Corporate Compliance

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Understanding Medicare Secondary Payer (MSP)

Understanding the role that Medicare Secondary Payer plays to patient care and your agency is critical.

Quality Management Role For The Betterment of Your Agency Picture

Quality Management Role For The Betterment of Your Agency

The Quality Manager can be a catalytic agent between departments in your organization. A Quality Manager in a strategic position in an organization can help improve revenues in multiple ways. Identifying processes assigned to staff ....

Does staff cohesiveness impact your organization success?

Leadership tools must include alternative effective forms of communication in order to achieve cohesiveness in an organization, read more...

CMS Quality Measurements Projects and the Goals

CMS is presently developing outcome core measures that are patient oriented and cross providers setting during the continuum of care.

Tips

Falls

Patients falls are a marker of frailty, immobility...

Ready for CMS QAPI Program?

According to CMS in 2011 several nursing homes providers begun testing CMS QAPI Program, Quality Assurance (QA) and Performance Improvement (PI), Program which includes Five Elements...

OASIS Tip - M1600 Patients discharged with an UTI on discharge and PAEs Report

Are your Potentially Avoidable Events (PAEs) Report showing an increase in patients being discharged while having an UTI?

Do you have a Corporate Compliance Plan?

If you don't, is in your organization's best interest to have one. The following documents were developed by the OIG to provide guidance to organizations that would like to, voluntarily develop a compliance plan.

Is better to be proactive than reactive and have a Corporate Compliance Plan in place, especially when you are dealing with a Federal funded program. In 2009 the federal government put in a place The Health Care Fraud Prevention and Enforcement Action Team (HEAT) Task Force. This task force is composed of multi-federal and state programs as the Department of Health, Department of Justice, FBI and other state organizations. HEAT's Task Force mission is to help prevent waste, fraud, and abuse in the Medicare and Medicaid programs, crack down on the people and organizations who abuse the system and cost Americans billions of dollars each year, reduce health care costs and improve quality of care by preventing fraudsters from preying on people with Medicare and Medicaid, highlight best practices by providers and organizations dedicated to ending waste, fraud, and abuse in Medicare and build upon the existing partnerships between HHS and DOJ to reduce fraud and recover taxpayer dollars.

According to the HEAT's Medicare Fraud Strike Force, they have charged more than 1,400 defendants who collectively falsely billed the Medicare program more than $4.8 billion since 2007 and in 2011 HEAT coordinated the largest-ever federal health care fraud takedown involving $530 million in fraudulent billing.