Healthicity

NOVEMBER 14, 2023

Reporting incidents of potential fraud should be on every compliance professional’s radar (because it’s definitely on the OIG ’s).

Compliance 52

Compliance Fraud 52

HIPAA Journal

MAY 27, 2022

The plaintiffs alleged that they face an ongoing and imminent risk of identity theft and fraud, as there is no way to cancel protected health information. Judge Bricetti referred to the decision of the Second Circuit Court’s decision in McMorris v.

Fraud 79

Fraud HIPAA 79

HIT Consultant

MAY 11, 2023

1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation’s $2.26 Simply stated, one definition of artificial intelligence (AI) is technology that thinks and does what a human can do, but much faster.

Fraud 98

Fraud Governance Public Health 98

Verisys

NOVEMBER 8, 2023

All individuals and organizations that meet the definition of healthcare provider as described in 45 CFR 160.103 and conduct HIPAA transactions or use health records must obtain an NPI. Tracking actions to a standardized identifier provides transparency that can identify and impede fraud. Who Needs an NPI?

Fraud 97

Fraud HIPAA Medicare Medicare 97

Hall Render

APRIL 6, 2022

Second, the relator pointed out that Pharmacy Benefit Managers (“PBMs”) adopted and incorporated this definition of the “usually and customary” pricing into their agreements with pharmacies. Regarding the PBM’s adoption of this definition, the Court stated that this may not serve as the basis of a fraud claim under the FCA.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

MedTrainer

AUGUST 8, 2024

Fraud, Waste, and Abuse (FWA) Training Fraud, Waste, and Abuse (FWA) training is designed to help healthcare professionals detect, prevent, correct, and report fraudulent, wasteful, and abusive practices within the Medicare system. Attestation: Providers must complete training within 90 days of their hire date and annually thereafter.

Medicare 93

Medicare Medicare Compliance Medicaid 93

Compliancy Group

OCTOBER 1, 2024

Compliance with Medicare and other programs requires relevant staff to take regular fraud, waste, and abuse (FWA) training. Components of Medicare FWA Training An essential learning outcome of FWA training is differentiating fraud, waste, and abuse. Importance of FWA Training First and foremost, training in FWA compliance is the law.

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

MAY 11, 2022

The doctor will be sentenced in July for multiple counts of healthcare fraud. A Florida physician, serving as a medical director for a sober living facility, was found guilty of healthcare fraud. He faces up to 20 years in prison for healthcare fraud and wire fraud conspiracy. Billing for unnecessary urine drug testing.

Compliance Officers 52

Compliance Officers Fraud Compliance Medicare 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. Additionally, education regarding Medicare FWA is crucial to providing proper care and the prevention of FWA.

Medicare 52

Medicare Medicare Compliance Fraud 52

HIT Consultant

MAY 4, 2023

But as the average recovery cost for a healthcare organization after a breach has now passed the $10 million mark in 2022 , a 40% increase from 2020, the time for definitive action is now. As organizations harden their security posture in response to specific threats, new threats emerge that companies may not be aware of.

Hospitals 97

Hospitals HIPAA Regulatory Compliance Compliance 97

Health Law RX

JULY 18, 2023

The IB Rule, among other things, promulgated regulations further defining what information blocking is and establishing reasonable and necessary activities that do not constitute information blocking, i.e., exceptions to the definition of information blocking. The OIG anticipates working closely with ONC to make these threshold assessments.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

HIT Consultant

FEBRUARY 23, 2023

We need to think beyond our current systems to develop a broader definition of interoperability—one rooted in “possibility thinking” that focuses first and foremost on the patient experience. Trying to create interoperability with tools and processes we already have is limited thinking that leads to limited results.

COVID-19 96

COVID-19 Fraud Hospitals 96

Physician Credentialing Company

MARCH 19, 2025

Understanding 99284 CPT Code Definition and 99284 CPT Code Description CPT code 99283 is assigned to normal emergency department services where the history is problem-focused and expanded, the examination is also problem-focused, and the MDM is moderate.

