Recorded Webinars

Joyce Freville

Understanding Exclusions from Participation in Federal Health Care Programs

OIG was established in the U.S. Department of Health and Human Services (Department) to identify and eliminate fraud, waste, and abuse in the Department's programs and to promote efficiency and economy in Departmental operations. OIG carries out this mission through a nationwide program of audits, inspections, and investigations. In addition, the Secretary has delegated authority to OIG to exclude from participation in Medicare, Medicaid, and other Federal health care programs Persons that have engaged in fraud or abuse and to impose civil money penalties (CMPs) for certain misconduct related to Federal health care programs.

Joyce Freville

ABCs of ZPICs (Zone Provider Integrity Contractors)

CMS established the Zone Program Integrity Contractor (ZPIC) program to combat fraud, waste and abuse in the Medicare program. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, CMS established seven zones throughout the United States for the purpose of processing Medicare claims. ZPICs replaced Program Safeguard Contractors (PSC), which had been established by the Health Insurance Portability and Accountability Act of 1996.

Joyce Freville

What You Don't Know Can Hurt You: Understanding Medicare and Medicaid Overpayments

The Affordable Care Act requires that Medicare and Medicaid "overpayments" be reported and returned by the later of 60 days after the overpayment was "identified" or the date any corresponding cost report is due (if applicable). This standard is intended to encourage providers and suppliers to exercise reasonable diligence to determine whether an overpayment exists. Failure to identify and return overpayments could result in liabilities. There are several sources of liability.

Joyce Freville

The SNF 'Perfect Storm'…A Convergence of Quality, Compliance and Risk Management

The U.S. Department of Health and Human Services' (HHS) and the Office of Inspector General (OIG) believe that an effective compliance program can significantly reduce fraud, waste and abuse. In addition, prosecutors may not pursue a criminal action against organizations that have an effective compliance program. Consequently, implementing an effective compliance program could minimize the consequences resulting from a violation of the law. Generally, the OIG will look to the effectiveness of the compliance program as a factor when determining the level of sanctions, penalties, and/or exclusions to be imposed on the provider.

Joyce Freville

Be Prepared for a HIPAA Security Audit

Office of Civil Rights will conduct security audits on covered entities and business associates. Covered entities and business associates should proactively develop a work plan to review their operations in light of the specifications identified in the protocol. The detailed audit guidance can serve as a roadmap for compliance. Covered entities and business associates may assess current practices for each established performance criterion using OCR's audit procedures in order to understand their current state of compliance. Such efforts may help reduce the risks of adverse findings in an actual audit, and reduce the likelihood of a breach or some other form of HIPAA violation.

Joyce Freville

HIPAA Risk Analysis: The HIPAA Standard, HIPAA Security Rule

The HIPAA Security Rule establishes national standards to protect individuals electronic personal health information that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information.




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