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Healthcare Fraud and Abuse

Decoding a Corporate Integrity Agreement

2023-11-07T11:57:07-04:00By |Healthcare Fraud and Abuse, Operational Analysis|

Corporate Integrity Agreement (CIA) is a legally binding contract, established between a healthcare provider and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), and plays a significant role in upholding ethical standards in the corporate landscape. In this comprehensive guide, we'll delve into the intricacies of Corporate Integrity Agreements, understanding their significance, and how they contribute to ensuring ethical excellence in corporate practices.

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Healthcare Data Breaches: Is 2015 The Year of the Cyber Attack?

2023-10-06T13:05:01-04:00By |Healthcare Fraud and Abuse, Healthcare IT, Uncategorized|

From Anthem to Premera Blue Cross, healthcare data breaches have been buzzing in our news feed since the beginning of 2015. But did you know that five of the biggest data breaches in the healthcare industry occurred this year? And that over "92 million individuals" have been affected by healthcare breaches in 2015 already (just up until May). Unfortunately, it's been a big year for cyber attacks and according to Bloomberg Business "nearly 90 percent of health-care providers were hit by breaches in the past two years, half of them criminal in nature, the report found." While many organizations are buffing up on security and creating awareness around the important issues of cyber security and healthcare, a recent survey by KPMG found that only 66% of providers feel they are prepared a cyber attack.

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HIPAA Enforcement Around the Corner

2017-04-02T13:28:21-04:00By |Healthcare Fraud and Abuse, News and Events, Organizational Analysis|

Many healthcare providers are gearing up in 2015 for the HIPAA enforcement that's slotted to take place throughout the year. In fact, the Office of Civil Rights (OCR) anticipates receiving 17,000+ complaints this year filed for breaches of private patient information. As of early December 2014, 1,170 security breaches under the Health Insurance Portability and Accountability Act involving 31 million records had been reported to the U.S. Department of Health and Human Services (HHS)--so the problem of data breaches is very real. Enforcement can come with serious fines for violations, too. Accidental violations can cost anywhere from $100-$50,000...even on the first offense. So what should you be on the lookout for? In this post, we'll discuss some of the main areas you should beef up security around to prepare for HIPAA enforcement.

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Managed Care – Not New but our Healthcare Perspective Might Be

2017-04-02T13:28:26-04:00By |Care Coordination, Financial Analysis, Health Insurance, Healthcare Fraud and Abuse, Managed Care, Physician Advisor/Peer Review, Services|

Managed care has been around for almost one hundred years, at least in theory. When placed up against fee-for-service payment models, however, it was a hard sell. Traditionally, the way that physicians were compensated for their services was a fairly straight-forward invoicing process: they would bill the patient (or later, the payer) for everything they did in terms of diagnosing or treating the patient. Everything.

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RAC Audits Still Haunting Medicare Patients, Hospitals.

2017-04-02T13:28:39-04:00By |Healthcare Fraud and Abuse, Medicare and Medicaid, Services|

Since last fall, the Recovery Audit Contractors have greatly slowed their requests for charts from hospitals nationwide. The program, which has been under fire from the American Hospital Association virtually since it’s inception in 2006, is currently undergoing reform. That being said, for many involved in the previous audits the damage has already been done.

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