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.

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.

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Compliance HIPAA Medicaid Medicaid 105

HIPAA Journal

MARCH 15, 2023

FHKC is a state-created entity that offers health and dental insurance to children in Florida between the ages of 5 and 18. FHKC receives Medicaid funds and state funds for providing health insurance programs for children in Florida.

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Health Insurance HIPAA Fraud Due Diligence 100

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

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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Compliance Officers Compliance Patient Advocacy Regulatory Compliance 102

Bill of Health

OCTOBER 30, 2023

In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. In health care, complexity is everywhere. Health insurance is confusing. Notes about our health can be difficult to understand. This year a “thumbs-up” emoji was found to be part of a legally binding contract.

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Doctors Hospitals Fraud Health Insurance 290

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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Compliance Compliance Officers ACA Patient Satisfaction 98

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

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?

Compliance 72

Compliance Compliance Officers Regulations Compliance HIPAA 72

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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Compliance Officers Compliance Fraud Electronic Medical Records 64

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. This means your practice could face prolonged damages.

Compliance 59

Compliance Fraud Regulatory Compliance Health Insurance 59

Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

Fraud 59

Fraud COVID-19 Health Insurance Compliance 59

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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HIPAA Journal

APRIL 25, 2024

The exposed and stolen data included contact information, Social Security numbers, driver’s license numbers, financial information, health insurance information, medical records, medical histories, diagnoses/conditions, and health insurance information.

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Fraud Health Insurance HIPAA Licensing 119

HIPAA Journal

JULY 9, 2024

The data compromised in the incident included names, addresses, phone numbers, Social Security numbers, birth dates, diagnoses, treatment information, prescriptions, physician names, medical record numbers, device serial numbers, and health insurance information. Another lawsuit was filed by plaintiff Arthur Podroykin in the U.S.

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Fraud Health Insurance HIPAA Compliance 121

Healthcare IT Today

NOVEMBER 22, 2024

In addition to the challenges that all organizations face like multiple devices, applications, and operating systems being used for day-to-day operations, they also store massive amounts of sensitive protected health information (PHI). Failure to comply with these laws can result in large fines, lawsuits, and a loss of trust from patients.

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Ransomware Hospitals COVID-19 Compliance 72

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

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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Medicare Medicare Compliance Fraud 52

HIPAA Journal

OCTOBER 7, 2022

Questions are often sent to HIPAA Journal about the Health Insurance Portability and Accountability Act, one of which is how HIPAA has improved healthcare. In this article, I explain some of the main ways that healthcare has been improved by HIPAA for healthcare providers, health plans, and patients.

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HIPAA Fraud Health Insurance Compliance 108

MedTrainer

JULY 25, 2024

Adhering to the Health Insurance Portability and Accountability Act (HIPAA) standards is crucial to uphold compliance and regulatory requirements for any health organization. HIPAA, enacted in 1996, originally aimed to improve health insurance portability and reduce healthcare fraud. What Is HIPAA?

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HIPAA Compliance Health Insurance Fraud 52

HIPAA Journal

JANUARY 1, 2023

Most state that HIPAA is an acronym of the Health Insurance Portability and Accountability Act of 1996 and that it led to the development of standards for the privacy of Protected Health Information. However, at the time, the healthcare insurance industry was governed by a hotchpotch of federal and state legislation.

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HIPAA Health Insurance Fraud Governance 100

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

HIPAA Journal

JANUARY 20, 2023

It has been almost 27 years since the Health Insurance Portability and Accountability Act (HIPAA) was signed into law, more than 2 decades since the Privacy Rule was enacted, and this February will be the 20 th anniversary of the HIPAA Security Rule.

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HIPAA Fraud Compliance Health Insurance 121

Healthcare IT Today

DECEMBER 21, 2023

The following is a guest article by Mitchell Perry, VP Compliance & Security at Access In the ever-evolving landscape of healthcare IT in US healthcare frameworks, integrating electronic health records (EHRs) has become a cornerstone for providers. If healthcare providers fail to comply, the consequences can be costly.

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Records Management Regulatory Compliance Compliance HIPAA 128

Compliancy Group

OCTOBER 16, 2024

There’s a significant connection between healthcare compliance and risk management. Compliance officers must thoroughly understand both concepts to protect their organizations and the patients they serve. We’ll discuss how regulatory compliance enables proper risk management and how risk assessment advances healthcare compliance.

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Compliance Compliance Officers Fraud Regulatory Compliance 52

Healthcare IT News - Telehealth

JULY 2, 2020

Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma to provide a written plan for permanent changes to Medicare, Medicaid and Children’s Health Insurance Program rules around telehealth.

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Compliancy Group

MAY 15, 2024

As we move deeper into 2024, hospitals must increasingly focus on compliance with regulations set forth by the Office of Inspector General (OIG). This guide outlines the OIG’s hospital compliance priorities and provides actionable advice on ensuring your hospital meets these rigorous standards.

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Compliance Hospitals Fraud Regulatory Compliance 52

Compliancy Group

MARCH 21, 2024

It’s challenging enough to stay on top of constantly changing compliance regulations in healthcare, including training. Instead of continuously working hard to maintain all these administrative and logistical functions, you can be more innovative by letting compliance training software do the heavy lifting.

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

Compliancy Group

FEBRUARY 28, 2024

Many industries have compliance rules and regulations to meet and follow, but few would argue that healthcare is one of the most stringent. Privacy and security – Compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient privacy and data security is crucial.

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Compliance US Department of Health and Human Services Fraud Medicare 52

HIPAA Journal

MARCH 11, 2025

An investigation was launched, and it was confirmed that RIPTAs previous health insurance provider, UnitedHealthcare of New England, had provided RIPTA with files containing the data of non-RIPTA employees, and that data was compromised in the attack.

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Ransomware Fraud HIPAA Health Insurance 51

Compliancy Group

AUGUST 30, 2024

Ensuring compliance in your hospital, private practice, or healthcare company means safeguarding patient data, optimizing working conditions for employees, and promoting the highest quality of care. We suggest incorporating them into an annual compliance checklist for companies across the healthcare sector.

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Compliance Fraud Compliance Officers HIPAA 52

MedTrainer

JANUARY 31, 2024

Healthcare compliance isn’t a new concept. Who started the first healthcare compliance program? It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. What is Healthcare Compliance?

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Compliance Fraud Governance ACA 52

Compliancy Group

MARCH 19, 2024

Hospitals and private practices aren’t the only enterprises with compliance obligations within this sector. Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations.

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

Compliancy Group

OCTOBER 4, 2024

Despite your best efforts in meeting healthcare compliance requirements, errors may still occur. Maintaining the security and integrity of sensitive information and preventing waste, fraud, and abuse is essential to quality healthcare and promoting workplace safety. What is an Audit in Healthcare?

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Compliance Officers Compliance Regulatory Compliance Fraud 59

HIPAA Journal

OCTOBER 21, 2022

A pharmaceutical sales rep has pleaded guilty to conspiring to commit healthcare fraud and wrongfully disclosing and obtaining patients’ protected health information in an elaborate healthcare fraud scheme involving criminal HIPAA violations. Ritson identified the patients through the medical practice of Dr. Frank Alario.

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Fraud HIPAA FDA Health Insurance 60

HIPAA Journal

FEBRUARY 23, 2022

HIPAA is an acronym for the Health Insurance Portability and Accountability Act. When the Health Insurance Portability and Accountability Act was passed by Congress in 1996, the establishment of federal standards for safeguarding PHI was not one of the primary objectives. What is HIPAA? What is HIPAA Title II?

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HIPAA Fraud Health Insurance Medicaid 102