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

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

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 306

Fraud HIPAA Compliance Hospitals 306

Medisys Compliance

JANUARY 16, 2025

Family psychotherapy (CPT 90846, 90847): Therapy sessions focused on family dynamics, with or without the patient present. 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

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

Healthcare IT Today

MARCH 27, 2025

With only 6% of organizations having fully operationalized responsible AI frameworks , the healthcare industry must take a measured approach to ensure AI integration aligns with patient safety and regulatory compliance.

Governance 64

Governance Compliance HIPAA Regulatory Compliance 64

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.

Compliance 52

Compliance Fraud Regulatory Compliance Medicare 52

HIT Consultant

JANUARY 12, 2025

AI-generated identity fraud, including deepfakes, and other sophisticated tactics are making traditional security systems obsolete. In retail, e-commerce platforms deploy facial recognition alongside behavioral biometrics to reduce fraud during online purchases, providing a seamless yet secure shopping experience.

Fraud 64

Fraud Regulatory Compliance Ransomware Compliance 64

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.

Fraud 72

Fraud Medicare Medicare Overpayments 72

Healthcare IT Today

DECEMBER 26, 2024

Check out our community’s Healthcare Cybersecurity predictions: Bill Murphy, Director of Security and Compliance at LeanTaaS As we enter 2025, AI is revolutionizing cyber threats in concerning ways. Recent incidents involving fake video calls and voice cloning demonstrate the technology’s potential for sophisticated fraud.

US Department of Health and Human Services 93

US Department of Health and Human Services Ransomware Compliance Hospitals 93

Med-Net Compliance

JULY 20, 2022

According to court documents and evidence presented at trial, the doctor billed Medicare and Medicaid for an incision procedure of the external ear for hundreds of patients, when in fact all he actually performed was an ear exam or ear wax removal. He was convicted of one count of healthcare fraud and one count of making a false claim.

Fraud 59

Fraud Doctors Medicare Medicare 59

Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas. The psychologist was convicted of four counts of healthcare fraud.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Med-Net Compliance

JUNE 22, 2022

A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud. Update your policies as needed.

COVID-19 Vaccine 59

COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

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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Fraud Compliance Medicaid Medicaid 98

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. To become certified, please visit us at: American Medical Compliance (AMC).

Fraud 52

Fraud Medicare Medicare Compliance 52

Med-Net Compliance

SEPTEMBER 20, 2022

The defendant was also convicted for falsification of records designed to prevent detection of this fraud and aggravated identity theft for falsely corresponding with Medicare under the name of another physician. Million Healthcare Fraud Scheme appeared first on Med-Net. He is scheduled to be sentenced on Jan.

Fraud 59

Fraud US Department of Health and Human Services Medicare Medicare 59

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. Since then, the FCA has changed significantly.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

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.

Records Management 128

Records Management Regulatory Compliance Compliance HIPAA 128

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

Fraud 52

Fraud Medicare Medicare Compliance 52

Verisys

DECEMBER 29, 2024

Healthcare organizations and insurance companies rely on credentialing to ensure patient safety, regulatory compliance, and minimize liability risks. It plays a key role in reducing malpractice risks, preventing fraud, and verifying that healthcare professionals have the necessary training and clinical experience to perform their duties.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

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. Alario pleaded guilty to his role in the healthcare fraud scheme earlier this month.

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Fraud HIPAA FDA Health Insurance 60

Healthcare Law Blog

NOVEMBER 9, 2023

In late April this year, the Office of Inspector General, Department of Health and Human Services (OIG) announced that it would make changes to its existing body of healthcare compliance program guidance (CPGs) as part of its current Modernization Initiative. [1] On November 6, 2023, OIG finally published the GCPG on its website [3].

Compliance 52

Compliance Compliance Officers Fraud Medicare 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.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

Compliancy Group

JULY 18, 2024

It’s becoming more well-known that billing is one of the most common compliance risk areas outlined by the Office of the Inspector General (OIG). The occurrence of these issues is consistent, and over time, they can result in thousands of dollars lost in compliance penalties.

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Medical Billing Compliance Fraud Compliance Officers 52

Healthcare Law Blog

MAY 11, 2023

The Department of Health and Human Services Office of Inspector General (OIG) recently announced changes to its process for informing healthcare industry stakeholders of new or updated Compliance Program Guidance (CPG). Historically, sector-specific CPG has been published in the Federal Register.

Compliance 52

Compliance Fraud Nurses Medicare 52

MedTrainer

APRIL 22, 2024

Creating and using a supplier compliance checklist ensures vendors meet regulatory requirements and are trusted partners in managing sensitive information. In this article, I’ll discuss why supplier compliance is as critical as legal and regulatory adherence for healthcare organization employees.

Compliance 52

Compliance HIPAA Licensing Fraud 52

Med-Net Compliance

JULY 26, 2022

In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds. Discussion Points: Review policies and procedures regarding the use of telemedicine within the facility and related requirements for preventing fraud, waste, and abuse of government funds.

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Fraud Telemedicine Medicare Medicare 59

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors?

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

MedTrainer

FEBRUARY 7, 2025

Being prepared for a healthcare coding and compliance audit protects your healthcare organization from significant risks, such as fines, reimbursement issues, and potential loss of patient trust. This article will walk you through the steps so that your organization is healthcare coding and compliance audit-ready.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

AIHC

MAY 24, 2022

Once your suspicions have been reported to the Compliance Officer, were you asked to partake in evidence gathering during the investigation? Forensic investigations are specialized in nature, and the work requires detailed knowledge of fraud investigation techniques and the legal framework.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

Compliancy Group

OCTOBER 9, 2024

The primary place where healthcare organizations go wrong with their compliance efforts is that their compliance programs are reactive versus proactive. Workforce compliance in healthcare involves a comprehensive approach to establishing certain protocols and guidelines and helps maintain a continuously safe working environment.

Compliance 52

Compliance Compliance Officers HIPAA Fraud 52

Verisys

JUNE 8, 2023

Data Compliance: How to Identify and Close Data Risk Gaps Using Technology A three-part compliance series that focuses on using technology to help you achieve your compliance goals. Hiring a provider with red flags, even if in the past, can put your organization at risk for non-compliance. Fraud Data Gap The U.S.

Compliance 52

Compliance Fraud Licensing Medicare 52

Health Care Law Brief

JULY 21, 2022

On July 20, 2022, the Office of Inspector General for the Department of Health and Human Services (“ OIG ”) issued a special fraud alert (“ Alert ”) advising “practitioners to exercise caution when entering into arrangements with purported telemedicine companies.” OIG Flags Seven Characteristics of Telehealth Fraud.

Fraud 52

Fraud Telemedicine COVID-19 Governance 52

Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. Donna Thiel, Chief Compliance Officer at ProviderTrust, said, “It’s an opportunity to promote partnership between HR and compliance.

Fraud 52

Fraud US Department of Health and Human Services Licensing Nurses 52

HIT Consultant

JULY 25, 2024

Presently, many healthcare organizations remain in limbo after the attack, which exposed 6 terabytes of sensitive patient data, without access to important services such as claim processing for prescriptions, and daily workflows around auditing and reporting. With expertise in leading teams and ensuring successful project execution.

Compliance 111

Compliance HIPAA Regulatory Compliance Ransomware 111

HIPAA Journal

JANUARY 10, 2023

An external investigation into credit card fraud pointed to Captify Health as the source of a data breach. As an online retailer, Captify Health collects customer information and processes debit/credit card payments through the website.

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HIPAA Doctors Fraud Compliance 117