Compliance Programs & Training
New Compliance Initiative Issued by U.S. Sentencing Commission
Leave a Comment The U.S. Sentencing Commission, the independent board tasked with promulgating Federal sentencing guidelines to the nation’s Federal courts, has issued a new proposed rule which would significantly decrease criminal penalties for corporations if they maintain an effective compliance plan. Under this new proposal, if corporations establish and utilize a compliance plan designed..
read more →Nurse Stands Trial for Reporting Allegedly Dirty Doctor
Leave a Comment In a case out of Western Texas, a nurse is preparing to stand trial for felony “Misuse of official information” after she reported a physician at her hospital to the Texas Medical Board. An administrative nurse and Compliance Officer for a West Texas hospital allegedly witnessed a number of unorthodox and potentially improper actions..
read more →New York Medicaid Makes Compliance Program Mandatory
Leave a Comment Chapter 442 of the Laws of 2006, which established the New York State Office of the Medicaid Inspector General (OMIG), also created a new Social Services Law § 363-d which requires that Medicaid providers develop, adopt and implement effective compliance programs aimed at detecting fraud, waste, and abuse in the Medicaid program. The purpose..
read more →The U.S. Sentencing Commission has issued proposed changes that may significantly impact compliance plans and compliance professionals.
Leave a Comment An effective Compliance Plan can greatly reduce the likelihood that your practice or clinic will find itself in violation of criminal statutory and regulatory requirements. Should a violation still occur, Federal Sentencing Guidelines have long credited an organization’s efforts to comply with the law. Notably, on February 9, 2010, the U.S. Sentencing Commission announced..
read more →The Next “Patient” You See May be an Undercover Physician Auditing Your Practice.
Leave a Comment As the American Medical Association (AMA) recently reported on March 22nd, health care providers may find themselves subjected to “Secret Shopper” audits by fellow providers hired by the government conduct reviews and investigations. In a speech he made March 10th, President Obama expressed interest in a proposal by Senator Tom Coburn, M.D...
read more →Conducting Mock Audits
Leave a Comment (November 2, 2011) Recent years have seen health care providers grow more weary of government audits, malpractice claims, peer review concerns and other actions which can create a legal nightmare for a provider. Understandably, the health care industry has redoubled its efforts to achieve better compliance with the numerous statutory and regulatory..
read more →HIPAA Audits Are Here – Make Sure Your Privacy Policy is Fully Compliant
Leave a Comment (December 28, 2011): The Office of Civil Rights (OCR), an agency of the Department of Health and Human Services (HHS), is the central organization responsible for enforcing compliance with the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). As OCR’s website reflects, the agency: “. . [I]nvestigates complaints, enforces rights, and..
read more →RACs, PSCs, ZPICs, MFCUs, MICs, MRACs, OIG, DOJ, FBI, and Now. . . Patients?
The Department of Health and Human Services (HHS) has long used reports and complaints from affected patients to further investigate allegations of possible Medicare fraud, waste and abuse. Last June, it was reported that HHS was planning on implementing a “Mystery Shopper” program, with a Federal contractor posing as a potential patient when calling a..
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