HIPAA Seal of Compliance = Consumer Fraud
Healthcare IT Today
JANUARY 19, 2021
The Federal Trade Commission (FTC) announced a consumer fraud settlement against a company that displayed a ‘HIPAA Compliant’ seal on its website.
Using Compliance Software To Prevent Healthcare Fraud, Waste, and Abuse
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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Healthcare Providers’ Role in Preventing Fraud, Waste, and Abuse
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.
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How to Conduct Effective Compliance Audits
American Medical Compliance
OCTOBER 25, 2024
Compliance isn’t just a box to check—it’s a vital responsibility that safeguards patient well-being and protects organizations from significant financial losses. A powerful way to ensure this is through regular compliance audits. This is to confirm that staff are properly trained in compliance protocols.
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Everything You Wanted to Know About FACIS, but Didn’t Know to Ask
Speaker: Amy Anderson
Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. Verisys innovates compliance by leveraging data to meet specific healthcare needs such as eligibility screening, pre-hire screening, and ongoing monitoring.
Understanding FWA Compliance in Healthcare
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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Seven Elements of a Compliance Program
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.
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Mastering HR Compliance Training in Healthcare
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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Spring Forward With 2024 Compliance Changes
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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These are the compliance issues providers should be preparing for, post-PHE
Healthcare IT News - Telehealth
JUNE 8, 2022
based attorney in the health law practice of Baker, Donelson, Bearman, Caldwell & Berkowitz about what providers should be doing to ensure compliance when the PHE finally sunsets. What do you see as the primary compliance issues providers will have to contend with? We spoke recently with Allison M. Cohen, a Washington, D.C.-based
HITECH Compliance
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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Indiana Physician Fraud Conviction Highlights Compliance Risks
Hall Render
NOVEMBER 1, 2024
Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. This disparity highlights the difficulty in accurately assessing the risks and potential penalties associated with health care fraud violations.
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Navigating Healthcare Compliance and Fraud: Insights from a Legal Expert
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.
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Detecting Behavioral Health Fraud: How Health Plans Can Strengthen Their Approach
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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What the future holds for HHS-OIG health IT enforcement
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.
Secure Payment Card Industry (PCI) Compliance Training
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.
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False Claims Act Retaliation Decision Calls into Question the Heightened Burden for Employees Whose Duties Include Compliance and Fraud Investigation
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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Essentials of Medicare Fraud, Waste, and Abuse Training
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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Healthcare Compliance for New Providers: Getting Started
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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Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks
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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The Essential Components of an Effective Healthcare Compliance Program
Healthcare Blog
NOVEMBER 9, 2023
An effective healthcare compliance program is a crucial aspect of any healthcare organization. Healthcare organizations should clearly define their expectations and the consequences for non-compliance. Healthcare organizations should clearly define their expectations and the consequences for non-compliance.
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Dental Fraud Schemes Uncovered
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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Best Practices for Healthcare Compliance Documentation
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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Preventing Genetic Testing Fraud: 5 Actions for Health Plans
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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Building an OIG Compliance Program for Physicians
Compliancy Group
JUNE 13, 2024
Data privacy is only part of Office of the Inspector General (OIG) compliance. Since the start of the data privacy rule in 2003 alone, there have been at least 350,000 Health Insurance Portability and Accountability Act complaints with 1,188 compliance reviews. While these compliance programs are voluntary, they are essential.
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Introducing Our New Service: Exclusion Screening for Healthcare Compliance
Total Medical ComplianceHIPAA
APRIL 12, 2024
As healthcare providers navigate the complex web of rules and regulations in compliance, one aspect that needs more attention is exclusion screening of those working with federally funded healthcare programs. Non-compliance with these requirements could result in financial penalties and jeopardize participation in Federal healthcare programs.
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Your Guide on How to Be a Good Compliance Officer
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?
Two Healthcare Organizations Caught Up in Medicare Fraud Schemes
Compliancy Group
FEBRUARY 12, 2024
Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.
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Is Your Cybersecurity Strategy Gambling Everything?
Healthcare IT Today
MAY 10, 2022
Contract Enforcements Tie Cybersecurity to Financial Fraud and Liability The receptionist you yelled at for shopping online could turn you in and get a $900,000 reward. When it comes to compliance, ignoring the contracts you sign – including with Medicare and your insurance policies – can hit you really hard and really fast.
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Community Health Network reports online tracking data breach affecting 1.5 million
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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The Role of Compliance Officers in Healthcare Organizations: Challenges and Responsibilities
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.
Why Workforce Compliance Software Is the Solution for Healthcare
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.
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OIG Releases New Industry-Specific Compliance Program Guidance for Nursing Facilities
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.
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OIG Compliance Program Guidance for Nursing Facilities
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.
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Emoji Laws in Health Care ????
Bill of Health
OCTOBER 30, 2023
In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. Finally, emojis raise legal issues as a new form of data subject to HIPAA compliance, as well as accessibility concerns for the visually impaired. This year a “thumbs-up” emoji was found to be part of a legally binding contract.
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How To Prepare for an OIG Inspection
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. That mean, maintaining compliance standards, efficient reporting, and conducting thorough internal audits are vital.
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An Overview of Healthcare Compliance Laws and Regulations
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.
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OIG looking closely at telehealth as it weighs future enforcement
Healthcare IT News - Telehealth
AUGUST 11, 2021
In a session at HIMSS21 on Tuesday, two HHS OIG leaders offered a look at the enforcement priorities the agency has in mind these days, and some hints about the compliance responsibilities healthcare organizations should be prioritizing in the coming months. billion, with a B, of alleged fraud. "One scheme went for $1.6
Why Are Incident Reports Important in the Compliance Reporting Process?
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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Ensuring Effective Healthcare Regulatory Compliance Training
Compliancy Group
JULY 3, 2024
One area that is often overlooked in onboarding training is regulatory compliance. Healthcare regulatory compliance training is of particular importance as it ensures the safety and wellbeing of patients and staff, and that privacy standards are upheld. Some compliance training is mandatory, while others are recommended.
Medicare FWA Compliance Training
American Medical Compliance
JULY 9, 2024
The Medicare FWA Compliance Training aims to educate healthcare providers (HCP) on the definitions of fraud, waste, and abuse in the context of Medicare. American Medical Compliance is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education to physicians.
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Celebrating the Healthcare Compliance Officer
AIHC
SEPTEMBER 3, 2024
Celebrating the Healthcare Compliance Officer The American Institute of Healthcare Compliance is recognizing healthcare Compliance Officers – hats off to you! The primary goal of a compliance officer is to mitigate risk. This involves investigating complaints and conducting internal auditing and monitoring for compliance.
Important Resources to Ensure Medicare Compliance
Compliancy Group
MARCH 22, 2024
As a compliance officer or critical decision-maker, you can help your healthcare organization avoid exclusion from this valuable program by creating a comprehensive compliance program and using software to streamline your compliance processes. Remaining in good standing with Medicare has several advantages.
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