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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Fraud Compliance Compliance Officers Licensing 94

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

Compliancy Group

DECEMBER 9, 2024

Details of the ransomware attack that exposed PHI, and that may have resulted in unauthorized parties obtaining protected health information, are provided below. The demographic information, including the names, social security numbers, addresses, driver license numbers, and birthdates, may also constitute ePHI.

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Ransomware Licensing HIPAA Compliance 98

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. Staying informed about the latest policies, best practices, and reporting requirements is essential for healthcare professionals to mitigate risks and uphold ethical standards.

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Compliancy Group

MARCH 5, 2025

With data breaches rising, protecting sensitive information is essential for staying compliant and sustaining patients’ trust. 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.

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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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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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Fraud Compliance Medicaid Medicaid 105

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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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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HIT Consultant

NOVEMBER 4, 2024

Yigal Rozenberg, SVP Technology, Protegrity The healthcare IT sector faces significant challenges in ensuring the security and privacy of sensitive patient information. Personal health information (PHI) is especially vulnerable to ransomware and cyber attacks. billion and $2.45

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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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Compliance HIPAA Licensing Governance 52

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 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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Compliance Payment Systems Fraud 105

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

Healthcare It News

DECEMBER 5, 2022

Community Health Network said it discovered on September 22 that the configuration of certain pixels on its digital properties allowed for a broader scope of patient information collection and transfer to third-party vendors, such as Meta and Google, than it realized. WHY IT MATTERS. THE LARGER TREND. This past week, the U.S.

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Fraud HIPAA Compliance Hospitals 306

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

Healthcare IT Today

MARCH 19, 2025

The following is a guest article by Philipp Pointner, Chief of Digital Identity at Jumio The healthcare industry is increasingly vulnerable to advanced cyber threats, including AI-driven attacks like deepfakes that compromise sensitive patient information.

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Fraud Ransomware HIPAA Compliance 60

HIT Consultant

DECEMBER 18, 2024

Data breaches, ransomware attacks, and system vulnerabilities have emerged as major disruptors, threatening sensitive patient information and the very foundation of patient care. The exposure of sensitive patient data, such as health records and insurance information, can lead to more insidious consequences. million in 2024.

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Ransomware Fraud Doctors HIPAA 105

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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Compliancy Group

DECEMBER 13, 2024

Maintaining healthcare compliance includes being vigilant for warning signs of potential waste, abuse, and fraud due to identity theft. Handling sensitive data like Social Security numbers, insurance coverage or enrollment information, names, or credit card numbers always puts an organization at risk for identity theft.

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Compliance Officers Compliance Electronic Medical Records Fraud 94

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. Cybersecurity is just one aspect of the broader information security landscape, with physical security being another crucial component that can sometimes be neglected.

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ADA HIPAA Compliance Fraud 59

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

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. This online system is mandatory, and it’s crucial to keep your enrollment information accurate and up-to-date.

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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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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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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

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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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.

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Fraud Medicare Medicare Compliance 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

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Fraud Medicaid Medicaid 105

Compliancy Group

FEBRUARY 5, 2025

The individuals and entities on the list are excluded from participation in federal healthcare programs because they have committed a crime, such as Medicare or Medicaid fraud, or have engaged in other misconduct. States maintain their own exclusion lists for their Medicaid programs.

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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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Compliancy Group

DECEMBER 20, 2024

In May of 2015, the NYPD informed Montefiore Medical Center that there was evidence that patient information had been stolen from the hospitals database – leading Montefiore to investigate and discover that the theft had taken place two years earlier. Monitor and safeguard its health information systems activity.

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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

NOVEMBER 25, 2024

In the healthcare industry specifically, more businesses are using tools and tactics like an OIG LEIE exclusion search to safeguard their hiring choices and automating that search with compliance software solutions. In cases like this, checking the employee’s information against Medicaid databases could also be helpful.

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Compliance Fraud Medicaid Medicaid 52

HIT Consultant

FEBRUARY 28, 2025

Bill Bruno, CEO at Celebrus Patient experience (PX) in healthcare is a crucial factor in engagement, compliance, and operational efficiency. Prioritizing Privacy and Compliance With increasing regulations around patient data, healthcare organizations must strike a careful balance between efficiency and security.

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Compliance Fraud 59

Bill of Health

OCTOBER 30, 2023

In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. This code of ethics prohibits ads from using misleading statements or omitting necessary material information. This year a “thumbs-up” emoji was found to be part of a legally binding contract. All these concerns are valid.

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Doctors Hospitals Fraud Health Insurance 290

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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