Verisys

JANUARY 2, 2024

With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Secure your success by choosing Verisys.

Fraud 52

Fraud Licensing Doctors Medicare 52

Health Care Performance

FEBRUARY 21, 2023

The scheme 25 people were charged with wire fraud – administrators and employees of three Florida nursing schools as well as recruiters. The recruiters sought out individuals that were willing to pay $10,000 to $15,000 for fake nursing school documents that allowed them to take national nursing licensure examinations.

Nurses 52

Nurses Licensing Fraud Hospitals 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 89

Hospitals Fraud Licensing HIPAA 89

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

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

Healthcare Compliance Blog

MARCH 10, 2022

Complaints of resident abuse in a Michigan nursing home led to an investigation by the Michigan Office of Attorney General’s Health Care Fraud Division, working with the Michigan Sentinel Project. The investigation determined that a nurse was working at the nursing home while her license was suspended, which is a felony.

Nursing Homes 59

Nursing Homes Nurses Licensing Fraud 59

MedTrainer

SEPTEMBER 5, 2024

In an effort to prevent fraud, the Drug Enforcement Agency (DEA) implemented additional security for their Registrant Validation Toolset. In cases where verification documentation is still provided, it is often lacking the critical information that proves the document was verified directly with the DEA.

Compliance 52

Compliance Fraud Licensing 52

Healthcare Compliance Blog

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. Additionally, the LPN’s nursing license was suspended for an unspecified period of time. Discussion Points: Review your policies and procedures on CPR. Update as needed.

Nurses 59

Nurses Nursing Homes Licensing Fraud 59

Med-Net Compliance

SEPTEMBER 14, 2022

A Massachusetts home health aide, who was licensed as a Certified Nursing Assistant (CNA), has been indicted in connection with a home surveillance video showing her abusing an elderly patient, Attorney General Maura Healey announced. Document that the training occurred, and record in each employee’s education file.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Medicaid Medicaid 59

HIPAA Journal

FEBRUARY 14, 2023

The compromised email accounts contained patient names, medical record numbers, driver’s license numbers, financial account information, Social Security numbers, health insurance information, and clinical or treatment information. Class members will also be provided with two years of credit monitoring services.

Fraud 104

Fraud Licensing Health Insurance HIPAA 104

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

Med-Net Compliance

SEPTEMBER 7, 2022

A 49-year-old Texas physician assistant was arrested and charged for his role in a scheme to defraud Medicaid by working with a suspended medical license. On July 20, 2021, the Texas Medical Board allegedly ordered the immediate suspension of his physician assistant license, deeming him to be a “continuing threat to public welfare.”

Medicaid 59

Medicaid Medicaid Licensing Medical Personnel 59

Healthcare Compliance Blog

MARCH 11, 2022

A Boston registered nurse (RN) has pled guilty to one count of tampering with a consumer product and one count of obtaining a controlled substance by fraud and deception. Licensed staff who have access to controlled substances are at particular risk for committing fraud and theft of controlled substances when they have an addiction disorder.

Nurses 59

Nurses Nursing Homes Fraud Licensing 59

Compliancy Group

JANUARY 22, 2024

Documentation Review The first step in any healthcare audit is thoroughly reviewing all required documentation. This includes: Patient Records Consent Forms Billing Codes Medical Orders Other Relevant Documents This review aims to verify accuracy, completeness, and compliance with regulatory guidelines.

Compliance 52

Compliance Fraud Regulatory Compliance HIPAA 52

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.

Ransomware 114

Ransomware Fraud Licensing Nurses 114

HIPAA Journal

FEBRUARY 15, 2023

Associates affected by the breach had their Social Security numbers, driver’s license numbers, and financial account information exposed. Claims may be submitted for reimbursement of documented, unreimbursed extraordinary losses due to identity theft and fraud, up to a maximum of $5,000.

Ransomware 97

Ransomware Fraud Licensing Health Insurance 97

MedTrainer

JANUARY 12, 2024

Department of Health and Human Services focuses on preventing fraud, abuse, and waste in federal healthcare programs. These assessments typically involve reviewing documentation, interviewing staff, and evaluating processes to identify potential violations. Office of Inspector General (OIG): This independent agency within the U.S.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Verisys

JULY 27, 2023

This includes licensed and unlicensed staff members, as well as partners, investors, contingent workers, agents, and contractors you do business with. The safety of your patients depends on making sound hiring decisions and ensuring that the licenses of your staff are current.

Compliance 52

Compliance Due Diligence Licensing Fraud 52

Verisys

JULY 5, 2023

This includes licensed and unlicensed staff members, as well as partners, investors, contingent workers, agents, and contractors you do business with. Not only does thorough screening and rigorous continuous monitoring help ensure quality employees, but it also provides 360-degree transparency.

Compliance 52

Compliance Due Diligence Licensing Fraud 52

MedTrainer

APRIL 22, 2024

In its updated compliance program guidance documents , the Office of Inspector General (OIG) included updated voluntary guidance for “third-party billers and durable medical equipment suppliers, among others, to encourage the development and use of internal controls to monitor adherence to applicable statutes, regulations, and program requirements.”

