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

Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

Fraud 59

Fraud COVID-19 Health Insurance Compliance 59

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 136

Ransomware Fraud HIPAA Licensing 136

HIPAA Journal

SEPTEMBER 30, 2022

The plaintiffs alleged the security failures were in violation of the Health Insurance Portability and Accountability Act, although the lawsuit was filed over the violation of state laws. The plaintiffs also took issue with how Magellan Health handled the data breach and the delay in issuing notifications.

Fraud 115

Fraud HIPAA Health Insurance 115

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

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.

Compliance 52

Compliance HIPAA Electronic Medical Records Fraud 52

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 127

HIPAA Ransomware Fraud Health Insurance 127

HIPAA Journal

JULY 4, 2024

The types of data involved varied from individual to individual and may have included names, addresses, dates of birth, Social Security numbers, health insurance information, and/or health information. Pinnacle said it is implementing enhanced security measures to prevent similar incidents in the future.

Electronic Medical Records 116

Electronic Medical Records Health Insurance Ransomware Fraud 116

MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Verisys

MARCH 6, 2025

Health Insurance Portability and Accountability Act (HIPAA) Ensuring patient privacy by constantly monitoring data handling practices. Improved Efficiency and Cost Savings AI takes the busywork out of compliance by handling tasks like audit prep, tracking regulatory changes, and reviewing documentation.

Compliance 52

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

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 99

Hospitals Fraud Licensing HIPAA 99

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. Compliance with physician self-referral law requires strict adherence to its provisions.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

HIPAA Journal

MAY 2, 2024

Hackers gained access to the BioPlus network for more than 2 weeks between October and November 2021, and potentially stole names, dates of birth, contact information, health insurance information, prescription information, and Social Security numbers.

Fraud 109

Fraud HIPAA Health Insurance Compliance 109

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.

Fraud 52

Fraud Compliance Governance Compliance Officers 52

HIPAA Journal

AUGUST 4, 2022

The forensic investigation confirmed that names, addresses, diagnoses, treatment information, patient account numbers, billing information, dentists’ names, payment card information, and health insurance information had potentially been compromised. Individuals were notified about the breach in December 2020.

Fraud 126

Fraud HIPAA Health Insurance 126

HIPAA Journal

JULY 20, 2022

While data theft could not be determined, the affected email accounts contained the protected health information of patients of 19 of its hospitals, including names, birth dates, health insurance information, Social Security numbers, driver’s license, and healthcare data. Ordinary claims are capped at $250 per person.

Fraud 125

Fraud Licensing HIPAA Health Insurance 125

HIPAA Journal

FEBRUARY 14, 2023

Hackers gained access to Umass Memorial Health’s email environment between June 24, 2020 and January 7, 2021, as a result of responses to phishing emails. Claims may also be submitted for extraordinary losses up to a maximum of $5,000, which can include documented, unreimbursed losses to fraud and identity theft.

Fraud 112

Fraud Licensing Health Insurance HIPAA 112

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

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.

Medical Billing 52

Medical Billing Electronic Medical Records Hospitals Fraud 52

HIPAA Journal

MARCH 1, 2023

The Albuquerque, NM-based health insurance provider, True Health New Mexico, has proposed a settlement to resolve claims related to a 2021 data breach that affected 62,983 members of its health plans.

Fraud 112

Fraud Ransomware Health Insurance HIPAA 112

HIPAA Journal

APRIL 25, 2023

On February 13, 2023, NationsBenefits confirmed that the data compromised in the attack included protected health information such as name, address, phone number, gender, date of birth, health insurance number, medical ID number, Social Security number, date(s) of service, medical device or product purchased, and provider/caregiver name.

Health Insurance 104

Health Insurance Public Health Ransomware Fraud 104

HIPAA Journal

FEBRUARY 15, 2023

The attack was detected and blocked by Electromed on June 16, 2021, and the forensic investigation confirmed that files were accessed – and potentially stolen – that included customers’ first and last names, mailing addresses, medical information, and health insurance information.

Ransomware 105

Ransomware Fraud Licensing Health Insurance 105

HIPAA Journal

DECEMBER 27, 2022

The breached information included names, addresses, Social Security numbers, birthdates, client identification numbers, medical diagnostic and treatment information, and health insurance information.

Fraud 115

Fraud HIPAA Health Insurance 115

HIPAA Journal

JANUARY 1, 2023

Most state that HIPAA is an acronym of the Health Insurance Portability and Accountability Act of 1996 and that it led to the development of standards for the privacy of Protected Health Information. However, at the time, the healthcare insurance industry was governed by a hotchpotch of federal and state legislation.

