HIPAA Journal

AUGUST 30, 2022

An unauthorized individual had access to the network of Avamere Health Services between January 19, 2022, and March 17, 2022, and exfiltrated files containing protected health information. The breach was detected on or around March 17, 2022, yet Avamere waited until July 13, 2022, to issue notifications to affected individuals.

Nursing Homes 122

Nursing Homes Fraud Ransomware HIPAA 122

Fierce Healthcare

FEBRUARY 2, 2022

DOJ recovers over $5B in healthcare fraud settlements, judgments in 2021. Wed, 02/02/2022 - 12:13.

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Fraud 109

Fierce Healthcare

DECEMBER 8, 2022

to settle Medicaid fraud allegations in California. Thu, 12/08/2022 - 16:58. 3 providers to pay $22.5M

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Fraud Medicaid Medicaid 109

Fierce Healthcare

NOVEMBER 9, 2022

Customization vs. Configuration in Healthcare Fraud Detection. Wed, 11/09/2022 - 16:55.

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Fraud 98

HIPAA Journal

JANUARY 24, 2023

Even with that reduction, 2022 still ranked as the second-worst-ever year in terms of the number of reported breaches. million records in 2022. The theft of protected health information places patients and health plan members at risk of identity theft and fraud, but by far the biggest concern is the threat to patient safety.

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HIPAA Ransomware Hospitals Fraud 137

HIPAA Journal

FEBRUARY 22, 2023

A lawsuit has been filed against Freehold Township, NJ-based CentraState Healthcare System over its December 2022 ransomware attack, a few days after the health system started sending notification letters to around 617,000 affected patients.

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Ransomware Fraud Health Insurance HIPAA 114

HIT Consultant

JANUARY 5, 2025

government alleged that between January 2017 and November 2022, Meditelecare submitted claims to Medicare for telehealth psychotherapy sessions that did not meet the minimum time requirements for reimbursement. The settlement was announced today by U.S. Attorney Michael A. Bennett of the Western District of Kentucky. – The U.S.

Medicare 52

Medicare Medicare Fraud Governance 52

HIT Consultant

AUGUST 17, 2023

Erin Rutzler, VP of Fraud, Waste, and Abuse at Cotiviti As behavioral health claim volumes continue to increase, there’s a growing need for health plans to be vigilant in spotting fraud, waste and abuse. But not every plan has access to a large SIU to combat fraud, waste and abuse in behavioral health.

Fraud 98

Fraud COVID-19 Medicare Medicare 98

Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

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Fraud Nurses Medicare Medicare 98

Healthcare Dive

JUNE 10, 2024

From 2020 to 2022, CityMD falsely documented insured patients as uninsured before fraudulently billing the federal government for their COVID-19 care, according to regulators. CityMD denies the allegations.

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COVID-19 Fraud Governance 111

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

Healthcare IT Today

JANUARY 10, 2022

The following is a guest article by Mike Noshay, MSE, Founder and Chief Strategy & Marketing Officer at Verinovum. This time last year, we healthcare leaders were excited to be looking ahead to 2021 and leaving 2020 firmly behind us. But our dreams of putting the pandemic in the past were put on pause. Now, […].

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COVID-19 Fraud Telemedicine 145

HIPAA Journal

DECEMBER 23, 2022

It has been another bad year for healthcare data breaches, with some of the biggest HIPAA breaches of 2022 resulting in the impermissible disclosure of well over a million records. In addition to the high number of data breaches, 2022 stands out for the sheer number of healthcare records breached, which currently stands at 49.8

HIPAA 103

HIPAA Ransomware Health Insurance Compliance 103

HIT Consultant

DECEMBER 10, 2021

What You Should Know: – Improving patient access to medical services is a top priority for health system leaders in 2022, according to new research from the Center for Connected Medicine (CCM) and KLAS Research. Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know. Report Background.

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COVID-19 Fraud Nurses Licensing 98

Becker's Health IT

APRIL 22, 2024

Federal judge recommends dismissing class-action lawsuit against CommonSpirit Health over 2022 cyberattack due to lack of evidence linking breach to bank fraud.

Fraud 108

Fraud 108

Healthcare IT Today

SEPTEMBER 24, 2022

Read more… How AI Can Help Spot Telehealth Fraud. As telehealth use has increased, so have instances of telehealth fraud. Asimily’s Constancio Fernandes identified four factors that make IOMT security unique and emphasized the importance of identifying and addressing the biggest risks first.

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Fraud Nurses Hospitals 75

Healthcare Law Blog

DECEMBER 1, 2023

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released its “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2022 ” (the “Report”), highlighting continued enforcement and recovery actions under the Health Care Fraud and Abuse Control Program (HCFAC).

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COVID-19 Fraud Telemedicine Medicaid 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.

Fraud 67

Fraud Medicare Medicare Overpayment 67

Healthcare It News

DECEMBER 5, 2022

" Community also said that the investigation has not found evidence that misuse or fraud has occurred as a result of the breach, and it "cannot say with certainty what information was involved." ON THE RECORD. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org. Healthcare IT News is a HIMSS publication.

