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

HIT Consultant

JUNE 6, 2024

Healthcare fraud is a significant issue in the U.S. the cost of healthcare fraud in the country is close to $100 billion a year. Recent advances in technology are now enabling government agencies to be more effective in their efforts to detect and prevent healthcare fraud. According to the U.S. Department of Justice (D.O.J.),

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Fraud Medicare Medicare Governance 94

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

Healthcare IT News - Telehealth

MARCH 2, 2021

Policymakers and stakeholders emphasized the importance of balancing access to care with addressing concerns around fraud and overutilization. When it comes to fraud – a frequently invoked fear in conversations around telehealth – some experts said the concern was overblown. Doris Matsui, D-Calif. Larry Bucshon, R-Ind.

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Fraud Telemedicine COVID-19 Medicare 217

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

Healthcare IT News - Telehealth

MAY 13, 2022

The owners of a national telehealth company pleaded guilty this week to charges of conspiracy to violate the federal Anti-Kickback Statute and to commit healthcare fraud. Law enforcement agencies have ramped up the pressure on telehealth fraud, particularly amid the COVID-19 pandemic. According to a statement released by the U.S.

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Fraud Doctors COVID-19 Medicare 172

Compliancy Group

AUGUST 9, 2024

Perhaps the most essential element is compliance documentation. Paperwork can be a chore, but these documents help you keep track of all the moving parts that make up regulatory healthcare compliance. We examine the nature of compliance documentation, its importance, and how you can maintain a solid documentation framework.

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Compliance Compliance Officers Regulations Compliance HIPAA 72

Healthcare Dive

JUNE 10, 2024

From 2020 to 2022, CityMD falsely documented insured patients as uninsured before fraudulently billing the federal government for their COVID-19 care, according to regulators. CityMD denies the allegations.

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COVID-19 Fraud Governance 111

HIT Consultant

AUGUST 17, 2023

Erin Rutzler, VP of Fraud, Waste, and Abuse at Cotiviti As behavioral health claim volumes continue to increase, there’s a growing need for health plans to be vigilant in spotting fraud, waste and abuse. But not every plan has access to a large SIU to combat fraud, waste and abuse in behavioral health.

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Fraud COVID-19 Medicare Medicare 98

Bill of Health

OCTOBER 30, 2023

In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. The use of emojis in healthcare documents would align with the idea of legal design. This year a “thumbs-up” emoji was found to be part of a legally binding contract. This legal evolution may seem a bit strange.

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Doctors Hospitals Fraud Health Insurance 290

Healthcare IT Today

OCTOBER 26, 2024

In the wrong hands, LLMs can generate false or exaggerated medical documentation in an instant. Staying a step ahead of this type of fraud requires a proactive approach to real-tine auditing and coding, noted David Lareau at Medicomp Systems. Read more… It’s Time to Combat “Instafraud” in Medicare Advantage.

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Ransomware Fraud Licensing Nurses 95

American Medical Compliance

OCTOBER 25, 2024

Audits serve as a critical defense against fraud and inefficiency while fostering trust in your practice. It could target several key areas, such as patient privacy and security to ensure compliance with HIPAA guidelines, or billing and coding accuracy to prevent fraud and abuse under CMS regulations.

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Compliance Fraud Compliance Framework HIPAA 105

Medisys Compliance

JANUARY 16, 2025

Documentation should support the need for these services, linking them directly to the patients diagnosis and treatment plan. Documentation Requirements Proper documentation is vital for compliant billing and successful reimbursement. Avoid fraud: Ensure billing accurately reflects services rendered.

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Medicare Medicare Medical Billing Outsourcing Fraud 59

Compliancy Group

APRIL 25, 2024

Components of Medicare Fraud, Waste, and Abuse Training One of the most important elements of CMS Medicare fraud, waste, and abuse training is defining and differentiating these three terms : Fraud is the deliberate attempt to obtain financial gain through deceptive means, such as providing false information. See how it works!

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Fraud Medicare Medicare Compliance 59

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.

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Fraud Medicare Medicare Overpayment 72

Healthcare IT Today

DECEMBER 17, 2024

Unlocking the Value of Unstructured Medical Data The first step in the process of unlocking the valuable information found in unstructured medical data (often in medical notes), is emtelligents Document Manager. This solution identifies and categorizes medical documents (faxes, PDFs, etc) and prepares them for processing.

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Doctors Fraud Nurses Hospitals 59

Medisys Compliance

MARCH 31, 2025

This necessitates clear, concise, and comprehensive documentation in the patient’s medical record that directly supports the services billed and the medical necessity for those services. Practices must be vigilant in preventing Medicare fraud, waste, and abuse (FWA).

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Medicare Medicare Medical Billing Medical Billing Outsourcing 59

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."

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Fraud HIPAA Compliance Hospitals 306

American Medical Compliance

JANUARY 9, 2024

The following Documentation and Provider Standards Training educates healthcare providers on the significance of documentation compliance in healthcare. Documentation Guidelines and Standards The legal system views documentation as a fundamental component.

