This session will focus on the top “target areas” for 2023 from the OIG/CMS. We will cover the False Claims Act, Split/Shared Services, Incident-to and Evaluation & Management services. We will also discuss the importance of practices having compliance programs.
The Department of Health and Human Services, Office of Inspector General participated alongside key law enforcement partners in the 2023 Nationwide Health Care Fraud Enforcement Action. This action resulted in criminal charges brought against telemedicine platform owners, laboratory owners, durable medical equipment (DME) providers, hospice operators, and pharmacists, among others, with losses exceeding $1.1 billion. In this webinar, Sean M. Weiss, CHC, CMCO, CPMA, CMPE, CPC-P, CPC, will provide an update on key FCA trends and developments, the latest cases and their implications, and actions you can take to protect your organization in an increasingly complex and perilous environment.
Learning Objective:
- Learn about the False Claims Act
- Understand what Medical Necessity means
- Understand the benefits of compliance programs and what is mandatory
- Understand what is meant by cloning and how to avoid it
- Guidance on best practices for keeping your organization safe under today’s aggressive enforcement conditions
- Understand CMS guidelines for Split/Shared Services, Incident-to and Evaluation & Management services
Areas Covered in the Session:
- Medicare Voluntary Refund – Potential Language Change
- Continued Proposed Language Change – 2023
- The False Claims Act
- Evaluation and Management Services Prior to 2021 & 2023
- Split / Shared Services
- Compliance Programs for Physicians
- The Federal Register
- Patient Protection and Affordable Care Act of 2010 (the “Healthcare Reform Act,” or the “Act”)
- Mandatory Compliance
- Healthcare Fraud Criminal Offense
- 2023 Areas of Focus
- Evaluation and Management Services
- Amniotic Fluid for MSK
- Medical Necessity
- Cloning and Clinical Plagiarism
- Infusion Services
- Evaluation and Management Services and Application of 25 modifier
- Incident-to & Split Shared Services
- Evaluation and Management Services
- Defining “Medical Necessity”
- Incident-to
- Medicaid and Medicare 72-Hour Rule
- Signature Requirements
- Cloning
Suggested Attendees:
- Medical Providers, who are Involved in the Payment Process of their Practice
- C-Level Executives
- Office Staff and Billing Managers
- Medical Billing Companies
- Hospital Revenue Cycle Staff
- Physician
- Nurses
- Physician Assistants
- Nurse Practitioners
- Medical Assistants
- Practice Manager
- Office Managers
- Billers
- Coders
- Auditors
- CDI Specialists
- Collection Staff
- Front Desk
- IT Specialists
- HIPAA Privacy and Security officers
- Compliance Officers
- Telemedicine System Vendors
- Patient Accounts Personnel
- Medical Record Supervisors
- Health Information Management Administrators and Technicians
- Other Personnel Interested in Billing Privileges with the Medicare Program
Presenter Biography:
Sean has dedicated his career to serving and advocating on behalf of healthcare providers, hospital networks, and integrated health systems to ensure a level playing field and due process. Over the past 27-years Sean has focused on helping organizations achieve measurable financial results to ensure stability in their market all while significantly reducing the risk of non-compliance. Sean’s knowledge of the inner workings of government agencies at both the state and federal level make him an invaluable asset to clients
Sean leads the strategic litigation defense and audit team for Doctors Management, LLC. Sean is engaged by the largest and most revered law firms in the nation on matters tied to the False Claims Act and Health Care Fraud Statute cases to ensure the best possible defense for clients targeted by government agencies, their contractors, and commercial payer special investigative units.
Sean serves as a third-party Compliance Officer for numerous nationally recognized organizations across the country creating and ensuring a “Culture of Compliance” to mitigate risk and culpability.
Sean is a published author and the host of The Compliance Guy Podcast, the intersection where Compliance and the Business of Medicine meet… bringing to life regulatory compliance and health law-related issues, reaching tens of thousands of healthcare professionals weekly.
A sought-after healthcare speaker, Sean has an engaging, no-nonsense style and has delivered keynote addresses for countless professional societies and healthcare organizations. In his educational sessions, Sean presents workable solutions to the latest issues surrounding healthcare compliance, medical auditing, and practice and revenue cycle management. In May of 2021, Sean created The Compliance Guy Podcast©, bringing industry experts in the areas of operations, clinical, and legal together to ensure the highest level of learning and guidance to healthcare professionals.
Sean serves on boards of directors for both for-profit and non-profit organizations. He is a published author and a contributing author, and his written voice has reached tens of thousands of readers. His contributions to print and online publications (JAMA, Medical Economics, Part B News, BC Advantage, The Coding Edge, and MGMA Connections) cover a wide range of healthcare topics.
