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Podcast — medicaid

Enforcement Activity Is Up! Do You Have A Legit Paper Trail?

During the 4th Quarter of 2021 we saw a lot of enforcement activity, from the agencies that are announcing their fraud enforcement efforts to insurance companies that are initiating audits, etc. So whatever you’re involved with (Medicare, Medicaid, Indian Health Services, etc.), be sure you have an audit process in place that includes good records on the steps you’ve taken. You need to be able to prove your compliance should an audit or investigation comes your way. Narcotics charges against a Michigan Dentist, and lesson for all of us A Michigan Dentist was busted recently on narcotics charges, and it’s...

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HIPAA: The Treatment, Payment, and Healthcare Operations (TPO) Exception

A lot of people get the Treatment, Payment, and Healthcare Operations (TPO) Exception wrong. So in this episode of Talking with the Toothcop, Andrea and I dissect what it is. We also talk about what to do if you need patient authorization and the importance of informed consent for treatment. Don’t miss it!  Outline of This Episode [0:21] Coffee + Rom-Coms [4:07] Learn more about ProEdge Dental! [5:24] The treatment exception [10:00] The payment exception  [11:01] The operations exception  [12:14] If you NEED authorization [13:25] Informed consent for treatment [17:49] Learn more about protectit dental! The treatment exception You can...

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Where Are You Rusty in Your Dental Practice?

We’ve had a lot of distractions with the pandemic. Because of this, I’ve seen a lot of “rusty strings” in dental practices. People are forgetting to do a step-wedge test for their x-ray machines. They’re forgetting medical emergency training and preparedness. Many people are just going through the motions. 

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Walking Through a Corporate Integrity Agreement [CIAS Part III]

In the first episode of this series, we talked about what a corporate integrity agreement is. In the second episode, we covered focusing on compliance. In this episode of Talking with the Toothcop, we are going to walk through an actual corporate integrity agreement. If you’re caught in the OIG’s crosshairs, this is just one example of what you might expect.  NOTE: These are NOT confidential and are public documents on the OIG website. Outline of This Episode [2:15] A pediatric corporate integrity agreement [9:27] Reach out to us for support [12:02] Compliance Bootcamp 2021 A pediatric corporate integrity agreement...

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The OIG’s Focus on Compliance [CIAs Part II]

When an organization is under a CIA, they have to maintain an error rate of less than 5% in their audits. Based on my experience, this is difficult to accomplish. I’ve been doing record audits for over 10 years and the average error rate is north of 15%. Why? Because auditing processes aren’t in place and people don’t go back and check for mistakes.

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