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

Fraud 105

Fraud Medicaid Medicaid 105

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.

Compliance 72

Compliance Compliance Officers Regulations Compliance HIPAA 72

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.

Fraud 206

Fraud Telemedicine COVID-19 Medicare 206

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.

Fraud 166

Fraud Doctors COVID-19 Medicare 166

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.

Fraud 113

Fraud COVID-19 Governance 113

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.

Fraud 98

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.

Doctors 290

Doctors Hospitals Fraud Health Insurance 290

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!

Fraud 59

Fraud Medicare Medicare Compliance 59

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.

Fraud 52

Fraud Compliance HIPAA Health Insurance 52

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 Overpayment 72

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.

Compliance 52

Compliance Fraud Hospitals 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 299

Fraud HIPAA Compliance Hospitals 299

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

Fraud 59

Fraud HIPAA Medicare Medicare 59

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.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. Case documents revealed that Dr. Farley’s billing practices included false claims for extended, complex patient visits that did not occur.

Fraud 40

Fraud Compliance Medicaid Medicaid 40

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.

COVID-19 162

COVID-19 Governance Medicare Medicare 162

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.

Ransomware 133

Ransomware Fraud HIPAA Licensing 133

Healthcare IT Today

DECEMBER 28, 2023

This metamorphosis has not only redefined the way healthcare is delivered, documented, and accessed but has also heightened the significance of precise patient identity verification. Traditional methods, such as paper documents and basic ID cards, are no longer sufficient to ensure patient identity security.

Fraud 124

Fraud Hospitals 124

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.

Medicare 80

Medicare Medicare Fraud Doctors 80

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.

Fraud 105

Fraud HIPAA Health Insurance 105

HIT Consultant

JULY 26, 2023

What You Should Know: HealthLock , a leading medical fraud and overbilling protection solution, today unveiled insightful findings from a recent attitudinal study exploring how adults in the United States feel about healthcare, from claims and billing to medical fraud and privacy.

Medical Billing 98

Medical Billing Fraud Health Insurance Doctors 98

HIT Consultant

NOVEMBER 13, 2024

The company’s AI-powered platform tackles the estimated $300B fraud, waste, and abuse (FWA) crisis in healthcare, which often manifests as medical overbilling. The platform leverages an evidence-based approach, incorporating concepts from cybersecurity and anti-fraud domains to identify overbilling instances.

Fraud 98

Fraud Medical Billing 98

Natalia Mazina

MARCH 19, 2023

But in a nutshell, a group of California pharmacies brought a case against Optum alleging misrepresentation, fraud, and breach of contract. The California Court of Appeal, First Appellate District has just affirmed the holding of a trial court that Optum’s arbitration clause in its manual is unconscionable and unenforceable.

Fraud 132

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

Compliance 88

Compliance Fraud HIPAA Health Insurance 88

HIPAA Journal

APRIL 13, 2023

Several Insight Global employees created Google accounts to share information, including documents and spreadsheets containing contact tracing data. Claims for documented extraordinary losses will also be accepted up to a maximum of $5,000. Insight Global chose to settle the lawsuit with no admission of wrongdoing.

Fraud 100

Fraud COVID-19 HIPAA 100

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. But what exactly is considered fraud, waste, and abuse? These complaints can trigger an audit. Data Analysis and Trends.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

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.

Hospitals 87

Hospitals Fraud Licensing HIPAA 87

Compliancy Group

AUGUST 28, 2024

The Importance of HR Compliance Training Courses Compliance regulations in healthcare are designed to help organizations prevent fraud, waste, and abuse. As regulations evolve, employees need to know what changes they must make in their operations and which important new documents they should be aware of.

Compliance 97

Compliance Fraud Regulatory Compliance HIPAA 97

HIPAA Journal

AUGUST 4, 2022

The plaintiffs alleged that they face an increased risk of identity theft and fraud due to the negligence of Dental Care Alliance and that their sensitive personal and protected health information is now in the hands of data thieves. Those services include dark web monitoring and coverage by a $1 million identity theft insurance policy.

Fraud 122

Fraud HIPAA Health Insurance 122

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.

Fraud 121

Fraud HIPAA 121

HIPAA Journal

MAY 2, 2024

If they were, class members can claim a cash payment of $50 and can claim up to $7,500 for documented expenses incurred as a result of the data breach, including 3 hours of lost time at $25 per hour, and any unreimbursed losses to identity theft and fraud.

Fraud 108

Fraud HIPAA Health Insurance Compliance 108

MedTrainer

JANUARY 10, 2024

The OIG is making major investments to systematically detect and prosecute fraud. In this guidance it’s clear the OIG expects healthcare organizations and suppliers to understand their role and responsibilities to fight fraud, waste, and abuse. Remember: If it isn’t documented, it didn’t happen.

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

Healthcare IT News - Telehealth

SEPTEMBER 2, 2021

The scheme, as outlined in court documents, exploited COVID-19-era amendments to telehealth restrictions. Fraud has been raised as a concern regarding the future of telehealth regulations – and, indeed, a few cases have made splashy headlines over the past year. WHY IT MATTERS. THE LARGER TREND.

COVID-19 144

COVID-19 Medicare Medicare Public Health 144

HIPAA Journal

MARCH 1, 2023

No evidence of misuse of plan member data was identified at the time of issuing notification letters; however, as a precaution against identity theft and fraud, complimentary credit monitoring and identity theft protection services were offered to affected individuals.

Fraud 108

Fraud Ransomware Health Insurance HIPAA 108

HIPAA Journal

SEPTEMBER 7, 2022

Before file encryption, the attackers potentially accessed or acquired documents from its systems that contained names, addresses, dates of birth, Social Security numbers, health insurance information, and medical treatment information.

HIPAA 114

HIPAA Ransomware Fraud Health Insurance 114

HIPAA Journal

MARCH 3, 2023

The lawsuit alleged negligence for failing to implement reasonable cybersecurity measures to protect against a known risk of ransomware attacks on the sector, and that as a result of that negligence, victims were placed at an imminent and elevated risk of identity theft and fraud.

Ransomware 91

Ransomware Fraud HIPAA 91

HIT Consultant

OCTOBER 18, 2023

Hilton Hudson, MD, FACS, and CEO of HPC International In May 2022, a California doctor was sentenced to nearly eight years in prison for his involvement in a $12 million Medicare fraud scheme. Accurate Documentation: Complete and accurate medical documentation is essential for justifying the services provided. He received $4.5

Medicare 105

Medicare Medicare Fraud Hospitals 105