Category: COMPLIANCE

Office Manager for Chicago Medical Practice Sentenced to a Year in Federal Prison for Fraudulently Writing Opioid Prescriptions

Office Manager for Chicago Medical Practice Sentenced to a Year in Federal Prison for Fraudulently Writing Opioid Prescriptions

It is critical for providers to keep strict control of their prescription pads and access into e-prescribing. 

An office manager in Chicago, IL has been sentenced to federal prison for writing over 3,000 fraudulent opioid prescriptions for individuals who were not patients of the provider.  She and her co-conspirator used family and friends, who were not patients nor in need of opioid medications, to take the fraudulent prescriptions to the pharmacy to get filled and then return the drugs to them.  Some of these drugs were later sold throughout Chicago, for profit.

ONC Health IT Certification Program Updates

ONC Health IT Certification Program Updates

ONC Health IT Certification Program Updates *Important Deadline Coming Up: December 31, 2022 The Promoting Interoperability Program started in 2011 with requiring certain clinical data be captured electronically, which including providing functionality so that patients could receive electronic copies of their health records (Stage 1).  In Stage 2, there was a requirement to provide Meaningful […]

Health Plan Audits: Penalties & Risks

Health Plan Audits: Penalties & Risks

If wrong-doing is identified, based on health plan audits or evaluation of information, the company and company’s officials could face certain penalties, fines, and risks.  The penalties and fines will be based on the type of offense, how egregious the offense is, how long it has been going on, how much harm it has done […]

Highlights of the General Audit Process

Highlights of the General Audit Process General Audit Process

Typically, a letter announcing the intention of an audit is sent to the company.  However, I have experienced where State Agents came directly into a clinic and started the investigation immediately on premises.  In this case, the investigation was based on a complaint issued to the State Medicaid agency.  Having Federal and State Agents come […]

Ways a Health Plan Audit Can Be Initiated

Ways a Health Plan Audit Can Be Initiated Health Plan Audit

There are several ways that a Health Plan audit can be initiated: As a result of pre-delegation audit and annual audit findings From a delegation/contractual standpoint, there can be Key Performance Indicators (KPIs) that must be met for a health plan to remain in compliance with the Centers for Medicare and Medicaid Services (CMS).  For […]

Customers Perceive Shortfall in Medicare Advantage Plan Coverage of Mental Health and Substance Abuse Services, J.D. Power Finds

Customers Perceive Shortfall in Medicare Advantage Plan Coverage of Mental Health and Substance Abuse Services, J.D. Power Finds

August 19, 2022

This is an interesting in article, just published yesterday from JD Power regarding Medicare Advantage (MA) plans and mental health coverage. 

According to the study conducted by JD Power, patient satisfaction with MA plans has increased in the last year, however, patients have indicated that there is inadequate coverage for mental health and substance use disorders.  The senior population has been significantly affected by the pandemic (loneliness, isolation), including many aspects around Social Determinants of Health (SDOH) such as Community, Safety & Social Context (e.g., social integration, support systems, community engagement) and Health Care System (e.g., health coverage, access/availability, and quality of care). 

The OIG has become more sophisticated in their detection and fight against fraudulent schemes.

The OIG has become more sophisticated in their detection and fight against fraudulent schemes.

July 6, 2022

In an interview with Health Care Compliance Association (HCCA), the new Inspector General of HHS-OIG, Christi A. Grimm indicated that their focus continues to be around compliance and fraud, waste, and abuse.