Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

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Fraud Medicaid Medicaid Nurses 52

Health Law Checkup

MARCH 13, 2023

The carrot or the stick … which motivates compliance conduct more? Department of Justice to motivate or cajole corporate compliance. In separate announcements over the past several weeks, DOJ dangled two new “carrots” in front of companies involved in fraud investigations and criminal cases.

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Fraud Compliance 52

Compliancy Group

FEBRUARY 16, 2024

This month, fraud in the medical industry has been making headlines fairly frequently. We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. Each charge also comes with five years probation, while the fraud charge includes 18 months of house arrest.

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Fraud Licensing Medicaid Medicaid 52

Healthcare Compliance Blog

APRIL 29, 2022

On April 25, 2022, a former owner of multiple Texas adult day care centers was sentenced to 60 months in prison and ordered to pay $1,784,817.96 in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. Provide periodic retraining to members of the compliance and ethics committee as well.

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Fraud Governance Compliance Medicaid 59

American Medical Compliance

MARCH 13, 2023

The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. Healthcare organizations must take all possible steps to prevent instances of fraud. Employees should receive training that educates them on how to identify, report, and combat fraud, waste, and abuse in the workplace.

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Fraud Medicare Medicare Compliance 52

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.

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Fraud Medicare Medicare Overpayments 67

Med-Net Compliance

JUNE 15, 2022

Division of Medi-Cal Fraud and Elder Abuse (DMFEA) and the US Attorney’s Office for the Eastern District of California intervened in the? The investigation culminated in the doctor pleading guilty to one count of federal healthcare fraud, and on May 2, 2022, he was sentenced to a?prison prison term?of

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Fraud Doctors Elder Abuse Medicare 59

Compliancy Group

AUGUST 31, 2022

Department of Justice’s (DOJ) Civil Cyber Fraud Initiative (CCFI). Details of DOJ Cyber Fraud Initiative Settlements. Let’s Simplify Compliance Do you need help with HIPAA? Compliancy Group can help! × Automated HIPAA Compliance. DOJ Cyber Fraud Initiative and the HIPAA Connection. Learn More! ×

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Fraud HIPAA Electronic Medical Records Governance 52

Healthicity

OCTOBER 5, 2022

The Office of Inspector General recently made Work Plan updates that impact price transparency rules, Medicaid fraud referrals, and inpatient rehabilitation. If you support compliance for hospitals or hospital systems, listen up! Have you heard? Our latest eBrief covers the updates you need to know.

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Fraud Medicaid Medicaid Compliance 98

Healthcare Compliance Blog

FEBRUARY 2, 2022

On January 27, 2022, he was sentenced to 90 days in state prison, followed by 5 years’ probation, and was ordered to pay $74,00 in restitution. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1 Compliance and Ethics Program, CP 2.3 General Legal Duties and Antitrust Laws.

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Nursing Homes Fraud Medicaid Medicaid 59

Healthcare IT Today

NOVEMBER 22, 2024

According to a report from the Office of the Director of National Intelligence, ransomware attacks on healthcare organizations doubled between 2022 and 2023 , making the healthcare sector one of the fastest-growing targets for cybercriminals.

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Ransomware Hospitals COVID-19 Compliance 67

Compliancy Group

DECEMBER 20, 2024

On October 31, 2017, OCR initiated a compliance review of HVHS after the media reported that HVHS had experienced a ransomware attack. In May of 2022, OCR received a breach notification report from BCAA. The settlement is the third ransomware settlement entered into by OCR.

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Ransomware HIPAA Fraud Electronic Medical Records 98

HIPAA Journal

FEBRUARY 1, 2023

The 2022 Data Breach Report from the Identity Theft Resource Center (ITRC) has confirmed this trend. In 2022, two-thirds of data breach notices lacked the necessary information to allow individuals and businesses affected by those data breaches to accurately assess potential risk. The LastPass data breach was a good case in point.

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Fraud HIPAA Ransomware Compliance 120

Med-Net Compliance

OCTOBER 21, 2022

The Office of Inspector General (OIG) has recently posted the False Claims Act (FCA) settlements for FY 2022 Q1–Q4 on the risk spectrum. The government’s primary civil tool for addressing healthcare fraud is the FCA. Issue: Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate.

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Fraud Compliance Medicare Medicare 59

AIHC

JUNE 14, 2024

Part 3 in a series of articles to support World Elder Abuse Awareness Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS of the American Institute of Healthcare Compliance ( AIHC ), a non-profit healthcare education organization. As of August 2023, losses have already exceeded those in 2022 by 40%.

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Fraud Elder Abuse Governance Compliance 52

Compliancy Group

MARCH 30, 2023

The 2022 Internet Crime Report has revealed alarming statistics about the rampant rise in cybercrime, making it more critical than ever to be aware of the dangers and take necessary precautions. In 2022 there were a total of 800,944 complaints, which shows a 5% decrease from 2021, but the potential total loss has increased from $6.9

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Ransomware Fraud HIPAA Compliance 52

Innovaare Compliance

JULY 19, 2024

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

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Fraud Medicare Medicare Compliance 52

HIPAA Journal

OCTOBER 21, 2022

A pharmaceutical sales rep has pleaded guilty to conspiring to commit healthcare fraud and wrongfully disclosing and obtaining patients’ protected health information in an elaborate healthcare fraud scheme involving criminal HIPAA violations. Alario pleaded guilty to his role in the healthcare fraud scheme earlier this month.

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Fraud HIPAA FDA Health Insurance 59

Healthcare Law Blog

MAY 8, 2023

Department of Health and Human Services (“HHS”) is responsible for detecting and preventing fraud, waste, and abuse in federal health care programs. Upon request from health care providers and others, the OIG periodically issues advisory opinions concerning the application of fraud and abuse laws to existing or proposed business arrangements.

