Fraud and Abuse

Beware Third Party Scams - 11/07/2024

As technological capabilities have evolved, some individuals and organizations are using these capabilities to try to scam others out of their private personal or payment information.

Beware of Phony TMB, DEA Agents and Other Scams - 11/06/2024

The Texas Medical Board (TMB) is warning physicians and pharmacies of a scam involving criminals who sometimes pose as TMB officials. TMB passed along a report from the U.S. Drug Enforcement Administration (DEA) that says physicians registered with the DEA are receiving calls and emails from criminals who identify themselves as DEA personnel or other law enforcement agents.

Stark Self-Referral Laws and Regulations - 10/07/2022

Stark generally prohibits a physician (or an immediate family member of such physician) who has a direct or indirect financial relationship with an entity that provides a designated health service from making a referral for that service for which Medicare or Medicaid would otherwise pay. This very broad prohibition is mitigated by a large number of exceptions. These exceptions must be met exactly. Failure to meet a Stark exception will result in a violation.

Data Driven: Medicaid’s Inspector General Focuses on Fraud Prevention, Not Just Prosecution - 09/06/2021

Since her appointment in 2018, Texas Health and Human Services Inspector General Sylvia Hernandez Kauffman has homed in on using data analytics not only to prosecute fraud, waste, and abuse within the Medicaid program, but also to prevent it from happening in the first place. Texas Medicine spoke to Ms. Kauffman about what appears to be a shift in tone from this department as it also focuses on using the data it collects to educate physicians and other health care professionals on common billing mistakes.

What Triggers a Coding Audit? - 08/20/2021

What Triggers a Coding Audit?

Microsoft Windows, Server Systems Vulnerable to Hackers, Feds Warn - 01/17/2020

Texas physicians should look out for a security weakness in Microsoft Windows 10, Server 2016, and Server 2019, the Department of Homeland Security (DHS) said this week.

Ousting the ‘F-Word’ From Your Practice - 10/29/2019

You do everything you can to keep your patients safe and healthy. But are you sure your practice is safe from fraud and abuse? Don’t wait for a costly government audit – or a criminal charge – to come knocking. Check out the Texas Medical Association’s e-book, Fraud and Abuse Prevention Simplified, which can help you learn to protect both your practice and patients.

Greenway Clients Entitled to Free EHR Upgrade After Fraud Settlement - 02/12/2019

Electronic Health Record vendor Greenway Health has been ordered to offer its clients free upgrades to its latest version of Prime Suite as part of a settlement in a multimillion-dollar fraud case.  

Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.

EHR Vendors Behaving Badly; What Can You Do? - 08/27/2018

Have you had a problem with your electronic health record vendor not following through on its contractual obligations? Many practices don’t know how or where to get help.

Fraud, Waste, and Abuse Training: Not Just for Medicare Advantage Plans - 01/27/2017

Medicare requires annual fraud, waste, and abuse training for physicians contracted with any Medicare Advantage plan and their staff. But all practices should provide this type of training to all employees, regardless of health plan participation, says TMA.

Identify Your Own Fraud and Abuse Red Flags - 09/26/2016

One way to help keep your practice operations squeaky clean and in compliance with fraud and abuse laws is to develop an internal set of warning indicators.

Waiving Copays - 06/03/2016

Waiving Copays

TMLT Policies Cover RAC Audits - 06/03/2016

Texas Medical Liability Trust (TMLT) policyholders audited under Medicare's Recovery Audit Contractor (RAC) program are now covered.