Compliance 52

Compliance HIPAA Licensing Fraud 52

MedTrainer

SEPTEMBER 5, 2024

This confidential clearinghouse primarily aims to safeguard public interest and healthcare quality while reducing fraud and abuse. Organizations must register for an account, submit the required documentation, and receive authorization before searching the National Practitioner Data Bank.

Malpractice 52

Malpractice Fraud Licensing 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. The lawsuit, filed in the Circuit Court of the City of St.

Fraud 123

Fraud Licensing HIPAA Health Insurance 123

Compliancy Group

OCTOBER 25, 2024

An exclusion means a healthcare entity is barred from receiving financial funding, assistance, or a federal contract or subcontract because of a non-compliance incident, such as fraud, waste, or abuse of Medicare benefits. Exclusions can apply to individuals, entities, services, and vendors.

Compliance 52

Compliance Medicare Medicare Fraud 52

HIPAA Journal

JANUARY 10, 2024

As well as its payment processing activities, Stripe provides billing, identity verification, and fraud management services. However, Stripe is not HIPAA compliant because of the way it records personal data within transaction data and uses the combined data to help detect fraud. Coinbase ) or dubious privacy practices (i.e.,

HIPAA 77

HIPAA US Department of Health and Human Services Fraud Telemedicine 77

MedTrainer

FEBRUARY 12, 2024

Non-compliance can lead to significant fines, legal battles, and the loss of license or accreditation. For example, healthcare fraud or intentional non-compliance with regulations can lead to criminal charges. These actions can include fines, sanctions, or even revocation of licenses or certifications.

Compliance 52

Compliance Licensing Governance Fraud 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Healthcare Compliance Blog

APRIL 6, 2022

The defendant presented the facility staff with falsified documentation indicating that she had performed neurological evaluations throughout the evening. The nurse was sentenced to six months under house arrest and may not seek reinstatement of her license or work in a care facility/home during her five-year supervision period.

Nurses 59

Nurses Nursing Homes Fraud Licensing 59

MedTrainer

APRIL 17, 2024

Navigating the complex landscape of state licensing laws can be time-consuming and costly for organizations. This may involve additional steps, such as biometric authentication or identity verification services, to prevent fraud and ensure patient safety.

Licensing 52

Licensing Compliance Fraud HIPAA 52

Med-Net Compliance

JULY 19, 2022

An individual or entity excluded under section 1128(b)(4) of the Social Security Act, whose period of exclusion is indefinite, may apply for reinstatement when they have regained the license referenced in the exclusion notice. Document that the trainings occurred and file the signed document in each employee’s education file.

US Department of Health and Human Services 59

US Department of Health and Human Services Licensing Medicare Medicare 59

Verisys

MARCH 1, 2024

As the healthcare industry is increasingly targeted for data theft and fraud, information security has emerged as a top priority for healthcare institutions. Automating Risk Assessment Risk assessment officers in a healthcare institution take on many responsibilities, including paperwork, documentation, and follow-up actions.

Governance 52

Governance Compliance Fraud HIPAA 52

MedTrainer

JANUARY 26, 2024

Medical Billing Fraud: Some healthcare providers engage in fraudulent billing practices, such as upcoding (charging for more expensive services than provided) or unbundling (billing separately for services that should be bundled together). This ensures that staff members are well-informed and equipped to avoid compliance pitfalls.

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

Hall Render

FEBRUARY 8, 2023

Department of Justice (“DOJ”) charged over two dozen individuals with wire fraud and conspiracy to commit wire fraud in connection with leading the alleged fraudulent scheme – each defendant faces up to 20 years in prison. Fraudulent Scheme On January 25, 2023, the U.S.

Nurses 40

Nurses Licensing Fraud Governance 40

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

Physician Credentialing Company

JULY 15, 2024

This process reduces the risk of fraud and ensures accuracy. This includes verifying licenses, liability insurance, and education history. It allows all parties to access and verify credentials, reducing the time needed for background checks and decreasing the potential for fraud.

Malpractice 52

Malpractice Compliance Licensing Medical Billing 52

HIPAA Journal

JULY 24, 2023

The team’s roles are to investigate and audit the Department’s operations to prevent fraud, waste, and abuse within the Department, and also to audit and investigate potential crimes against the Department. Subsequent Acts of Congress increased the OIG’s regulatory authority to prevent crimes against the Department.

Fraud 52

Fraud Medicare Medicare Medicaid 52

MedTrainer

MARCH 14, 2024

The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Maintaining compliance helps protect against fraud, waste, and abuse. Meets compliance standards: Both processes verify a provider has met compliance standards.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

MedTrainer

JUNE 10, 2024

Domestic violence training is required based on licensing. Provide required and often hard-to-find CE courses for licensed employees. California also requires all individuals who are considered mandated reporters under California law to receive training. Included in this blog post are the results of an audit on California requirements.

Compliance 52

Compliance Licensing HIPAA Compliance Framework 52