HIT Consultant

JUNE 6, 2024

Healthcare fraud is a significant issue in the U.S. the cost of healthcare fraud in the country is close to $100 billion a year. Recent advances in technology are now enabling government agencies to be more effective in their efforts to detect and prevent healthcare fraud. According to the U.S. Department of Justice (D.O.J.),

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MedTrainer

MAY 3, 2024

Healthcare fraud, waste, and abuse is a costly problem for both public and private payers. The National Health Care Anti-Fraud Association estimates financial losses due to healthcare fraud could be as much as $300 billion annually. Keep in mind that these are just examples of provider fraud!

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Electronic Health Reporter

JUNE 10, 2020

This article is copyrighted strictly for Electronic Health Reporter. There is interesting research in Forbes’ recent article named “How E-Commerce’s Explosive Growth Is Attracting Fraud”. The article Fraud Detection with Machine Learning For e-Commerce and Retailers appeared first on electronichealthreporter.com.

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Healthcare IT Today

MARCH 19, 2025

The following is a guest article by Philipp Pointner, Chief of Digital Identity at Jumio The healthcare industry is increasingly vulnerable to advanced cyber threats, including AI-driven attacks like deepfakes that compromise sensitive patient information.

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Healthcare IT Today

APRIL 2, 2025

The following is a guest article by Rob Shavell, CEO at DeleteMe Healthcare cybersecurity is currently experiencing explosive growth. Bad actors can exploit PHI to commit medical fraud, insurance fraud, and identity theft. Experts believe that the size of the market will reach $35.3 billion by 2028.

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Healthcare IT Today

NOVEMBER 24, 2024

This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Cotiviti launched 360 Pattern Review , which combines pre-pay fraud, waste, and abuse prevention with post-pay review across the claim payment cycle.

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Healthcare IT Today

OCTOBER 26, 2024

Each week, we’ll be providing a look back at the articles we posted and why they’re important to the healthcare IT community. Staying a step ahead of this type of fraud requires a proactive approach to real-tine auditing and coding, noted David Lareau at Medicomp Systems. Welcome to our Healthcare IT Today Weekly Roundup.

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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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Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. Some denials result from noncompliance with federal fraud, waste, and abuse laws. Such noncompliance can result in non compliance fines.

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Electronic Health Reporter

JUNE 26, 2019

This article is copyrighted strictly for Electronic Health Reporter. These insurers do not possess the specialized knowledge needed to determine medical necessity, so they have to shift the responsibility to providers in order to minimize instances of fraud and abuse. Illegal copying is prohibited. Recently, major U.S.

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Electronic Health Reporter

OCTOBER 6, 2022

This article is copyrighted strictly for Electronic Health Reporter. The Centers for Medicare and Medicaid Services (CMS) has made no secret of its intentions to crack down on fraud, abuse, and waste, throwing more budget dollars into audits, heightening program […]. Illegal copying is prohibited. By Dana Finnegan, MDaudit.

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Hall Render

NOVEMBER 21, 2023

The United States District Court for the Eastern District of Wisconsin recently issued a decision involving protections for employees whose jobs involve the investigation of fraud. This category of individuals is sometimes called a “fraud alert employee.” Since 2009, the FCA’s anti-retaliation provision,(codified at 31 U.S.C.

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AIHC

FEBRUARY 24, 2025

Part 2: When Criminal Behavior Infiltrates Your Audit Program Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) We Recommend Reading Part 1 Fraud Indicators and Red Flags When Audit Managers Knowingly Skew Audit Results as this article is Part 2, the rest of the story.

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Electronic Health Reporter

JANUARY 31, 2024

This article is copyrighted strictly for Electronic Health Reporter. Matthew Hawley leads operations and content development for Cotiviti’s prospective payment integrity and fraud, waste, and abuse solutions. Illegal copying is prohibited. Responses from Matthew Hawley, EVP, payment integrity, Cotiviti.

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Healthcare IT Today

SEPTEMBER 21, 2022

The following is a guest article by Mandy Fogle, Healthcare Value Engineering at Shift Technology. New types of fraud are continually emerging, and it’s also become harder to uncover with traditional approaches. The telehealth market is growing at a significant rate, and fraud is continuing to grow with it.

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Electronic Health Reporter

SEPTEMBER 25, 2024

This article is copyrighted strictly for Electronic Health Reporter. Payers are increasing scrutiny and regulatory agencies are reinforcing fraud mitigation. Illegal copying is prohibited. Revenue integrity has become harder to maintain as audits grow in volume and complexity.

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Health Law Advisor

MARCH 31, 2022

Department of Justice (DOJ) intend to leverage its enforcement authority under the False Claims Act to advance DOJ’s recently announced Civil Cyber-Fraud Initiative? For more information, read our recent article: “DOJ’s Civil Cyber-Fraud Initiative: What Contractors Need to Know About Novel Use of False Claims Act”.

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Hall Render

MARCH 12, 2025

However, if a complaint alleges specific, geographically limited fraud that does not suggest a broader scheme, claims against different subsidiaries may not be precluded. This decision ensures that whistleblowers can still bring new and distinct allegations of fraud even if similar cases were filed previously.

