Verisys

MARCH 6, 2025

What Is AI in Healthcare Compliance? Imagine having a tireless assistant who handles the nitty-gritty of regulatory compliance so healthcare teams can focus on what matters mostpatient care and privacy. AI in healthcare compliance taps into the power of machine learning, natural language processing, and automation.

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

Compliancy Group

AUGUST 9, 2024

Maintaining healthcare compliance depends on having many tools and strategies at your disposal, especially when faced with an audit or incident of non-compliance. Perhaps the most essential element is compliance documentation. What Does Compliance Documentation Involve?

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Compliancy Group

MARCH 5, 2025

When it comes to HIPAA compliance vs. ISO 27001, many businesses opt for both because the HIPAA Security Rule and the ISO 27001 framework can be used for data risk management. Lets examine the differences and similarities between HIPAA compliance vs. ISO 27001 and consider how you can simplify your approach to compliance.

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HIPAA Compliance Fraud Health Insurance 52

YouCompli

MARCH 18, 2025

opioid epidemic holds important lessons for compliance professionals. In the context of the opioid epidemic, the HHS OIGs responsibilities are multi-faceted, including fraud and abuse enforcement, corporate accountability, audits of pharmaceutical practices, and civil and criminal penalties.

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Compliance Compliance Officers Public Health Doctors 52

Verisys

MARCH 6, 2025

In the healthcare industry, compliance with regulatory standards is not merely a requirement but a cornerstone of safe, effective, and ethical patient care. When healthcare organizations fail to meet compliance standards, the consequences can be severespanning legal and financial realms. What is Non-Compliance in Healthcare?

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American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. The Department of Justice recently revealed charges against 78 individuals involved in healthcare fraud schemes. In this comprehensive guide, we delve into FWA compliance in healthcare.

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Compliance Fraud HIPAA Health Insurance 105

Compliancy Group

AUGUST 28, 2024

Human resources (HR) professionals have a stake in their organizations’ healthcare compliance practices. Regardless of company size or number of employees, thorough HR compliance training ensures that your practice, hospital, or company protects patients and workers.

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Compliance Fraud Regulatory Compliance HIPAA 97

American Medical Compliance

AUGUST 7, 2024

Notably, many of these incidents are preventable and could have been avoided with proper compliance measures. Compliance with healthcare regulations is crucial not only for avoiding legal repercussions but also for ensuring high standards of patient care and safety. It ensures its confidentiality and maintains security.

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Compliance HIPAA Medicaid Medicaid 105

Medisys Compliance

JANUARY 16, 2025

Documentation should support the need for these services, linking them directly to the patients diagnosis and treatment plan. Documentation Requirements Proper documentation is vital for compliant billing and successful reimbursement. Compliance with Medicare Regulations Compliance is crucial to avoid audits and penalties.

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Medicare Medicare Medical Billing Outsourcing Fraud 59

Healthcare IT Today

OCTOBER 26, 2024

In the wrong hands, LLMs can generate false or exaggerated medical documentation in an instant. 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. Read more… It’s Time to Combat “Instafraud” in Medicare Advantage.

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Medisys Compliance

MARCH 31, 2025

Accurate and efficient Medicare billing is not merely about receiving timely payments; it forms the base for financial stability, regulatory compliance, and ultimately, the ability to continue providing quality patient care. Medicare Compliance & Audit Risks Compliance with Medicare regulations is crucial to avoid penalties and audits.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 59

MedTrainer

JANUARY 10, 2024

It may seem a little early to do some spring cleaning, but not when it comes to compliance! It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. The OIG is making major investments to systematically detect and prosecute fraud.

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Compliance Fraud HIPAA Compliance Officers 94

Bill of Health

OCTOBER 30, 2023

In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. The use of emojis in healthcare documents would align with the idea of legal design. Finally, emojis raise legal issues as a new form of data subject to HIPAA compliance, as well as accessibility concerns for the visually impaired.

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Doctors Hospitals Fraud Health Insurance 290

Compliancy Group

DECEMBER 13, 2024

Maintaining healthcare compliance includes being vigilant for warning signs of potential waste, abuse, and fraud due to identity theft. The term red flag refers to warning signs of fraud, waste, and abuse due to identity theft and other unlawful acts. Specific indications or red flags can tip you off to nefarious activities.

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Compliance Officers Compliance Electronic Medical Records Fraud 94

Hall Render

MARCH 4, 2025

Department of Health and Human Services (HHS) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community. Medical Directors in Nursing Homes 42 CFR 483.70(g) See 42 C.F.R. See 42 C.F.R.

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AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

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Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

Healthcare IT Today

FEBRUARY 13, 2025

For instance, Sarbanes-Oxley (SOX) followed the Enron fraud, updates to FISMA came after the 2015 Office of Personnel Management (OPM) breach, and the Securities and Exchange Commissions cybersecurity disclosure provisions were implemented after breaches at Equifax and SolarWinds. Whats Changing in Healthcare Cybersecurity?

