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The resignation of HHS Secretary Tom Price, MD casts doubt on initiatives championed by the former orthopedic surgeon in altering the trajectory of the Patient Protection and Affordable Care Act. Under intense criticism and amid growing frustration by President Donald Trump, U.S. Department of Health and Human Services (HHS) Secretary…
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EDITOR'S NOTE: Edward Roche, in association with RACmonitor, is writing a series of articles on the need for U.S. healthcare facilities to protect themselves from cybercriminals demanding ransoms for patient records. This is the tenth installment in the series. The U.S. Department of Health and Human Services (HHS) recently defined…
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The primary function of the hospital business office is to submit, process, and collect payment for healthcare claims. To complete these tasks effectively, millions of medical records are sent to third-party payers by business office personnel every year. These business office disclosures occur during the claims submission process or as…
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Once a year, for the past eight years, the U.S. Attorney General has announced his or her annual healthcare fraud enforcement efforts in the form of the U.S. Department of Justice’s (DOJ) “National Health Care Fraud Takedown.”  The Takedown, which compiles the year’s healthcare fraud-enforcement actions, is a reflection of…
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More than 400 people across the country have been charged in connection with $1.3 billion in healthcare fraud losses as part of what the federal government has labeled the largest enforcement action of its kind in U.S. Department of Justice (DOJ) history. United States Attorney General Jeff Sessions and U.S.…
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The Centers for Medicare & Medicaid Services (CMS) held an MLN Connects national provider call on June 29 to educate providers and interested parties on the U.S. Department of Health and Human Services (HHS) final rule to improve the Medicare appeals process. CMS and the Office of Medicare Hearings and…
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The American College of Physician Advisors (ACPA) has responded to a Centers for Medicare & Medicaid Services (CMS) request for recommendations for improvements to the Medicare Advantage program with a detailed position paper outlining a wide variety of proposed changes. In an April 24 letter to U.S. Secretary of Health…
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Each year the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) releases its annual Medicaid Fraud Compliance Performance Report. There is much to learn from this compendium of information provided by 50 Medicaid Fraud Control Units (MFCUs), and this article will highlight some of…
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With 402 metrics listed in a 55-page guidance sheet, “HCCA-OIG Measuring Compliance Program Effectiveness: A Resource Guide" is a collection of best practices for measuring effectiveness at any U.S. healthcare facility.
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A $2.5 million settlement reported last month by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) reveals the risks when providers fail to understand requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).