Healthcare IT Today

MARCH 27, 2025

The Risks: Ethics, Bias, and Compliance Challenges AI’s role in healthcare is evolving, but so are its associated challenges. Without strict governance, AI tools could inadvertently violate HIPAA and other healthcare privacy laws, placing patient confidentiality at riskmissteps that are not easily forgiven.

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Governance Compliance HIPAA Regulatory Compliance 60

MedTrainer

NOVEMBER 2, 2023

This critical responsibility rests on the shoulders of the healthcare compliance officer. Read on if you’ve ever wondered about the unsung heroes as we answer the question: What does a compliance officer do in healthcare? What Is the Primary Role of a Compliance Officer in Healthcare?

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Compliance Officers Compliance HIPAA Regulatory Compliance 52

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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MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

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Fraud Compliance Governance Compliance Officers 52

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. Abuse of government healthcare programs is a federal offense with severe penalties. government or a government contractor.

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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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Fraud Compliance Governance Compliance Officers 52

AIHC

JUNE 14, 2024

Understanding Elder Abuse and Financial Exploitation Statutes The federal government, states, commonwealths, territories and the District of Columbia all have laws designed to protect older adults from elder abuse and guide the practice of adult protective services agencies, law enforcement agencies, and others.

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Fraud Elder Abuse Governance Compliance 52

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. To become certified, please visit us at: American Medical Compliance (AMC).

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Fraud Medicare Medicare Compliance 52

MedTrainer

JULY 31, 2024

Healthcare organizations of all sizes and types are increasingly adopting governance, risk, and compliance (GRC) frameworks to address the industry’s complex regulatory landscape and evolving challenges. The integration of GRC programs in healthcare has been significantly bolstered by technological advancements.

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Governance Compliance HIPAA Regulatory Compliance 52

MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

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Governance Compliance Nursing Homes Medicaid 52

Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. Donna Thiel, Chief Compliance Officer at ProviderTrust, said, “It’s an opportunity to promote partnership between HR and compliance.

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Fraud US Department of Health and Human Services Licensing Nurses 52

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

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Fraud Medicare Medicare Compliance 52

Verisys

APRIL 3, 2025

Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Criminal convictions related to healthcare Felonies or misdemeanors involving fraud, patient abuse, or drug-related offenses. As such, its important to remain compliant when reporting.

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Malpractice Licensing Compliance Hospitals 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. But what exactly is considered fraud, waste, and abuse? Risk Assessment. Legislation and Congressional Requests.

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Fraud Compliance Medicaid Medicaid 98

Healthcare Compliance Blog

FEBRUARY 15, 2022

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. Congress strengthened the False Claims Act by increasing incentives for whistleblowers to file lawsuits alleging false claims on behalf of the government.

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Fraud Governance Compliance Medicare 59

Healthcare Compliance Blog

APRIL 26, 2022

The Office of Inspector General (OIG) for the US Department of Health and Human Services (HHS) has made educational resources available for healthcare providers to comply with federal healthcare laws and regulations. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.

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US Department of Health and Human Services Fraud Compliance Medicaid 59

AIHC

SEPTEMBER 25, 2024

Reviewing the Office of Inspector General's (OIG) enforcement actions is important for compliance officers because it can help them understand the OIG's focus and priorities, and how to comply with federal health care laws and regulations. Government agencies expect your organization to stay informed.

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Healthcare IT Today

DECEMBER 26, 2024

Recent incidents involving fake video calls and voice cloning demonstrate the technology’s potential for sophisticated fraud. Deepfake technology presents another critical threat, with AI-generated video and voice content enabling unprecedented impersonation attacks.

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US Department of Health and Human Services Ransomware Compliance Hospitals 90

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

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Fraud Compliance Officers Compliance Medicare 52

YouCompli

AUGUST 2, 2022

Healthcare compliance history has shown that when the government disperses significant funds, audits and enforcement associated with the disbursement of those funds will shortly follow. The Federal government spent unprecedented trillions of dollars throughout the COVID public health emergency (PHE). MorseLife agreed to pay $1.75

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COVID-19 Vaccine COVID-19 Nursing Homes Compliance Officers 52

Compliancy Group

SEPTEMBER 16, 2024

Office of Inspector General (OIG) enforces the General Compliance Program Guidance. This comprehensive document governs patient care, worker safety, and privacy and confidentiality of protected health information (PHI). Compliance officers have access to more information about their responsibilities and roles.