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Fraud COVID-19 Public Health Compliance 52

MedTrainer

FEBRUARY 12, 2024

in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022. How are healthcare organizations ensuring compliance and minimizing exposure risks to false claims? We’ll also highlight tools to streamline compliance processes and reduce the risk of potential legal and financial judgments.

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Compliance Fraud Medicaid Medicaid 52

HIPAA Journal

JANUARY 10, 2023

An external investigation into credit card fraud pointed to Captify Health as the source of a data breach. The affected individuals were then identified and contact information was verified, and breach notification letters were sent on December 16, 2022.

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HIPAA Doctors Fraud Compliance 114

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The post CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance appeared first on Inovaare.

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Fraud Medicare Medicare Medicaid 52

Health Care Law Brief

JULY 21, 2022

On July 20, 2022, the Office of Inspector General for the Department of Health and Human Services (“ OIG ”) issued a special fraud alert (“ Alert ”) advising “practitioners to exercise caution when entering into arrangements with purported telemedicine companies.” OIG Flags Seven Characteristics of Telehealth Fraud.

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Fraud Telemedicine COVID-19 Governance 52

HIPAA Journal

DECEMBER 31, 2022

To best answer the question what is a HIPAA violation, it is necessary to explain what HIPAA is, who it applies to, and what constitutes a violation; for although most people believe they know what a HIPAA compliance violation is, evidence suggests otherwise. What is HIPAA and Who Does It Apply To? Other Types of HIPAA Law Violation.

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HIPAA Due Diligence Compliance Fraud 132

HIPAA Journal

OCTOBER 6, 2022

Mon Health announced the security breach on February 28, 2022, and confirmed that the hackers had access to the personal and protected health information of 492,861 individuals , including information about patients, employees, providers, and contractors.

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HIPAA Fraud Hospitals Health Insurance 115

Florida Health Care Law Firm

DECEMBER 7, 2021

Telemedicine pharmacy arrangements continue to be of significant interest to fraud enforcement. The federal jury trial in the billion-dollar telehealth pharmacy fraud scheme resulted in conviction on 22 counts of mail fraud, conspiracy to commit health care fraud and introduction of misbranded drugs into interstate commerce.

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Fraud Telemedicine Governance Compliance 40

Provider Trust

SEPTEMBER 29, 2022

From August 2021 to February 2022, Mendez provided patient assessments and evaluations and ordered treatments and prescriptions, all while billing Medicaid for his services. Mendez faces seven counts of healthcare fraud and up to 10 years in federal prison. These numerous counts of fraud also carry a possible fine of up to $250,000.

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Licensing Fraud Medicaid Medicaid 52

Healthcare Law Blog

FEBRUARY 3, 2023

New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1]

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Medicaid Medicaid Compliance Overpayments 52

Compliancy Group

APRIL 27, 2022

In April of 2022, the Department of Health and Human Services (HHS)’ Office of Information Security issued a 27-page publication, entitled “Insider Threats in Healthcare.” Let’s Simplify Compliance HIPAA compliance helps to prevent insider data breaches. × Simplified HIPAA Compliance. Become compliant today!

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Fraud Compliance HIPAA Public Health 98

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. New York Social Services Law § 363-d.

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Compliance Overpayments Overpayment Compliance Officers 52

HIPAA Journal

MARCH 11, 2025

State employees who had their data compromised in the incident may submit a claim for up to $1,000 to cover out-of-pocket expenses due to the data breach, up to 4 hours of lost time at $15 per hour, and up to $7,500 as reimbursement of any extraordinary losses such as identity theft and fraud.

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Ransomware Fraud HIPAA Health Insurance 50

Healthcare IT Today

APRIL 25, 2024

For a healthcare entity, the data and information are viewed as extremely valuable as it includes PII as well as other health information that can be used for insurance fraud and identity theft. Troy is a frequent speaker and highly published thought leader on IT compliance and cybersecurity topics.

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Ransomware Compliance Fraud Governance 122

HIT Consultant

JANUARY 3, 2023

Department of Health and Human Services Office of Information Security noted in a 2022 report on health sector cybersecurity, that threat actors continue to evolve and become more sophisticated and effective in their attacks. The Challenges to Meeting Compliance Regulations. Compliance with regulations is nothing new for the industry.

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Compliance Ransomware Fraud Regulatory Compliance 52

HIPAA Journal

MARCH 20, 2025

You can view our H1, 2024 Report here.You can also receive a free copy of our HIPAA Compliance Checklist to understand your organization’s responsibilities under HIPAA. Data breaches increased once again in 2022, with OCR receiving reports of 720 data breaches of 500 or more records. 2021 was a bad year for data breaches with 45.9

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HIPAA Ransomware Compliance Hospitals 109

HIPAA Journal

JANUARY 23, 2024

Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors. Balwani was convicted of conspiracy to commit wire fraud against Theranos’s patients and investors and was sentenced to 12 years and 11 months in prison.

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Fraud FDA Medicaid Medicaid 89

Health Law Checkup

JANUARY 27, 2022

In the past few years, the Office of the Inspector General (OIG) and the Department of Justice (DOJ) have focused on risk adjustment coding as an area susceptible to fraud which will likely continue into 2022.

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Fraud Compliance Medicare Medicare 52

HIPAA Journal

OCTOBER 21, 2022

For example, the Administrative Requirements (Part 162) helped reduce insurance fraud and accelerated eligibility inquiries, authorization requests, and claims processing. Consequently, when data breaches occurred due to a lack of compliance by Business Associates, there was no accountability.

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HIPAA Compliance Medicare Medicare 106