“Throughout the GCPG, helpful revisions and clarity are provided to a few areas that have proven problematic over the years.”
Continue readingKey Takeaways from OIG’s New General Compliance Program Guidance (GCPG)
New, Stronger Evaluation and Management Upcoding Enforcement
“Earlier this year, regulators made the most significant changes to E&M documentation and coding guidelines in over two decades. They’re more complex than ever before, and enforcement actions are increasing.”
Continue readingIncreasing Enforcement of Modifier Codes
“Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. This is why selecting appropriate modifier codes is essential for operating and being reimbursed compliantly.”
Continue readingRecent Telehealth Enforcement and How to Prepare
“As healthcare fraud, waste, and abuse continues to emerge, and poses more of a risk to organizational compliance, professionals should become familiar with some of the potential areas of noncompliance associated with telehealth.”
Continue readingSignificant Upcoding Risks Emerge with Medicare Advantage
Christi Grimm, the Inspector General of HHS, gave a recent keynote address to compliance professionals. In it, she said, “Simply put, the financial incentives created by risk adjustment may be driving upcoding in the severity of diagnoses to garner additional payments.”
Continue readingTelehealth Enforcement Actions
“It behooves all healthcare compliance professionals to be aware of the fraud, waste and abuse risks associated with telehealth services. This mode of delivery holds great promise. For it to fulfill that promise, non-compliance needs to be rooted out and corrected.”
Continue readingComplexities of Covered Entities and Business Associates
Due to their violations of patient rights, covered entities and business associates are now facing increasing enforcement actions. In a breach, both parties bear financial and reputational risk. Shawn DeGroot recommends proactive compliance officers prioritize their agreements based on risk, establish communication channels, and collaborate on risk analysis to protect their organization.
Continue readingAnti-Kickback Statute Enforcement in Healthcare
The recent surge in healthcare fraud has prompted heightened enforcement of the Anti-Kickback Statute (AKS). Government agencies are cracking down on illegal financial arrangements that jeopardize patient care. This article explores the significance of AKS enforcement, the impact on healthcare providers, and strategies for compliance in an evolving regulatory landscape.
Continue readingNew DOJ Guidance on Compliance Programs Released March 2023
Healthcare organizations should benchmark the DOJ Evaluation of Corporate Compliance Programs (ECCP) guidance (March 2023) to assess their compliance program.
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