Healthicity Blog

When a lot of healthcare organizations consider their risk under the False Claims Act, they often think of coding and billing errors submitted on 1500s or UBs. It’s probably the first place I’d consider looking as well for the greatest risk to a Medicare or Medicaid healthcare provider.

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.

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.

340B Drug Pricing Program

The 340B drug pricing program was authorized by Congress in 1992 to generate savings for certain safety-net healthcare providers by allowing them to purchase outpatient drugs at discounted prices. It is estimated that the savings to 340B providers attributable to the...

Most healthcare fraud and abuse cases settle before ever going to trial. However, when they occasionally do go to trial, the outcomes can be as varied as the facts and circumstances of a specific case. A recent trial in Houston didn’t turn out so well for Dr. Ronald Kahn, a Houston physician.

On July 13, 2017, the Department of Justice (DOJ) announced the largest healthcare fraud takedown in history.

When compliance officers hear of healthcare organization settlements associated with compliance problems, they’re typically hearing of settlements engineered by a government agency such as the U.S. Department of Justice or the HHS Office for Civil Rights.

Compliance officers don’t necessarily need to know everything about medical coding and modifiers, but at a minimum, compliance officers should know that modifiers matter.