has never been under as much scrutiny as it is right now under states’ unwinding of autoenrollment imperatives of the Public Health...
One goal, two teams: Aligning on managing risk and audits
In today’s world, with unpredictable economic and geopolitical events that have contributed to relentless volatility, it is essential for risk and compliance professionals and their...
How to ensure your compliance training program stands the test of time
Have your favorite ’90s sitcoms aged well? More likely than not, some of the shows you remember watching 30 years ago may make you cringe...
Florida Web Designer Settles with DOJ on 2020 HealthyKids.org Medicaid Breach
A Florida communications firm and its owner agreed to pay $293,771 to resolve False Claims Act (FCA) allegations that they failed to secure personal information...
United States v. Holland and its importance to compliance professionals
The recent decision of a U.S. Federal District Court in United States. v. Holland[1] is an important development in the application of the federal Anti-Kickback...
Enforcement actions relating to a lack of medical necessity
In a climate of shrinking margins, diminishing reimbursement, and frequent denials, healthcare organizations may make efforts to increase the volume of services they provide, especially...
Covered recipients and the open payments review and dispute process
The Centers for Medicare & Medicaid Services (CMS) oversees the Open Payments program, a “national transparency program”[1] designed to provide patients and the public with...
Strategic planning for compliance should be a major focus
Short- and long-term strategic planning should be a major focus area for healthcare compliance officers...
Successful split/shared implementation for your organization
If your healthcare organization utilizes split/shared billing, your organization could be at risk without proper training and attestation to support services billed correctly. If you...
