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 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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Compliance Compliance Officers Fraud Health Insurance 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

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

HIPAA Journal

DECEMBER 31, 2022

To best answer the question what is a HIPAA violation, it is necessary to explain what HIPAA is, who it applies to, and what constitutes a violation; for although most people believe they know what a HIPAA compliance violation is, evidence suggests otherwise. What is HIPAA and Who Does It Apply To?

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HIPAA Due Diligence Compliance Fraud 132

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

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 120

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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Compliance Compliance Officers Fraud HIPAA 109

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

DECEMBER 31, 2022

The Health Insurance Portability and Accountability Act (HIPAA) is a landmark piece of legislation, but why is HIPAA compliance important? What changes did HIPAA introduce and what are the benefits to the healthcare industry and patients? Why is HIPAA Important for Healthcare Organizations?

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HIPAA Compliance Fraud Health Insurance 109

Healthcare IT Today

DECEMBER 20, 2022

The hospital may be penalized for its HIPAA compliance based on the investigation caused by the alleged illegal activities of its rogue employees. Most HIPAA violations result in civil penalties against organizations for not adequately protecting patient information or by violating a patient’s right to access their medical records.

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HIPAA Nurses Licensing Compliance 107

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

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 link] EMTALA Compliance Training Course $30.00 link] EMTALA Compliance Training Course $30.00

ADA 59

ADA HIPAA Compliance Fraud 59

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

HIPAA Journal

FEBRUARY 23, 2022

What is HIPAA? HIPAA is an acronym for the Health Insurance Portability and Accountability Act. So how did HIPAA evolve from being a vehicle for improving the portability and continuity of health insurance coverage to being one of the most comprehensive and detailed federal privacy laws? What is HIPAA Title II?

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HIPAA Fraud Health Insurance Medicaid 102

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 106

HIPAA Journal

JANUARY 12, 2023

One of the challenges with developing HIPAA was to create rules that would correct inefficiencies and get the healthcare system working more harmoniously. The way that HIPAA needed to be written has naturally led to the legislation receiving a lot of criticism. How HIPAA has Benefited Healthcare Organizations.

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HIPAA Compliance Fraud COVID-19 107

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

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. According to the HIPAA Journal, the cost of this breach is predicted to be “between $2.3 billion and $2.45

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Ransomware Regulatory Compliance Compliance Fraud 98

HIPAA Journal

JANUARY 1, 2023

Many articles discussing what does HIPAA stand for fail to give a complete answer. 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. Tackling the Cost Implications of HIPAA.

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HIPAA Health Insurance Fraud Governance 98

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

HIPAA Journal

OCTOBER 21, 2022

There are – and always have been – gaps in HIPAA and, after more than a quarter of a century, some have yet to be addressed. Most of the gaps in HIPAA are attributable to omissions from the original Act, provisions of HIPAA and HITECH that have never been enacted, and the increasing use of technology in healthcare.

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HIPAA Compliance Medicare Medicare 106

HIPAA Journal

MAY 18, 2023

The Department of Health and Human Services’ Office for Civil Rights is the main enforcer of HIPAA compliance; however, state Attorneys General also play a role in enforcing compliance with the Rules of the Health Insurance Portability and Accountability Act (HIPAA). in 2011 that was settled for $100,000.

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HIPAA Compliance Ransomware Hospitals 102

HIPAA Journal

JUNE 15, 2023

The HHS’ Office for Civil Rights (OCR) investigates all reported breaches of the protected health information of 500 or more individuals and some smaller breaches to determine if the breach was caused by the failure to comply with the HIPAA Rules.

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HIPAA Hospitals Electronic Medical Records Fraud 98

HIPAA Journal

DECEMBER 23, 2022

It has been another bad year for healthcare data breaches, with some of the biggest HIPAA breaches of 2022 resulting in the impermissible disclosure of well over a million records. The Biggest HIPAA Breaches of 2022. The 12 biggest HIPAA breaches of 2022 affected almost 22.66 million patients and health plan members.

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HIPAA Ransomware Health Insurance Compliance 103

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

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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Fraud Compliance Medicare Medicare 52

Compliancy Group

MAY 27, 2022

Here’s a roundup of recent HIPAA breach lawsuits and settlements. Lawsuits Increasing Following HIPAA Breaches – Facts and Figures. Let’s Simplify Compliance HIPAA and cybersecurity go hand-in-hand. × HIPAA Compliance Simplified. Protect your business, become compliant today! Learn More! ×

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HIPAA Ransomware Hospitals Compliance 98

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. What Is HIPAA? HIPAA, enacted in 1996, originally aimed to improve health insurance portability and reduce healthcare fraud.

HIPAA 52

HIPAA Compliance Health Insurance Fraud 52

Healthcare IT Today

MARCH 19, 2025

These events expose the limitations of traditional systems in combating emerging threats like AI-generated fraud and identity manipulation. Recent incidents, such as the massive theft of NHS records in 2024 and a surge in ransomware attacks on healthcare providers, emphasize the urgent need for stronger security frameworks.

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Fraud Ransomware HIPAA Compliance 60

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

Healthcare IT Today

MARCH 26, 2025

As the sector adapts, telehealth providers must navigate new compliance challenges, particularly regarding controlled substances, data privacy, and multi-state licensing. Telehealth providers must align with organizations like LegitScript , which certifies compliance with regulatory standards.

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FDA Compliance Licensing Fraud 52

Medisys Compliance

JANUARY 16, 2025

Providers must use HIPAA-compliant telehealth platforms and ensure informed consent is documented in the patients record. While some flexibilities have been made permanent, providers should stay updated on the latest CMS guidelines to ensure compliance. Avoid fraud: Ensure billing accurately reflects services rendered.

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Medicare Medicare Medical Billing Outsourcing Fraud 59

HIPAA Journal

DECEMBER 2, 2022

The HHS’ Office for Civil Rights has issued a bulletin confirming that the use of third-party tracking technologies on websites, web applications, and mobile apps without a business associate agreement (BAA) is a HIPAA violation if the tracking technology collects and transmits individually identifiable health information.

HIPAA 106

HIPAA Compliance Hospitals Fraud 106

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

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."

Fraud 294

Fraud HIPAA Compliance Hospitals 294

HIT Consultant

DECEMBER 18, 2024

Identity theft, fraud, and long-term financial harm are just a few examples of the personal fallout patients may face following a data breach. Prevention strategies, aligned with standards like HIPAA and HITRUST, are essential in safeguarding sensitive health data against exfiltration.

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Ransomware Fraud Doctors HIPAA 105