Healthicity Blog

As reimbursements shift from fee-for-service to value-based payments, the need for better risk adjustment audit tools are on the rise.

If you have a compliance program, you most likely have a full-time compliance officer or an individual who is accountable for your organization’s compliance program, even if it’s only a portion of that person’s overall duties.

Recently, compliance failures cost Florida physicians over $4 million dollars and resulted in a multi-million dollar settlement for a Tennessee hospital. The message is clear: compliance is no joke.

1. Surgery center says 34,000 patient records potentially breached - “St. Mark’s Surgery Center was hit by a ransomware attack that may have impacted the personal health information of 33,877 patients.

As an auditor, you need to really focus on the task at hand. You’re detail-oriented and if you’re like me, you’ve got a lot to do. From making lists to staying organized, there are a number of ways you can beat distractions and be more productive.

Many compliance programs rely on the OIG Work Plan when planning their own internal audit or compliance activities. Historically, the OIG Work Plan was updated annually. However, recently the OIG has been publishing periodic updates and additions more often.

An organization that fails to create and maintain an effective compliance program could be forced to return overpayments. And providers may face severe civil, criminal, and financial penalties.

1. Mylan Agrees to Pay $465 Million to Resolve False Claims Act Liability for Underpaying EpiPen Rebates - “Pharmaceutical companies Mylan Inc. and Mylan Specialty L.P. have agreed to pay $465 million to resolve claims