COVID-19 Resources
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Physician Who Billed COVID-19 UIP Quarter Billion Dollars Is Indicted
Report on Medicare Compliance Volume 32, Number 35. October 02, 2023 | Author: Nina Youngstrom | October 02, 2023
A California physician has been indicted for allegedly cheating the COVID-19 uninsured program (UIP) out of $150 million, the U.S. Attorney’s Office for the Central District of California said Sept. 28.[1] Anthony Hao Dinh, D.O., of Newport Coast, an ear, nose and throat physician and plastic surgeon, allegedly submitted claims for services provided to patients with insurance or for services that weren’t performed or weren’t medically necessary from July 2020 to March 2021...
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News Briefs: October 2, 2023
Report on Medicare Compliance Volume 32, Number 35. October 02, 2023 | Author: Nina Youngstrom | October 02, 2023
◆ HHS, the U.S. Department of Treasury and the U.S. Department of Labor—which are responsible for the No Surprises Act—on Sept. 26 proposed a regulation to amend a previous regulation on administrative fees charged for participation in the independent dispute resolution (IDR) process.[1] The proposed fee would increase from $50 to $150 per party per dispute. Also, the departments “propose that for disputes initiated on or after the later of the effective date of these rules or January 1, 2024, certified IDR entities would be permitted to charge a fixed certified IDR entity fee for single determinations within the range...
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A practical guide for utilizing psychotherapy notes in your EHR
Compliance Today - October 2023 | Authors: William Renda, Chris Holcomb, Cherene W. Fannin | October 2023
The prevalence of mental health conditions and the need for adequate treatment has long been on the rise in the United States. Early in the COVID-19 pandemic, many areas experienced a spike in demand for behavioral health services, and since then, overall demand seems to have returned to pre-pandemic levels.[1] Still, behavioral health providers need to be prepared for continued and increasing demand. Statistics related to mental health, in general, are compelling. Approximately half of all Americans will experience a mental health condition at some point in their lives.[2] Additionally, 46.3 million people aged 12 or older (16.5%) experienced a...
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Could NIH See a New Leader Soon? HELP Chair To Hold Hearing for NCI’s Bertagnolli This Month
Report on Research Compliance Volume 20, Number 10. September 21, 2023 | Author: Theresa Defino | September 21, 2023
Although the date has not yet been made public, this month, NIH director nominee Monica Bertagnolli, M.D., is predicted to have a hearing before the Senate Health, Education, Labor and Pensions (HELP) Committee—now that conditions imposed by two powerful senators have been satisfied. She would have to win committee approval and then the okay of the full Senate before becoming the permanent director...
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Where’s the Proof? NSF OIG Provides Insights on Crafting That All-Important Investigation Report
Report on Research Compliance Volume 20, Number 10. September 21, 2023 | Author: Theresa Defino | September 21, 2023
Please don’t send uncorrected transcripts of interviews conducted via Zoom or other means to the National Science Foundation (NSF) Office of Inspector General (OIG). Engaging in a “document dump” to OIG also doesn’t serve institutions or federal research misconduct investigators...
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CMS Transmittals and Federal Register Regulations, August 25-September 7
Report on Medicare Compliance Volume 32, Number 32. September 11, 2023 | September 11, 2023
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HCCA04 Auditing Compliance and Ethics at the Speed of Business
Compliance Auditing & Monitoring Conference | September 2023
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The COVID-19 pandemic and its aftermath have dramatically increased the speed with which compliance and ethics risks take root across all industries
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This elevated risk environment requires an auditing mindset and approach that is just as adaptive and resilient as business operations
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A resilient auditing approach and actual case study will be introduced that can help continuously assess what to audit and when
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Incorporating telehealth into your compliance work plan
Compliance Today - September 2023 | Authors: Holly J. Hester, Yolunda G. Dockett | September 2023
The rapid expansion of telehealth during the COVID-19 pandemic has brought both opportunities and challenges to healthcare providers. Providers have been able to reach patients who were unable to obtain in-person treatment or services and expand the types of services offered. For providers new to telehealth, quickly ramping up a program meant finding a telehealth platform, educating both patients and staff on this new mode of treatment, implementing new processes and procedures, and delivering care in a brand-new way. From a compliance perspective, telehealth brings new risks and focus areas to the forefront, necessitating review and revision of an organization’s...
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Research Compliance Conference update
Compliance Today - September 2023 | Author: Kelly M. Willenberg | September 2023
In June, the Health Care Compliance Association held its Research Compliance Conference, co-located with the Society of Corporate Compliance and Ethics’ Higher Education Conference, at the Sheraton Wild Horse Pass in Phoenix. With speakers from academic medical centers, community hospitals, cancer centers, law firms, and consultants, a plethora of knowledge was gained by those in attendance...
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National Compliance Officer Day is September 26
Compliance Today - September 2023 | Author: Betsy Wade | September 2023
Did you know that National Compliance Officer Day is recognized annually on September 26?[1]...
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Meet Melanie Fontes Rainer, Director, Office for Civil Rights, U.S. Department of Health and Human Services: “Working to make sure everyone has the best quality, affordable healthcare is my life’s mission”
Compliance Today - September 2023 | Authors: Melanie Fontes Rainer, Walter Johnson | September 2023
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CMS Transmittals and Federal Register Regulations, August 18-24
Report on Medicare Compliance Volume 32, Number 31. August 28, 2023 | August 28, 2023
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News Briefs: August 21, 2023
Report on Medicare Compliance Volume 32, Number 30. August 21, 2023 | Author: Nina Youngstrom | August 21, 2023
◆ The HHS Office of Inspector General (OIG) has updated its work plan. Items include an audit of health centers’ use of COVID-19 supplemental grant funding and reimbursement from the COVID-19 uninsured program.[1]...
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Physician Is Convicted in E/M Scheme Tied to COVID-19 Tests; Relief Funds Are a Target
Report on Medicare Compliance Volume 32, Number 29. August 14, 2023 | Author: Nina Youngstrom | August 14, 2023
A Maryland physician was convicted of health care fraud for billing Medicare, the COVID-19 uninsured program (UIP) and other payers for medically unnecessary or upcoded evaluation and management (E/M) services in connection with COVID-19 tests, the U.S. Attorney’s Office for the District of Maryland said Aug. 4.[1]...
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After Refund, Provider Settles CMP Case Over Medicare, UIP Payments for Virtual Check-Ins
Report on Medicare Compliance Volume 32, Number 28. August 07, 2023 | Author: Nina Youngstrom | August 07, 2023
After returning overpayments it received from Medicare and the COVID-19 uninsured program (UIP) for virtual check-ins associated with services provided and billed by its staff, Vault Medical Services realized it should also submit a self-disclosure to the HHS Office of Inspector General (OIG)...
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OIG: Telehealth Modality Wasn’t Documented; Consider Other Payers Too
Report on Medicare Compliance Volume 32, Number 28. August 07, 2023 | Author: Nina Youngstrom | August 07, 2023
How providers document their telehealth technology may be ripe for a review in the wake of a report from the HHS Office of Inspector General (OIG) posted Aug. 2.[1]...
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More Notices May Reduce Social Admissions; Expert: Consider Review of ‘Safe Discharge’
Report on Medicare Compliance Volume 32, Number 28. August 07, 2023 | Author: Nina Youngstrom | August 07, 2023
When people come to the emergency department (ED) without a genuine medical reason, hospitals may want to quickly admit them as inpatients and give them a notice that explains they will have to pay for the hospital care because it’s not covered, experts say. It’s a way to manage social admissions/custodial care hospitalizations...
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Make people do the right thing, because it is the right thing to do!
2023 SCCE Compliance, Ethics, and Organizational Culture | August 2023
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The need of a Culture of Compliance
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Value proposition for Compliance professional
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Measuring the impact on people's behavior
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Crisis management and the four pillars of communication
CEP Magazine - August 2023 | Author: Solomon Carter | August 2023
This may sound astonishingly euphemistic and even naïve, but it amazes me to see the number of brands that need crisis management when there are so many blueprints for exactly what not to say or do. These observations are further exacerbated when the response to a crisis causes an even greater issue than the original nightmare. Organizations pay so many important people a lot of money to lead them in effective communications, yet we still see the feverish cadence of these failures continue...
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Understanding the nuances of federal grants
CEP Magazine - August 2023 | Author: Ken Dieffenbach | August 2023
Why read this? If your organization receives, oversees, or does business with any recipients of the almost trillion dollars in annual federal grant funds, you need to understand the landscape and the inherent risks. Compliance starts with a firm grasp of the facts...
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Navigating employee burnout in a new normal: The role of ethics and compliance
CEP Magazine - August 2023 | Author: Camille Howard | August 2023
Whether or not you believe the COVID-19 pandemic is over, it is essential for employers to realize we are in a new normal that has created change in the workplace and a surge in employee burnout. The American Psychological Association’s 2021 “Stress in America” survey found that 61% of adults experienced undesired weight changes during the pandemic due to stress and burnout.[1] With remote work, increased workloads, and blurred boundaries between work and personal life still at an all-time high, it is no wonder employees are feeling exhausted and overwhelmed now that most organizations have returned to “normal” operations. Ethics...
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Trending Fraud and Abuse Developments and How to Address Them
2023 HCCA Webinar | August 2023
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What Fair Market Value Means
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Understanding Fair Market Value and Commercial Reasonableness Defensibility Analysis for Physician Compensation Arrangements
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Understanding The Stark Act and Anti-Kickback Statute
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340B Hot Topics for 2023
2023 HCCA Webinar | July 2023
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Understand 340B program basics and guidelines for program participation.
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Review key flexibilities extended as part of the COVID-19 public health emergency that will be ending effective May 12, 2023 and operational impacts.
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Identify potential billing pitfalls that could result in overpayments.
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Develop auditing and monitoring frameworks for 340B program compliance.
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Discuss recent industry events and activity.
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European Supply Chain Enforcement: What You Need to Know and Start Doing
2023 SCCE Corporate Compliance Enforcement Conference | July 2023
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Learn how Europe is growing much more aggressive in its demands for responsible sourcing
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Understand how human rights are becoming a compliance concern for organizations
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See what you need to do to ensure your organization is in compliance
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Messaging Apps and Government Expectations
2023 SCCE Corporate Compliance Enforcement Conference | July 2023
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What are enforcement authorities and regulators saying about the use of message apps in business?
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What financial services compliance teams have been doing to address this issue
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How one non-financial services company is starting to tackle the challenge
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