HIPAA 97

HIPAA Health Insurance Fraud Governance 97

HIPAA Journal

JANUARY 16, 2023

Rehoboth McKinley Christian Health Care Services – was filed on behalf of Alicia Charlie, Leona Garcia Lacey, Darrell Tsosie, and a minor child, represented by his guardian Gary Hicks. Rehoboth McKinley Christian Health Care Services had argued that there was no actionable duty to protect the plaintiffs’ data, but U.S.

Fraud 114

Fraud Health Insurance HIPAA Hospitals 114

HIPAA Journal

FEBRUARY 16, 2023

The investigation confirmed hackers had access to, and potentially stole, the protected health information of patients such as names, Social Security numbers, driver’s license information, dates of birth, health insurance, medical treatment information, and financial account information.

HIPAA 105

HIPAA Fraud Licensing Health Insurance 105

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Compliance isn’t just about meeting state or federal requirements; it’s about maintaining clean and easy-to-access policies, incident reports, safety plans, HR documents, and more. Certification.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

Compliancy Group

MARCH 5, 2025

The Health Insurance Portability and Accountability Act (HIPAA) established national standards for covered entities (healthcare providers, health plans, and healthcare clearinghouses) to safeguard the confidentiality, integrity, and availability of electronic protected health information (ePHI).

HIPAA 52

HIPAA Compliance Fraud Health Insurance 52

HIPAA Journal

DECEMBER 20, 2022

Work Health Solutions then verified contact information and sent notifications on November 9, 2022. The exposed files contained names, Social Security numbers, driver’s license numbers, health insurance information, and/or medical information. Patients of St. Patient Data Exposed in Cyberattack on Hawaiian Eye Center.

Health Insurance 108

Health Insurance Licensing Hospitals Fraud 108

HIPAA Journal

MARCH 28, 2023

A New York law firm that suffered a LockBit ransomware attack has agreed to pay a financial penalty of $200,000 to the New York Attorney General to resolve alleged violations of New York General Business Law and the Privacy and Security Rules of the Health Insurance Portability and Accountability Act (HIPAA).

HIPAA 109

HIPAA Ransomware Malpractice Health Insurance 109

HIT Consultant

JUNE 21, 2023

Attendees I talked to spoke of the need for faster, lower cost, straight-through processing of documents and forms and better data insights and manageability. Although AI was the big theme in presentations, attendees were extremely focused on wanting concrete solutions and outcomes.

Fraud 98

Fraud Health Insurance Compliance 98

Compliancy Group

JULY 10, 2024

If you hold this position, you likely understand what’s at stake in protecting health information and preventing fraud, abuse, and adverse incidents. Ensuring compliance with critical regulations falls on the compliance officer. We also discuss the steps and best practices that can guide you on how to be a good compliance officer.

Compliance Officers 64

Compliance Officers Compliance Fraud Electronic Medical Records 64

HIPAA Journal

DECEMBER 7, 2022

The review of those files revealed they contained information such as names, Social Security numbers, driver’s license numbers, government-issued ID numbers, financial information, medical information, and health insurance information. Notification letters started to be sent to affected individuals on November 18, 2022.

COVID-19 Vaccine 101

COVID-19 Vaccine COVID-19 Department of Veterans Affairs Licensing 101

HIPAA Journal

JANUARY 27, 2023

The forensic investigation and document review concluded on December 28, 2022, and confirmed that the attackers had access to its network between December 31, 2021, and January 27, 2022, and may have viewed or obtained files that contained protected health information.

Ransomware 105

Ransomware HIPAA Fraud Licensing 105

American Medical Compliance

AUGUST 7, 2024

These regulations protect patient privacy, ensure quality care, and prevent fraud and abuse. Here are the key areas of healthcare compliance. HIPAA (Health Insurance Portability and Accountability Act) This compliance is crucial for safeguarding patient health information.

Compliance 105

Compliance HIPAA Medicaid Medicaid 105

HIPAA Journal

JUNE 2, 2023

An Arizona man has been sentenced to 54 months in jail for aggravated identity theft and criminal violations of the Health Insurance Portability and Accountability Act (HIPAA). Prunty and his co-conspirators attempted to steal more than $181,000 from the victims.

HIPAA 55

HIPAA Fraud Health Insurance Compliance 55

HIPAA Journal

NOVEMBER 17, 2022

Salud Family Health said affected employees and patients have been offered free credit monitoring and identity fraud protection services, and security policies and procedures are being reviewed and will be updated to protect against future cyberattacks. Documents Containing PHI of Patients of Hilario Marilao, M.D

Ransomware 79

Ransomware Health Insurance Fraud HIPAA 79