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Compliance Compliance Officers Fraud Electronic Medical Records 52

Health Law Advisor

AUGUST 25, 2023

In July 2022, the New York State Office of the Medicaid Inspector General (“OMIG”) proposed extensive modifications to the regulatory requirements governing compliance programs for entities receiving “significant” Medicaid revenue (increased by these regulations from a threshold of $500,000 to $1 million).

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Compliance Overpayments Overpayment Compliance Officers 52

MedTrainer

JANUARY 31, 2024

Healthcare compliance isn’t a new concept. Who started the first healthcare compliance program? federal government enacted the Federal False Claims Act (FCA) in 1863 during the American Civil War. It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations.

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Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Such an ongoing auditing system is crucial to a healthcare organization’s compliance program.

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Compliance Officers Compliance Medicare Medicare 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

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US Department of Health and Human Services Compliance Officers Fraud Compliance 52

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws.

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Compliance Due Diligence Fraud Governance 52

MedTrainer

JANUARY 26, 2024

In this blog, we will explore what is a healthcare regulatory compliance certificates, provide a high-level description of its purpose, and list who typically uses such certificates. What is Healthcare Compliance? These certificates validate their expertise in monitoring and ensuring compliance within their institutions.

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Regulatory Compliance Compliance Compliance Officers HIPAA 52

Compliancy Group

JULY 12, 2023

Designating a compliance officer and compliance committee. Policies and Procedures Healthcare organizations must create comprehensive guidelines that outline the rules and regulations governing their operations. This individual or group plays a crucial role in implementing the compliance program effectively.

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AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse.

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Fraud Medicare Medicare Compliance 52

C&M Health Law

DECEMBER 18, 2023

Compliance policies should be developed under the direction and supervision of the compliance officer and compliance committee and should address the implementation and operation of an entity’s compliance program and processes. OIG’s updated take on the seven elements is briefly summarized below. (1)

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Compliance Compliance Officers Governance Overpayments 52

Healthcare Compliance Blog

APRIL 13, 2022

The two men, both 51, were convicted of criminal healthcare fraud and conspiracy charges in 2019. The owner and administrator of Texas-based hospice and home health entities have been named in a multimillion-dollar whistleblower lawsuit. Failure to promptly report a false claim or kickback can result in lawsuits, fines, and other sanctions.

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Fraud Medicare Medicare Compliance 59

Compliancy Group

AUGUST 30, 2024

We suggest incorporating them into an annual compliance checklist for companies across the healthcare sector. HIPAA The Health Insurance Portability and Accountability Act (HIPAA) of 1996 governs how healthcare organizations handle protected health information (PHI). Under the direction of the U.S.

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Compliance Fraud Compliance Officers HIPAA 52

Verisys

MAY 3, 2023

Healthcare entities, especially those that receive funding from Medicaid or Medicare, must meet compliance standards set forth by the Office of Inspector General (OIG). These standards help mitigate an organization’s risk by preventing waste, fraud, and abuse. What is an effective healthcare compliance program?

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Compliance Compliance Officers ADA Governance 52

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. Let’s delve into the importance of healthcare compliance laws and regulations, their impact on providers and organizations, and the guidelines governing their implementation.

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Compliance Compliance Officers Fraud Compliance Framework 52

HIPAA Journal

JANUARY 30, 2023

The National HIPAA Summit is the leading forum on healthcare EDI, privacy, breach notification, confidentiality, data security, and HIPAA compliance, and the deadline for registration for the Virtual 40th National HIPAA Summit is fast approaching.

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US Department of Health and Human Services HIPAA Compliance Medicaid 81

Medisys Compliance

JANUARY 30, 2023

The medical billing industry is a complex and ever-changing field, and it is crucial for healthcare providers and billing companies to stay compliant with government regulations. Violations of the False Claims Act can result in significant financial penalties, including fines and exclusion from government healthcare programs.

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Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

MedTrainer

AUGUST 31, 2023

Let’s delve into the world of compliance with answers to the most common compliance FAQs. What Is Healthcare Compliance? Healthcare compliance refers to the process of adhering to the laws, regulations, and ethical standards that govern the healthcare industry. What Is a Compliance Officer?

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