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The Importance of NCQA Certification for CVOs

Verifying credentials for practitioners and affiliated organizations is a key component of patient safety in health care. A CVO (credential verification organization) with the proper procedures, processes, and data in place to do a thorough, efficient, and accurate credentialing of a provider population doesn’t happen by accident. It takes months and years of careful review,…

What Is the OIG Exclusion List?

Since 1977, the federal government has provided a list of providers who are excluded from receiving payments from the federal government for committing certain violations. In its current form, this database is known as the List of Excluded Individuals/Entities (LEIE) and is managed by the Office of the Inspector General (OIG) at Health and Human…

Protecting and Serving Vulnerable Health Care Populations

While much is said about the monetary cost of fraud in health care, the danger to patients is more than just financial. Between 2012 and 2015, 1.2 million Medicare beneficiaries were defrauded by health care providers, and many were from vulnerable populations. In 1966, more than three-fourths of Americans had great confidence in medical leaders;…

The U.S. Department of Justice Governs the Health Care Fraud and Abuse Control Program

FOUNDING FATHERS FOR JUSTICE The early formulation of the Department of Justice started with the Judiciary Act of 1789 signed into law by President George Washington. The U.S. Department of Justice (DOJ) was created by an act led by the Attorney General and passed by Congress in 1870 to handle federal law enforcement, criminal and…

Compliance and Changing Pharmacy Technician Roles

As the demand for prescription drugs continues to increase, so does the demand for pharmaceutical services. According to the Bureau of Labor Statistics, jobs for pharmacy technicians are expected to grow 7% between 2018 and 2028 — faster than the average of all occupations in the United States. In the last 50 years, the roles…

Minimizing Risk and Maximizing Patient Safety through Hospital Credentialing

It was recently reported that Evelyn Yang, wife of presidential candidate Andrew Yang, joined 31 other women to sue Columbia University, its affiliates, and an OBGYN provider for sexual assault and actively concealing, conspiring, and enabling the abuse. Hospitals are among the many organizations at risk when a provider puts patients at risk either by…

Heat is a Valuable Strike Force Created to Combat Health Care Fraud

The Health Care Fraud Prevention and Enforcement Action Team, also known as the HEAT Strike Force, is a highly focused group of skilled investigators in collaboration with other federal, state, and local agencies specifically tasked with mitigating Medicare and Medicaid fraud. Two agencies responsible for investigating and prosecuting health care fraud, the Department of Health…

Verisys Presents at the 3rd Annual Medicare Advantage Leadership Innovations Forum in Phoenix, AZ

Medicare Advantage Plan Leaders Gather in Phoenix to Share Best Practices Verisys presented at the Medicare Advantage Leadership Innovations Forum this week in Phoenix, AZ where leaders from the nation’s top MA plans gathered to share best practice strategies and results amidst the ever-evolving regulatory environment. Jan Smith Reed, Verisys VP of Payer & Hospital…

A Beginner’s Guide to CVO Credentialing

Proper credentialing is at the core of the health care industry and other highly skilled service industries. Without proper, continuous, and verifiable credentialing, patients can be put at risk, as well as the health care organizations that hire and manage these providers. Those risks can extend to fines, civil monetary penalties, litigation, malpractice, and other…

What Is a Provider Entity?

According to the Centers for Medicare and Medicaid Services (CMS), a provider entity is a health care provider or supplier who bills Medicare or Medicaid for services rendered and has a National Provider Identifier (NPI) number. Similarly, a Provider-led entity (PLE) is a national professional medical specialty society or organization that is comprised primarily of…