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Fraud Compliance HIPAA Health Insurance 52

Total Medical Compliance Resources

MAY 11, 2023

trillion is spent on healthcare in the United States, of which an estimated $60 billion is attributable to fraud and abuse. In order to combat this, HIPAA established the Healthcare Fraud and Abuse Control Program (HCFAC). Criminal Health Care Fraud Statute – 18 U.S.C. Every year a minimum of $4.3

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Fraud HIPAA Medicare Medicare 59

Healthcare IT News - Telehealth

JANUARY 30, 2023

" The audit found that it did not require key implementation decisions and plans to be documented. It also did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, before implementing the temporary and permanent MBS telehealth items.

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COVID-19 Governance Medicare Medicare 187

Compliancy Group

FEBRUARY 9, 2024

One crucial tool that helps healthcare organizations achieve this is compliance program guidance documents. Let’s explore the significance of these healthcare compliance documents and how they benefit different sectors within the healthcare landscape. Some of these elements include: 1.

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Compliance Fraud Hospitals 52

Compliancy Group

DECEMBER 15, 2023

Differentiating Fraud, Abuse, and Waste Detecting and stopping fraud, abuse, and waste rely on distinguishing these behaviors in the healthcare context. What is Healthcare Fraud? Providers commit Medicare and Medicaid fraud when they knowingly submit or contribute to the submission of a false claim for financial gain.

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Fraud Medicaid Medicaid Medicare 52

Verisys

MARCH 6, 2025

Enhancing Data Accuracy and Reporting Maintaining detailed records is essential for regulatory compliance, but even minor documentation errors can result in missing provider details or negatively impact patient care. That means less time spent on paperwork and more time focused on what truly matters.

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

Verisys

DECEMBER 29, 2024

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. Ensure Accuracy Double-check all documents for accuracy before submitting. Incomplete applications are a leading cause of delays.

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Malpractice Licensing Regulatory Compliance Hospitals 52

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

Total Medical Compliance Resources

NOVEMBER 11, 2024

This course covers general procedures, handling verbal or physical threats, addressing profanity and abusive language, managing physically violent patients, post-incident documentation, breaking bad news to patients, and terminating a patient’s relationship with the practice. link] HIPAA Fraud, Waste, and Abuse Awareness Course $30.00

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ADA HIPAA Compliance Fraud 59

Physician Credentialing Company

MARCH 19, 2025

These topics of the guide will include an examination of the CPT code 99283, similarities with 99284, documentation of CPT 99283, and mistakes to avoid in determining the code. For CPT 99283, Documentation Should Include: Chief complaint with regards to a comprehensive history and also the medical history of the patient.

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Medical Billing Electronic Medical Records Hospitals Fraud 52

HIPAA Journal

SEPTEMBER 30, 2022

Had notifications been issued sooner, the plaintiffs argued that they could have taken steps to protect against identity theft and fraud. Class members that have incurred costs related to credit monitoring and fraud resolution may also be able to claim back those costs. Those claims must be supported by appropriate documentation.

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Fraud HIPAA Health Insurance 120

HIPAA Journal

MAY 25, 2022

Social Action Community Health System (SAC Health) has recently notified 149,940 patients that documents containing their protected health information were stolen in a break-in at an off-site storage location where patient records were stored. Notification letters were sent to those individuals on May 3, 2022.

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Ransomware Fraud HIPAA Licensing 137

Healthcare Blog

JANUARY 19, 2025

Provide a framework for proper documentation and billing practices. Prevent fraud and abuse of Medicare funds. Documentation Standards : Proper documentation is essential for both compliance and reimbursement. Utilize standardized assessment tools to determine eligibility and document findings thoroughly.

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Medicare Medicare Compliance Nurses 52

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.

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Compliance HIPAA Ransomware Fraud 59

HIPAA Journal

JUNE 28, 2023

The total settlement fund has not been disclosed; however, all class members are entitled to claim up to $1,500 as reimbursement for ordinary expenses, which are documented expenses that were incurred as a result of the data breach.

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Hospitals Fraud Licensing HIPAA 102

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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Compliance HIPAA Electronic Medical Records Fraud 52

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. However, they encounter numerous challenges in achieving this goal.

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Compliance Fraud HIPAA Health Insurance 105

Healthcare IT Today

OCTOBER 23, 2024

The following is a guest article by David Lareau, CEO at Medicomp Systems A couple of years ago, we predicted an impending “explosion” of Medicare Advantage (MA) fraud and penalties. For instance, an LLM might create documentation stating a patient has diabetic cataracts when they actually have age-related (senile) cataracts.

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Medicare Medicare Fraud Doctors 80

HIPAA Journal

SEPTEMBER 8, 2022

As a result of the negligence, the plaintiffs claim they face a substantial, increased, and immediate risk of fraud and identity theft. Under the terms of the settlement , the Urology Center of Colorado has agreed to provide compensation for documented out-of-pocket losses and lost time.

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Fraud HIPAA 133