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Compliance Guidance (April 14, 2017) Recently, the Office of Inspector General of the United States Department of Health and Human Services (OIG) and the Criminal Division of the Fraud Section at the United States Department of Justice (DOJ) have issued guidance on measuring the effectiveness of corporate compliance programs. In February, DOJ placed on its […]
OIG And DOJ Issue Important New Compliance Guidance Read More »
The mission of the Texas State Board of Dental Examiners (Texas Dental Board) is to “protect the public health and safety and promote high quality and safe dental care by providing enforcement, licensing, peer assistance, and related information services to licensees and their patients.” The Texas Dental Board is responsible for overseeing the actions of dentists,
Responding to Texas Dental Board Complaints Read More »
Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs), such as Nurse Practitioners, Clinical Nurse Specialists, Nurse Anesthetists, or Nurse Midwives are regulated in most states by their respective State Board of Nursing (Nursing Board). This article is intended to provide a general overview of the complaint process and address issues that you may face
Responding to a State Nursing Board Complaint Read More »
(Updated January 4, 2021): In April 2014, the Centers for Medicare and Medicaid Services (CMS) issued an Umbrella Statement of Work for the awarding of program integrity contracts by new organizations known as “Unified Program Integrity Contractors” (UPICs). UPICs took over the responsibilities of Zone Program Integrity Contractors (ZPICs) and Medicaid Integrity Contractors (MICs). Today,
ZPIC Audit Responsibilities Have Been Transferred to UPICs Around the Country Read More »
In an effort to avoid duplication of program integrity efforts and better integrate Medicare and Medicaid audits and investigations under a single contractor in a specific jurisdiction. CMS has contracted with a number of new private sector organizations to serve as Unified Program Integrity Contractors (UPICs). As set out below, Medicare and Medicaid providers and
(July 18, 2014): Over the last decade, Compliance Programs have become an essential part of the way large and mid-sized health care providers conduct business. In recent years, small health care providers have followed suit, and Compliance Program development, review and implementation has become a priority if the provider intends on staying within the four
Health Care Compliance Program Development, Review & Implementation Read More »
(January 3, 2014): A 57-year-old Queen City, New Hampshire dentist has recently been charged with 189 counts of Medicaid dental fraud. As a result, he could face many years in prison. The New Hampshire Medicaid program is a joint federal and state-funded health care program that serves individuals and families in that state who meet
Dentist Indicted on Nearly 200 Counts of New Hampshire Medicaid Dental Fraud Read More »
(December 26, 2013): The Department of Health and Human Services (HHS) has long viewed the adoption of Electronic Health Records (EHRs) as a way to better coordinate care, improve the quality of care, reduce unnecessary paperwork, and eliminate duplicative medical testing. Based, at least in part, on these beliefs, Congress authorized incentive payments to encourage
EHR Cloning Practices Can Lead to Medicare Audits Read More »
(November 8, 2013): Health Integrity serves as the Zone Program Integrity Contractor (ZPIC) for Zone 4. This zone is comprised of Texas, Oklahoma, New Mexico and Colorado. Generally, Health Integrity has been assigned responsibility for handling Medicare Part A, Medicare Part B, and Durable Medical Equipment (DME) claims. Health Integrity has been especially aggressive in
Health Integrity Educational Letter Sent to Home Health Agencies in Texas and Oklahoma Read More »
(August 14, 2013): In today’s reimbursement environment, solo physicians and physician practice groups are witnessing a steady decline in reimbursement rates. Unfortunately, their overhead costs and obligations due to the imposition of Electronic Medical Records, HIPAA Privacy, OSHA and a litany of other regulatory requirements are making more and more difficult to remain profitable each
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