Medical Billing 52

Medical Billing Electronic Medical Records Hospitals Fraud 52

Med Com Blog

JANUARY 18, 2023

By definition, Revenue Cycle Management (RCM) is the process by which healthcare providers manage and track the revenue generated by patient care. Fraud detection: AI can be used to detect and prevent fraudulent activity in the revenue cycle, such as billing for services that were not provided or upcoding of services.

Patient Satisfaction 52

Patient Satisfaction Fraud Compliance COVID-19 52

Healthcare Law Blog

FEBRUARY 2, 2023

A well-crafted letter of intent (“LOI”) adds value for the negotiating principals by helping to ensure the parties are in agreement on key deal terms before they spend significant time and money on diligence and definitive documents. Define indemnification terms. Schedule certain defined terms.

Due Diligence 52

Due Diligence Fraud Compliance 52

Verisys

FEBRUARY 1, 2022

All individuals and organizations that meet the definition of healthcare provider as described in 45 CFR 160.103 that conduct transactions or use health records that fall under HIPAA regulations are required to obtain an NPI. Tracking actions to a standardized identifier provides transparency that can identify and impede fraud.

Fraud 52

Fraud Medicare Medicare HIPAA 52

HIPAA Journal

JULY 4, 2024

Due to concerns that the cost of the reforms would be passed onto plan members and employers, and that this would negatively impact tax revenues, Congress added a second Title to HIPAA – “Preventing Health Care Fraud and Abuse; Administrative Simplification”. The measures in Title II were intended to neutralize the cost of the reforms.

HIPAA 55

HIPAA Compliance Fraud Medicare 55

Hall Render

FEBRUARY 14, 2025

This regulation, authorized under Section 1866(j)(3)(A) of the Social Security Act (Act), is designed to strengthen Medicare program integrity and minimize fraud, waste and abuse. A provider or supplier (including an HHA or hospice) undergoing a 100 percent change of ownership via a change of information request under 42 CFR Sec.

Medicare 52

Medicare Medicare Compliance Payment Systems 52

YouCompli

MAY 25, 2022

This post establishes a working definition of compliance culture and puts it in the context of overall healthcare priorities. Just look at the rampant, unreported fraud that took down Enron in the early 2000s. Definition of compliance culture in healthcare. Anstine, JD is a compliance professional and consultant in Colorado.

Compliance 52

Compliance Compliance Officers Fraud Regulatory Compliance 52

Healthcare Law Today

JANUARY 11, 2023

” The press release warned that “[t]he resolution of this matter illustrates the government’s emphasis on combating health care fraud.” The FDA has jurisdiction to regulate products that meet the definition of “device” under section 201(h) of the FDCA.

FDA 59

FDA Governance Medicare Medicare 59

AIHC

SEPTEMBER 21, 2023

On September 14, 2023, the Office of Inspector General (OIG) posted the Final Rule “ Fraud & Abuse; Information Blocking; OIG’s Civil Money Penalty Rules ” describing enforcement of the Information Blocking rule. The full definition of “health care provider” is available in the Public Health Service Act (42 U.S.C.

HIPAA 59

HIPAA Compliance Nurses Fraud 59

C&M Health Law

AUGUST 3, 2023

OIG confirmed that information blocking may also constitute an element of a fraud scheme, such as by forcing unnecessary tests or conditioning information exchange on referrals. Other than the information blocking penalties, the rest of the final rule’s provisions are effective August 2, 2023.

Fraud 52

Fraud HIPAA Governance Compliance 52

Healthcare Compliance Blog

JUNE 9, 2022

Those claims were for presumptive and definitive Urine Drug Tests (UDTs) that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients. Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare.

US Department of Health and Human Services 59

US Department of Health and Human Services Overpayment Overpayments Medicare 59

Verisys

DECEMBER 29, 2024

Healthcare providers and organizations that meet the definition of a provider under 45 CFR 160.103 must obtain an NPI if they conduct HIPAA-covered transactions. How Verisys Utilizes NPI Data: Verisys leverages NPI data through its healthcare provider credentialing solutions to enhance fraud prevention and ensure data accuracy.

