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

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 95

Compliance Fraud HIPAA Health Insurance 95

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 107

Electronic Medical Records Health Insurance Ransomware Fraud 107

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

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 89

Hospitals Fraud Licensing HIPAA 89

Compliancy Group

OCTOBER 16, 2024

Compliance means adhering to various rules and standards that protect patient privacy, uphold safe working conditions, and prevent fraud, waste, and abuse of federal resources. Risk management procedures enable healthcare organizations to pinpoint their vulnerabilities to such hazards as security breaches or Medicare fraud.

Compliance 52

Compliance Compliance Officers Fraud Regulatory Compliance 52

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

MedTrainer

JULY 25, 2024

Adhering to the Health Insurance Portability and Accountability Act (HIPAA) standards is crucial to uphold compliance and regulatory requirements for any health organization. This act safeguards patients’ protected health information (PHI) and health plans and defines security and privacy regulations regarding patient data.

HIPAA 52

HIPAA Compliance Health Insurance Fraud 52

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Compliance audits aren’t a “one size fits all” process.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

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 107

Fraud HIPAA Health Insurance 107

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 58

HIPAA Fraud Health Insurance Compliance 58

Compliancy Group

OCTOBER 4, 2024

Maintaining the security and integrity of sensitive information and preventing waste, fraud, and abuse is essential to quality healthcare and promoting workplace safety. Coding and documentation : Assesses the accuracy and completeness of medical documents and billing codes. What is an Audit in Healthcare?

Compliance Officers 59

Compliance Officers Compliance Regulatory Compliance Fraud 59

Compliancy Group

SEPTEMBER 16, 2024

This comprehensive document governs patient care, worker safety, and privacy and confidentiality of protected health information (PHI). The updates provide more detailed guidance for preventing fraud, waste, and abuse, maintaining organization-level compliance programs, and considering infrastructural issues in healthcare compliance.

Compliance 52

Compliance Compliance Officers Fraud Electronic Medical Records 52

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

Compliancy Group

AUGUST 30, 2024

HIPAA The Health Insurance Portability and Accountability Act (HIPAA) of 1996 governs how healthcare organizations handle protected health information (PHI). This set of regulations relates to sharing, collecting, storing, and disposing of health records, patient data, and other sensitive information.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 52

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 134

Ransomware Fraud HIPAA Licensing 134

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 96

Health Insurance Public Health Ransomware Fraud 96

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 104

Fraud Licensing Health Insurance HIPAA 104

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 116

HIPAA Ransomware Fraud Health Insurance 116

HIPAA Journal

JANUARY 31, 2023

The lawsuit alleged the plaintiff and class members now face a high risk of identity theft and fraud as a result of the data breach and have incurred out-of-pocket expenses and lost time securing their accounts and protecting against the misuse of their personal and protected health information.

Ransomware 63

Ransomware Fraud Health Insurance HIPAA 63

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

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 110

Fraud Ransomware Health Insurance HIPAA 110

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 97

Ransomware Fraud Licensing Health Insurance 97

Compliancy Group

JUNE 3, 2024

What To Know When Navigating HIPAA Incidents Health Insurance Portability and Accountability Act (HIPAA) regulations already require healthcare-based businesses to have a response plan while operational. For many compliance officers, though, it’s not only about the documentation tracking — it’s about the overall savings.

Compliance 59

Compliance Compliance Officers HIPAA Fraud 59

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 124

Fraud HIPAA Health Insurance 124

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 84

HIPAA Health Insurance Fraud Governance 84

HIPAA Journal

MAY 1, 2023

The document review took until March 21, 2023, and notification letters were sent on April 20, 2023. The information exposed and potentially stolen in the attack included names, dates of birth, billing and claims data, treatment details, medical record numbers, prescriptions, health insurance information, and Social Security numbers.

Health Insurance 58

Health Insurance Fraud HIPAA Hospitals 58

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 119

Fraud HIPAA Health Insurance 119

Medisys Compliance

NOVEMBER 6, 2023

By following a comprehensive orthopedic billing compliance checklist, providers can ensure that their claims are accurate, complete, and supported by proper documentation. Document the rationale for using any modifier codes. Documentation Review Review all medical records to ensure that they are complete and accurate.

Compliance 59

Compliance Medical Billing Outsourcing Medical Billing ACA 59

Compliancy Group

MAY 15, 2024

OIG compliance and compliance training intends to help hospitals protect patient health and safety, prevent fraud and abuse, ensure legal and regulatory compliance, and safeguard patient privacy, making it an invaluable tool for success. Quality of Care and Safety The OIG continues to focus on the quality of care provided to patients.

Compliance 52

Compliance Hospitals Fraud Regulatory Compliance 52

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 123

Fraud Licensing HIPAA Health Insurance 123

MedTrainer

FEBRUARY 1, 2024

These programs help to promote lawful and ethical conduct within healthcare organizations and minimize the risk of legal violations, such as fraud, abuse, and other unethical behaviors. Prevent Fraud and Abuse: Helps avoid improper billing and monitors for potential fraudulent or waste activities.

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

MedTrainer

JANUARY 31, 2024

It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. These laws require healthcare providers to establish internal controls and compliance programs to prevent fraud and abuse in the healthcare system. Who started the first healthcare compliance program?

Compliance 52

Compliance Fraud Governance ACA 52

MedTrainer

JANUARY 26, 2024

Here are some common non-compliance activities: Failure to Maintain HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) sets strict guidelines for safeguarding patient health information. Credentialing Workflows: Streamlining credentialing documentation can ensure you’re ready for a surveyor.

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

YouCompli

MAY 11, 2022

They perform procedures and surgeries, admit patients to hospitals, and document in the medical record. . In March of 2022, a New Jersey rheumatologist was convicted by a federal jury for defrauding Medicare and other health insurance programs. The doctor will be sentenced in July for multiple counts of healthcare fraud.

Compliance Officers 52

Compliance Officers Fraud Compliance Medicare 52

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

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 104

HIPAA Fraud Licensing Health Insurance 104