American Medical Compliance

MARCH 6, 2025

Fraud, Waste, and Abuse (FWA) remain critical challenges in the healthcare industry, impacting patient care, financial integrity, and regulatory compliance. Whether you’re a season professional or new to compliance training, this course will help you navigate FWA-related challenges with confidence and accountability.

Fraud 52

Fraud Medicare Medicare Compliance 52

AIHC

FEBRUARY 17, 2025

When Audit Managers Knowingly Skew Audit Results Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. on fraud detection and prevention in healthcare.

Fraud 52

Fraud Compliance Overpayment Overpayments 52

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!

Fraud 94

Fraud Compliance Compliance Officers Licensing 94

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.

HIPAA 52

HIPAA Compliance Fraud Health Insurance 52

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.

Compliance 52

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

Compliancy Group

NOVEMBER 6, 2024

Unfortunately, the complexity of healthcare compliance makes following the rules and being aware of updates challenging. Workforce compliance management entails implementing policies and procedures that align with these regulations. Staying compliant with healthcare regulations is everyone’s responsibility in the organization.

Compliance 52

Compliance Compliance Officers Fraud Health Insurance 52

Compliancy Group

OCTOBER 28, 2024

Health and Human Services (HHS) Department’s efforts to eliminate fraud, waste, and abuse. Its compliance program guidance (CPG) has improved the efficiency and effectiveness of Medicare and many other federal programs. However, in smaller facilities with staffing challenges, a compliance officer may need to fulfill other roles.

Nurses 52

Nurses Compliance Nursing Homes Compliance Officers 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?

Compliance 52

Compliance HIPAA Licensing Governance 52

Compliancy Group

JANUARY 23, 2025

A classic example is Medicare fraud. Providers who bill Medicare for services they did not actually provide and who present the bill with the knowledge that the service was not performed have committed Medicare fraud. The DOJ has focused much of its anti-fraud efforts on pursuing these cases, litigating several of them in 2024.

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

Compliancy Group

NOVEMBER 1, 2024

When you work in healthcare, you must comply with the most rigorous regulations that safeguard patient health and privacy, protect workers, and prevent fraud, waste, and abuse of federal funds. Anyone in this industry should know the healthcare compliance laws and regulations that guide how they do their jobs and provide quality care.

Compliance 52

Compliance HIPAA Electronic Medical Records Fraud 52

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.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

American Medical Compliance

JUNE 21, 2024

Fraud, waste, and abuse (FWA) in healthcare present significant challenges, causing substantial financial losses, eroding public trust, and compromising the quality of patient care. Unlike fraud, waste is not necessarily intentional but results from inefficiencies.

Fraud 105

Fraud Compliance Medicaid Medicaid 105

Health Law Attorney

NOVEMBER 22, 2024

On November 20, 2024, the Office of Inspector General (OIG) released its updated Industry-Specific Compliance Program Guidance (ICPG) for nursing facilities, marking an important step in its broader compliance initiative. This shift reflects OIG’s recognition of the direct relationship between care quality and compliance.

Nurses 52

Nurses Compliance Fraud Governance 52

Compliancy Group

DECEMBER 9, 2024

Jefferson Dental has also notified patients that they may place an initial or extended fraud alert on their credit files at no cost. How Compliancy Group Can Help Healthcare organizations that use Compliancy Groups healthcare compliance tracking software, the Guard, are better equipped to prevent, manage, and recover from security incidents.

Ransomware 98

Ransomware Licensing HIPAA Compliance 98

HIPAA Journal

MARCH 30, 2023

The seven elements of a compliance program are integrated processes organizations in all industries can adopt to help them develop a culture of compliance in the workplace. While the seven elements of a compliance program apply to all industries, they originated in the healthcare industry in the 1990s.

Compliance 111

Compliance Compliance Officers Fraud HIPAA 111

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.

Compliance 52

Compliance Nursing Homes Nurses Medicare 52

American Medical Compliance

FEBRUARY 21, 2025

AMC (American Medical Compliance) has achieved a major milestone by expanding into the UAE, Saudi Arabia, and the broader Middle East, reinforcing its position as a key player in global healthcare compliance.

Compliance 71

Compliance ADA Governance Medical Billing 71

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.

Compliance 97

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.

Compliance 105

Compliance HIPAA Medicaid Medicaid 105

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.

Fraud 52

Fraud Compliance Medicare Medicare 52

American Medical Compliance

AUGUST 15, 2024

In the healthcare industry, where sensitive financial and personal information is regularly processed, maintaining secure Payment Card Industry (PCI) compliance is critical. PCI compliance not only protects patient payment data but also ensures that healthcare organizations meet stringent regulatory requirements.

Compliance 105

Compliance Payment Systems Fraud 105

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.

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

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.

Compliance 99

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

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.

Compliance Officers 94

Compliance Officers Compliance Electronic Medical Records Fraud 94

HIT Consultant

NOVEMBER 21, 2024

billion annually to maintain HIPAA compliance with patient data. The ability to create a smart contract for a healthcare claim and remittance introduces automation, transparency, and auditability while removing fraud from the process of healthcare payments.

Fraud 97

Fraud HIPAA Compliance 97

Healthicity

SEPTEMBER 26, 2024

In the latest episode of Compliance Conversations , host Dr. CJ Wolf sits down with Rebecca Busch , a healthcare compliance expert with over four decades of experience.

Fraud 52

Fraud Compliance Nurses Compliance Officers 52

HIT Consultant

NOVEMBER 4, 2024

By implementing thorough cybersecurity measures and adhering to regulatory compliance, healthcare providers can fortify their systems and ensure the confidentiality and integrity of critical health information. However, protecting patient identity is equally crucial. billion and $2.45

Ransomware 98

Ransomware Regulatory Compliance Compliance Fraud 98

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

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.

Compliance Officers 102

Compliance Officers Compliance Patient Advocacy Regulatory Compliance 102

Healthcare IT News - Telehealth

JUNE 28, 2021

At the same time, he said, "it's important that these new policies that have this great potential to improve care aren't compromised by fraud or abuse or misuse." " VanLandingham explained that the healthcare fraud space gets "tens of thousands of complaints." in Venetian Lido 3104.

US Department of Health and Human Services 200

US Department of Health and Human Services Fraud Compliance Medicaid 200

Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

Fraud 98

Fraud Nurses Medicare Medicare 98

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.

Fraud 72

Fraud Compliance 72

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.

Fraud 59

Fraud Medicare Medicare Compliance 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.

ADA 59

ADA HIPAA Compliance Fraud 59

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?

Compliance 59

Compliance HIPAA Ransomware Fraud 59

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

Fraud 105

Fraud Medicaid Medicaid 105

Healthcare IT Today

OCTOBER 26, 2024

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. Medication tracking software maker Bluesight acquired Sectyr , a compliance and audit management platform. Read more… It’s Time to Combat “Instafraud” in Medicare Advantage.

Ransomware 95

Ransomware Fraud Licensing Nurses 95