HIPAA 52

HIPAA Fraud Health Insurance Medicare 52

Health Care Law Brief

JUNE 20, 2023

Second , the defendants argued that, based on the Court’s interpretation of the common‑law definitions of “knowing” and “reckless” in Safeco , the FCA should be read with the same interpretation— i.e. , using an objective reasonableness test. Because the FCA incorporates the common law of fraud, it embodies that same limitation.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT Today

AUGUST 9, 2024

That’s definitely something that we have to do something about. Brenton Hood, COO at ilumed Considering the last quarter of last year all of us got hammered by fraud waste and abuse – I think that’s something that needs to be talked about in more detail and how the government’s going to help find what we catch.

Fraud 73

Fraud Governance Hospitals 73

Healthcare Law Blog

MAY 16, 2022

Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2 The only changes made to the final definition were to include “individuals” as potential TPMOs, and to clarify that agents and brokers are TPMOs. and 422.107). 423.100 [3].

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Blog

MAY 11, 2023

Review of the Proposed Arrangement Under Federal AKS At a high level, the OIG concluded that the Arrangement presents a minimal risk of fraud and abuse under the AKS. Finally, the OIG noted that the listed safeguards set forth by the Companies reduce the risk of fraud and abuse.

Medicare 52

Medicare Medicare Fraud Compliance 52

Healthcare Law Today

DECEMBER 12, 2022

Maureen has extensive experience handling malicious insider matters ranging from employee fraud, embezzlement, and misappropriation to breaches of non-solicitation, non-compete and confidentiality agreements. I’m currently Deputy General Counsel of LifeMD, a growing telemedicine company. Maureen Stewart.

Telemedicine 49

Telemedicine Fraud Governance Compliance 49

Health Care Law Brief

APRIL 12, 2023

405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. The Court also held that the 60 Day Rule imposed a burdensome definition for “identified” without adequate notice to insurers. 3d 173, 191 (D.D.C. rather than a ‘limited duty to inquire.” UnitedHealthcare Ins.

Medicare 52

Medicare Medicare Overpayment Overpayments 52

Health Care Law Brief

APRIL 6, 2023

Measured by this definition,” the Sixth Circuit concluded, “the complaint [by the plaintiffs] fail[ed] to allege a cognizable kickback scheme.” Or consider the general practitioner who refuses to send patients for kidney dialysis treatment at a local health care facility until it obtains more state-of-the-art equipment. emphasis added).

Hospitals 52

Hospitals Doctors Fraud 52

Compliancy Group

JANUARY 3, 2024

This is why a regular review of these contracts is essential so that providers and administrators can clear up uncertainties in the terms or conditions, remain compliant, and ensure the payer is engaging in fair practices.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

Innovaare Compliance

AUGUST 24, 2023

Beginning CY 2019, activities related to fraud reduction and improvement of health care quality are included in the MLR calculation as expenditures.

Medicare 52

Medicare Medicare Fraud Medicaid 52

AIHC

APRIL 10, 2024

HIPAA and HITECH is for all health care organizations falling under the definition as a Covered Entity, from solo practices to larger clinics and hospital medical networks to health plans and clearinghouses. Does your organization have materials for patient education and risks of identity theft and medical fraud?

Compliance 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

Provider Trust

MAY 17, 2022

In this post, we’ll break down the definition of healthcare vendors and summarize the most important and impactful laws and regulations that apply to vendors and the healthcare organizations that contract with them. So what does that mean for your healthcare organization’s compliance program? How to ensure vendor compliance.

Compliance 52

Compliance Medicare Medicare Due Diligence 52

HIPAA Journal

JANUARY 16, 2023

One of the reasons why some people approach the topic of AI in healthcare with a degree of apprehension is that different sources offer different definitions of AI. To quote Microsoft´s definitions of the two terms: . AI is used by the finance industry to detect potential credit card fraud.

Governance 62

Governance HIPAA World Health Informed Consent 62

Total HIPAA

FEBRUARY 25, 2020

Healthcare data is extremely valuable on the black market because it can be used to commit healthcare fraud, which is very profitable. . A definition file is a list of known malware, which the software can use to find and eliminate malware. How to Protect Yourself from Ransomware. Back-up.

Ransomware 52

Ransomware HIPAA Compliance Fraud 52