NY Watchdog Releases Its Annual Fraud Fighting Plan

The New York State Office of the Medicaid Inspector General (OMIG or agency) has recently issued its 2017-2018 Workplan. The Workplan identifies key areas of OMIG’s focus impacting health care providers and suppliers.

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Recent Medicare Program Changes

Providers, suppliers and their billing staff need to be aware of the following recent changes to the Medicare program.

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New York’s Emergency Services and Surprise Bill Goes Into Effect

A new law impacting New York out-of-network providers, called the Emergency Services and Surprise Bill, went into effect on March 31, 2015, that will require providers to update their operations if they do not already comply with the legal requirements.

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Another HIPAA Settlement With a Pharmacy for $125,000

The Office of the Civil Rights (OCR) within the US Department of Health and Human Services recebtly settled a HIPAA violation case with a single location compounding pharmacy in Denver, Colorado. This is yet another HIPAA settlement underscoring the importance of properly implementing and maintaining a compliance plan.

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Which New York Providers Need a Compliance Program?

New York State Social Service Law §363-d and implementing regulations at 18 NYCRR §521 require that certain healthcare providers adopt and implement an effective compliance program and certify their compliance with the law every December.

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Lessons From a Major Settlement Over PHI Disposal

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) reached a major settlement with a non-profit covered entity (CE) resolving allegations of violation of the HIPAA Privacy Rule for allegedly failing to appropriately and reasonably safeguard protected health information.

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HHS OIG Releases 2014 Work Plan

Every year the U.S. Department of Health and Human Services Office of the Inspector General (OIG) publishes a work plan that provides industry stakeholders with insight as to the OIG’s new and ongoing auditing and investigative activities in the upcoming year.

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NJ Medicaid Provider Audits: Preparedness Checklists

Every year, the New Jersey Medicaid Fraud Division (MFD), the watchdog agency for New Jersey’s Medicaid program, releases a workplan which informs providers, suppliers and their advisers about the agency’s focus for the up-coming year. MFD’s 2012 workplan outlines a comprehensive audit and review agenda. We have summarized the agency’s audit criteria to help New Jersey Medicaid providers become aware of and stay prepared for scrutiny in 2012.

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Why Individual and Small Group Physician Practices Need A Compliance Program

More than a decade ago the Office of the Inspector General (OIG) issued Compliance Program Guidelines for Individual And Small Group Physician Practices, which are a set of voluntary guidelines for a small group physician practice or an individual practitioner. Nowadays, when federal and state governments are increasingly interested in cutting fraud, waste and abuse

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