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Compliance HIPAA Ransomware Fraud 59

Total Medical Compliance Resources

NOVEMBER 11, 2024

Total Medical Compliance is excited to announce the launch of its new suite of online courses designed to enhance the skills and knowledge of healthcare professionals. link] HIPAA Fraud, Waste, and Abuse Awareness Course $30.00 Our new online course on HIPAA regulations equips employees to combat fraud, waste, and abuse in healthcare.

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ADA HIPAA Compliance Fraud 59

Compliancy Group

FEBRUARY 9, 2024

One crucial tool that helps healthcare organizations achieve this is compliance program guidance documents. These comprehensive guidelines are designed to assist various healthcare settings in implementing effective compliance programs, ensuring that they operate within legal boundaries while providing quality care to patients.

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Compliance Fraud Hospitals 52

Med-Net Compliance

JUNE 13, 2022

Three independent clinical laboratories, their owner and holding company, an additional independent clinical laboratory and its owner, two laboratory marketing companies, and a Massachusetts physician have been charged in connection with Medicaid fraud, money laundering, and kickbacks involving urine drug tests?that

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Fraud Medicaid Medicaid 105

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."

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Compliancy Group

APRIL 25, 2024

Maintaining Medicare compliance and avoiding legal and financial repercussions requires Medicare compliance training for employees at all organizational levels. Examples of Medicare fraud include billing for unrendered services and using a billing code or a service that’s more expensive than what a patient received.

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Fraud Medicare Medicare Compliance 59

American Medical Compliance

FEBRUARY 9, 2024

Compliance officers’ responsibilities extend far beyond merely checking boxes and ticking off regulatory requirements. In fact, 61% of the compliance teams from a Thomson Reuters report also work on long-range strategies for their companies by putting regulatory and legislative changes as a top priority.

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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.

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Healthcare Blog

NOVEMBER 9, 2023

An effective healthcare compliance program is a crucial aspect of any healthcare organization. These documents should serve as a roadmap for employees. Healthcare organizations should clearly define their expectations and the consequences for non-compliance. Patient safety and consistent quality care will maintain priority.

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Compliance Compliance Officers ACA Patient Satisfaction 98

Healthcare Blog

JANUARY 19, 2025

However, the success of swing bed programs hinges on strict adherence to Medicare Swing Bed Rules , a set of regulations established by the Centers for Medicare & Medicaid Services (CMS) to ensure compliance and optimize patient care. Compliance with Medicare Swing Bed Rules is non-negotiable for CAHs operating these programs.

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American Medical Compliance

JANUARY 9, 2024

The following Documentation and Provider Standards Training educates healthcare providers on the significance of documentation compliance in healthcare. It also provides an introduction to all things related to healthcare compliance, which is important for all healthcare facilities to know about.

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Fraud Compliance HIPAA Health Insurance 52

Healthcare IT News - Telehealth

JANUARY 30, 2023

" The audit found that it did not require key implementation decisions and plans to be documented. It also did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, before implementing the temporary and permanent MBS telehealth items.

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Verisys

DECEMBER 29, 2024

Healthcare organizations and insurance companies rely on credentialing to ensure patient safety, regulatory compliance, and minimize liability risks. It plays a key role in reducing malpractice risks, preventing fraud, and verifying that healthcare professionals have the necessary training and clinical experience to perform their duties.

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Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas. The psychologist was convicted of four counts of healthcare fraud.

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Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Med-Net Compliance

JULY 20, 2022

According to court documents and evidence presented at trial, the doctor billed Medicare and Medicaid for an incision procedure of the external ear for hundreds of patients, when in fact all he actually performed was an ear exam or ear wax removal. He was convicted of one count of healthcare fraud and one count of making a false claim.

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Fraud Doctors Medicare Medicare 59

Compliancy Group

JULY 10, 2024

Compliance with healthcare regulations protects patients, safeguards employee safety, and maintains the security of electronic medical records (EMRs) and cyber networks. Ensuring compliance with critical regulations falls on the compliance officer. What Does a Compliance Officer Do?

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MedTrainer

JANUARY 21, 2025

Todays healthcare organizations face mounting pressures to keep impeccable compliance records while managing increasingly complex operations. Proactivity in the form of continuous OIG exclusion list monitoring is key to minimizing risk, maintaining compliance, and avoiding costly mistakes.

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Compliance Fraud Regulatory Compliance Medicare 52

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

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Fraud Medicaid Medicaid Compliance 59

Compliancy Group

JUNE 27, 2024

Completing compliance incident reports is crucial to reducing the number of accidents in the future and understanding why they occur. Understanding what incidents need reporting and how to complete an incident report can help providers, compliance officers, and other personnel maintain the highest safety standards.

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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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Fraud Medicare Medicare Overpayments 72

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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