Healthicity Blog

Compliance officers have a lot to juggle. Incident management, internal auditing and monitoring, and enforcing standards, are just a few of the things you need to master. Plus, it seems like new guidelines are emerging from every corner.

At the end of 2016 I posted a blog about the unsealing of an indictment of 21 individuals allegedly involved in a $40 million bribe and kickback scheme involving Forest Park Medical Center Dallas (FPMC).

If you’re anything like me, you are really looking forward to the HCCA’s annual Compliance Institute this month in National Harbor, MD. In addition to seeing colleagues and networking, it’s a great place to hear multiple perspectives on healthcare compliance.

For the last month or so I’ve been posting about various CIA compliance program requirements from the OIG in one of their most recently published CIA.

In last week’s blog post we examined the “ownership” requirements of a recently published CIA. This week we continue to dive deeper into the CIA by reviewing the requirements surrounding written standards/policies, training/education, and auditing/monitoring.

1. East Tennessee pharmacist indicted on healthcare fraud charges - “A Claiborne County grand jury indicted a New Tazewell pharmacist for healthcare fraud charges in October. Joseph “Jess” Collins, 56, of Middlesboro, Ky., is charged with TennCare fraud, insurance fraud and computer crimes. Each...

Most doctors read medical journals to stay abreast of the most current treatment options or cutting edge research about advancements in clinical care. And more and more physicians are seeing articles in their medical journals about compliance, fraud and abuse.

Medical necessity matters. The concept of medical necessity (or lack thereof) is what drives much of the multi-million dollar whistleblower suits and healthcare provider settlements we see in the healthcare industry today. Corporate integrity agreements often spell out requirements placed on...