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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. These scams are outlined in more detail below. 6:00 p.m.

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Med Law Blog

FEBRUARY 10, 2022

Highmark Health issued a Press Release on February 7, 2022 announcing that it’s Financial Investigations and Provider Review (FIPR) department generated more than $245 million in savings related to fraud waste and abuse in 2021, the majority of which was in Pennsylvania–$184 million.

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Med Law Blog

JULY 21, 2022

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”.

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Hall Render

MARCH 11, 2025

Government fraud enforcement remains aggressive : Despite this ruling, health care providers should continue prioritizing compliance with Medicare and Medicaid billing regulations. Hall Render blog posts and articles are intended for informational purposes only.

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Healthcare IT Today

FEBRUARY 7, 2025

The following is a guest article by Muhammad Shujja, Digital Marketing Lead at AltuMED Artificial Intelligence is making waves by redefining processes and streamlining operations in the evolving healthcare industry. This article examines how AI is changing medical billing. And it is just the beginning.

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Medisys Compliance

JANUARY 16, 2025

Avoid fraud: Ensure billing accurately reflects services rendered. Fraud and Abuse Prevention: Providers should routinely review their billing practices to avoid unintentional upcoding or errors that could be perceived as fraudulent. Disclaimer: CPT codes, descriptions, and other data are copyright American Medical Association (AMA).

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HIPAA Journal

MARCH 31, 2023

Ramirez (2021), which held that a risk of future harm standing alone does not constitute a concrete Article III injury in damages actions.” The lawsuit alleged breach of contract and violations of consumer protection laws in Maryland and Virginia. As such, the motion for class certification was denied.

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Healthcare IT Today

OCTOBER 23, 2024

The following is a guest article by David Lareau, CEO at Medicomp Systems A couple of years ago, we predicted an impending “explosion” of Medicare Advantage (MA) fraud and penalties. The Failure of Reactive Approaches The current approach to combating Medicare fraud is woefully inadequate.

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Healthcare IT Today

MARCH 26, 2025

The following is a guest article by Josh Rosaasen , Chief Operating Officer at Locke Bio The rise of direct-to-consumer ( DTC ) telehealth services has revolutionized how patients access medical care and prescriptions. The rise of telehealth has also led to increased scrutiny over prescription fraud and misuse.

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Med Law Blog

MARCH 18, 2024

Attached are links to the remarks of Attorney General Garland and Deputy Attorney General Monaco.

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Healthcare IT Today

NOVEMBER 22, 2024

The following is a guest article by Cody Hall, Product Manager at Synology Cybercriminals are attacking our healthcare systems at an alarming rate. This data is incredibly valuable to attackers and can be used to steal identities, commit fraud, or be sold on the black market to the highest bidder.

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Healthcare IT Today

FEBRUARY 9, 2024

Even worse, up to 10% of this spending is rife with waste, abuse, and fraud. For health payers and agencies, AI so far has been mostly applied to claims processing, member engagement, and identification of suspected cases of fraud, waste, and abuse. In other words, nearly half of all U.S. healthcare spending goes unaudited today.

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The Health Law Firm

OCTOBER 26, 2012

According to The Texas Tribune, the Texas Attorney General’s (AG) Office and the Office of Inspector General (OIG) at the Health and Human Services Commission (HHSC) have teamed up to increase investigations of fraud in the state’s Medicaid dental program for children.

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Hall Render

SEPTEMBER 15, 2022

This study comes on the heels of a recent Press Release issued July 20, 2022 (“Press Release”), in which the Department of Justice (“DOJ”) announced criminal charges against 36 defendants in 13 federal districts across the United States largely alleging fraud in the telemedicine space. Inspector General Christi A.

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Healthcare IT Today

MARCH 27, 2025

The following is a guest article by Luke Rutledge, President at Homecare Homebase The allure of AI in healthcare is undeniable. Additionally, AI-based healthcare billing and coding automation could also inadvertently perpetuate fraud or errors if the models are not adequately trained and monitored.

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Healthcare IT Today

JANUARY 14, 2025

Machine learning models will track and evaluate real-world patient data and outcomes against financial value metrics supporting outcomes-based contracts while also detecting anomalies and potential fraud. Generative AI can personalize patient education, tailoring information to each person’s needs and comprehension.

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HIPAA Journal

OCTOBER 7, 2022

In this article, I explain some of the main ways that healthcare has been improved by HIPAA for healthcare providers, health plans, and patients. HIPAA Improved Efficiency and Reduced Waste and Fraud. How Does HIPAA Improve Healthcare?

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Healthcare IT Today

OCTOBER 22, 2021

The following is a guest article by James Garvert, Senior Vice President and General Manager of Communications Solutions at Neustar. billion to phone fraud — legislators and the Federal Communications Commission […]. Faced with a ballooning epidemic of illegal robocalls and phone scams — in 2020, U.S.

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Healthcare IT Today

DECEMBER 11, 2020

The following is a guest article by Mike Noshay, MSE, Founder and Chief Strategy & Marketing Officer at Verinovum. As 2020 comes to a close, healthcare industry leaders are looking ahead to 2021 with excitement and anticipation.

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