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Fraud HIPAA Compliance Hospitals 301

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

Health Law RX

AUGUST 1, 2022

While this new flexibility increased access to care, it also increased opportunities for fraud. On July 20, 2022, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a Special Fraud Alert cautioning Practitioners about potential fraudulent telemedicine contracts ( Fraud Alert ).

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Fraud Telemedicine Nurses Governance 59

HealthIT Answers

MARCH 31, 2024

22 for civil fraud and false claims settlements and judgments recovered for taxpayers by the agency in fiscal 2023, or from Oct. 1, 2022, through Sept. The post Justice Department Sleeping at the Healthcare Fraud Wheel appeared first on Health IT Answers. By David R. Burda - Here are the DOJ stats released on Feb.

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Fraud 52

HIPAA Journal

SEPTEMBER 30, 2022

Had notifications been issued sooner, the plaintiffs argued that they could have taken steps to protect against identity theft and fraud. Class members that have incurred costs related to credit monitoring and fraud resolution may also be able to claim back those costs. Those claims must be supported by appropriate documentation.

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Fraud HIPAA Health Insurance 116

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

Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). MFCUs reported 1,143 total convictions in FY 2023—a marked decrease from 1,327 convictions in FY 2022.

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Fraud Medicaid Medicaid Licensing 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. The money judgment represents the proceeds that she obtained as part of her scheme.

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Fraud Governance Compliance Medicaid 59

HIPAA Journal

JUNE 15, 2022

On May 27, 2022, the Massachusetts-based medical imaging service provider reported the data breach to the HHS’ Office for Civil Rights and confirmed that an unauthorized actor had access to some of its IT systems from March 7 to March 21, 2022.

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Fraud HIPAA 125

HIPAA Journal

SEPTEMBER 7, 2022

The Morristown, VT-based healthcare provider, Lamoille Health Partners, is facing a class action lawsuit over a June 2022 ransomware attack that affected almost 60,000 of its patients. The attack was detected on June 13, 2022, with the investigation confirming the attackers gained access to its network the previous day.

HIPAA 128

HIPAA Ransomware Fraud Health Insurance 128

The Health Law Firm

MARCH 14, 2022

Board Certified by The Florida Bar in Health Law On March , 2022, a New York ophthalmologist was sentenced to 96 months in prison for fraudulently obtaining two government-guaranteed small business loans and for a seven-year fraudulent healthcare billing scheme, the Justice Department announced. By George F. Indest III, J.D.,

COVID-19 98

COVID-19 Fraud Governance Doctors 98

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.

Fraud 59

Fraud HIPAA FDA Health Insurance 59

HIPAA Journal

OCTOBER 17, 2022

Valle de Sol did not state in its notification letters when hackers gained access to its network, or for how long they had access, but did confirm that the unauthorized activity was detected on January 25, 2022. A comprehensive review was conducted of all files that may have been accessed, which was completed on July 18, 2022.

Health Insurance 134

Health Insurance Licensing Fraud HIPAA 134

Health Law Checkup

AUGUST 9, 2022

On July 20, 2022, the OIG released a Fraud Alert encouraging practitioners to exercise caution when entering into arrangements with telemedicine companies, given the various fraud and abuse risks associated with such arrangements, including an increased risk of fraudulent claims to Medicare, Medicaid, and other federal healthcare programs.

Fraud 52

Fraud Telemedicine Medicaid Medicaid 52

HIPAA Journal

MARCH 7, 2023

The cyberattack in question occurred on December 1, 2022. Hackers gained access to the medical groups’ IT systems, preventing access to certain servers on December 2, 2022. The attempted fraudulent activity occurred between December 2022 and February 2023, before being informed by the defendants about the data breach.

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Fraud Health Insurance Doctors HIPAA 120

Compliancy Group

AUGUST 31, 2022

Department of Justice’s (DOJ) Civil Cyber Fraud Initiative (CCFI). Details of DOJ Cyber Fraud Initiative Settlements. DOJ Cyber Fraud Initiative and the HIPAA Connection. Whistleblower Incentives Within the DOJ Cyber Fraud Initiative. million from the total settlement.

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Fraud HIPAA Electronic Medical Records Governance 52

HIPAA Journal

MAY 25, 2022

The break-in was discovered on March 4, 2022, with the subsequent investigation confirming on April 22, 2022, that six boxes of paper documents had been stolen from the facility, which included files relating to patients served by SAC Health in 1997 and between 2006 and 2020. Lifespan Services Suffers Ransomware Attack.

Ransomware 136

Ransomware Fraud HIPAA Licensing 136

HIPAA Journal

SEPTEMBER 29, 2022

On May 18, 2022, Choice Health learned that a Choice Health database was accessible over the Internet, with the investigation confirming the misconfiguration was caused by a third-party service provider. The exposed database was detected by Choice Health on May 14, 2022, with the theft of database files identified on May 18.

Health Insurance 128

Health Insurance Medicare Medicare Fraud 128

The Health Law Firm Blog

FEBRUARY 23, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

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Fraud Medicaid Medicaid Overpayment 52