The United States Department of Justice created the Health Care Fraud Unit to investigate allegations of health care fraud. This unit does not just focus on doctors and hospitals. Any professional that submits a bill with Medicare, Medicaid or other health insurance providers can find themselves the subject of the unit’s scrutiny and under investigation for alleged health care fraud.
AI: The next tool in the fight against health care fraud?
The Federal Bureau of Investigation (FBI) estimates health care fraud costs the United States billions of dollars every year. Artificial intelligence (AI) specialists claim they have a tool that can help the government recoup these losses. These specialists state the can develop AI for the government that will find three of the more common healthcare fraud crimes: upcoding, billing for services that were not provided and illegal kickbacks.
Common crime #1: Upcoding
Providers face allegations from the FBI of billing a relatively simple procedure as a more complex alternative in order to receive a larger payments. AI could provide investigators with a comparison of data of treatments typically used for a specific disease and red flag anomalies.
DOJ targets EHR vendors for antikickback violations
The health care market is evolving. Physicians are becoming more specialized and patients are more likely to see many different providers. A single patient may have one doctor to manage diabetes, another to manage heart issues and still a third for problems with their joints. Technological advances have also worked to help better ensure physicians are aware of other treatments a patient may receive. In some cases, the government has even become involved.
Texas nursing homes may soon have more funding
Texas nursing homes are struggling. Last year Senior Care Centers, the largest nursing facility in the state, filed for bankruptcy.
In addition to financial woes, these centers are struggling to keep good employees. A failure to have good staff can lead to problems and enforcement issues with the Department of Aging and Disability Services. Worker turnover in nursing facilities in Texas is one of the highest in the country:
Avoid these common compliance problems for pharmacies
Running a business of any kind takes diligence to ensure it satisfies all relevant regulations, from classifying employees to paying taxes. When your business is in the healthcare industry, such as running a pharmacy, the laws you must follow are even more numerous, complicated and ever-changing. It is easy to find yourself facing an audit, or worse.
You can reduce the chances of this happening, or at least going more smoothly, by being aware of compliance issues pharmacies commonly run into trouble with.
Preventing upcoding and overbilling in your medical practice
As someone who owns or operates a health care business, you may know all too well that medical billing and coding can prove time-consuming and complex. You can land in serious trouble, however, if Medicare, Medicaid or an insurance company alleges that you were fraudulently overcharging in a practice commonly called "upcoding."
In some cases, unethical owners of medical practices may intentionally overcharge in an effort to extract as much money from insurers as they can. In other situations, however, medical or administrative professionals may do so because of a lack of knowledge on billing practices, or because they make unintended clerical errors. The penalties associated with upcoding are the same for both types of offenders, however, so learning how to prevent upcoding issues should be among your top priorities as an owner.
So, what can you do to reduce your chance of someone accusing your medical practice of fraudulent billing practices?
Nurse accused of health care fraud loses nursing license
A government investigation recently led to allegations a nursing assistant was involved in a multi-year scheme to defraud Medicare and Medicaid. The investigation resulted in enough evidence to support criminal charges.
Based on this evidence, the woman agreed to a plea deal with the prosecution. Shortly after accepting the plea deal, the state Department of Health placed an emergency suspension on the accused’s certified nursing assistant license.
Social media can put your nursing license at risk
Social media is a part of our everyday lives. It is important for nurses to remember that professional standards apply online. This means every post, tweet or Instagram photo could put your license at risk.
A recent publication in American Nurse Today discussed these obstacles and provided advice on how to avoid the risk that comes with usage of social media. Some key takeaways from the piece include:
Important health care fraud case goes to trial this week
A trial this week involving the once-celebrated Dallas-based Forest Park Medical Center is said to be one of the biggest health care fraud trials in history. There are as many as 150 witnesses as part of the government's case against ten defendants, which include four surgeons and one pain doctor.
As The Dallas Morning News reported, the jury will have a tough job to do and will be hearing complex testimony regarding the intricacies of federal anti-kickback laws and the "safe harbor" exceptions that apply.
What to do as the subject of a nursing board complaint
As someone who makes a living working as a nurse, it makes sense that you would feel anxious and nervous upon receiving notification that someone has filed a nursing board complaint against you. A complaint made to the Texas Board of Nursing has the potential to threaten your professional license, which could have a monumental impact on your ability to earn a living and support yourself.
The actions you take in the aftermath of receiving a nursing board complaint can have a substantial impact on your case and your ability to hold on to your license. Therefore, it is critical you take the complaint seriously and respond to it accordingly if you wish to protect and preserve your professional reputation. When you receive word someone filed a complaint against you with the nursing board, there are a couple of things to make sure to do:
