Mergers and Acquisitions Due Diligence in Health Care
Hardly a day passes when the press doesn’t report on a new merger or acquisition in the health care sector. The trend…
Dissecting the Internal Audit Function in Health Care
The traditional role of the internal auditor is to independently and objectively analyze, review, and evaluate existing procedures and activities as well as report…
New Changes Proposed for the Medicare Advantage and Prescription Drug Benefit Programs (CMS-4159-P)
The Part D Medicare prescription drug benefit was enacted as part of the Medicare Modernization Act of 2003 and provides extensive drug coverage…
6,000 Whistleblowers and Still Counting
In 2013, the U.S. Department of Justice (DOJ) reported having secured $3.8 billion in settlements and judgments from civil cases…
Essential Policies And Procedures For Effective Hotline Programs
Hotlines are an essential communication channel for healthcare organizations and serve as a key component in their compliance programs. Hotlines…
The Tides are Shifting Once Again for Managed Care
The renewed focus on managed care underscores the importance for managed care organizations (MCOs) to focus on managing risks. Specifically, given…
The Anti-Kickback Statute: A Continuing Compliance Challenge
In recent months, the spotlight in the healthcare industry has largely been focused on the Congressional debate regarding healthcare reform, including implementation of federal…
Meeting the Challenge of Medicare Appeal Delays
Two years and counting … The Web site for the Office of Medicare Hearings and Appeals (OMHA) in the U.S. Department of…
Medicaid vs. Medicare Claims Audit Appeals: A Road Less Clear
In recent years the enforcement climate has become harsher than ever before as more and more providers experience significant recovery…
Elements Of An Effective Compliance Program – Written Policies And Procedures
The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) provides guidance to various healthcare providers…
Highlights Of HHS’ December Enforcement Actions
The Department of Health and Human Services (HHS) wrapped up 2013 with successful enforcement actions in its never-ending effort to…
Compliance Officer and the Audit Committee: Building an Effective Relationship
Both the compliance officer and the audit committee play important roles in a healthcare provider’s compliance program. The compliance officer administers the program…