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.

Compliance 52

Compliance US Department of Health and Human Services Regulatory Compliance Fraud 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 137

Ransomware Fraud HIPAA Licensing 137

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

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 101

Hospitals Fraud Licensing HIPAA 101

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

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 115

Fraud Licensing Health Insurance HIPAA 115

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 128

Fraud Licensing HIPAA Health Insurance 128

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 108

Ransomware Fraud Licensing Health Insurance 108

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

Verisys

MARCH 6, 2025

The Office of Inspector General (OIG) Monitors and enforces compliance with regulations that prevent fraud, waste, and abuse in healthcare programs. Loss of Licenses or Certifications Depending on their specialties and staff, healthcare organizations must maintain specific licenses and certifications to operate legally.

Compliance 52

Compliance HIPAA Licensing Governance 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

MedTrainer

JANUARY 21, 2025

Mandatory exclusions result from serious convictions, including Medicare fraud, patient abuse, and felony healthcare fraud. Permissive exclusions stem from less severe violations, such as defaulting on student loans or losing a healthcare license.

Compliance 52

Compliance Fraud Regulatory Compliance Medicare 52

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 107

HIPAA Fraud Licensing Health Insurance 107

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

HIPAA Journal

DECEMBER 20, 2022

The exposed files contained names, Social Security numbers, driver’s license numbers, health insurance information, and/or medical information. Those files contained names, addresses, email addresses, dates of birth, Social Security Numbers, driver’s license numbers, medical record numbers, and health insurance information.

Health Insurance 110

Health Insurance Licensing Hospitals Fraud 110

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 94

HIPAA US Department of Health and Human Services Fraud Telemedicine 94

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

APRIL 25, 2023

No evidence of misuse of plan member data has been uncovered; however, as a precaution against identity theft and fraud, individuals whose Social Security numbers were exposed have been offered complimentary credit monitoring services. Additional security measures have been implemented to better secure its systems against unauthorized access.

Health Insurance 106

Health Insurance Public Health Ransomware Fraud 106

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

HIPAA Journal

DECEMBER 7, 2022

In some cases, Social Security numbers, driver’s license numbers, or financial account information, were also exposed. Salud Family Health said impacted employees and patients have been offered free credit monitoring and identity fraud protection services.

COVID-19 Vaccine 103

COVID-19 Vaccine COVID-19 Department of Veterans Affairs Licensing 103

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

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 107

Ransomware HIPAA Fraud Licensing 107

Healthcare IT Today

AUGUST 9, 2024

We’re moving away from a world where people need to spend countless hours combing through medical documents to manually extract key information to put into a prior auth or other encounter. For example, a healthcare organization can now predict future revenue trends, denial trends, and fraud.

Patient Satisfaction 122

Patient Satisfaction Fraud Licensing Compliance 122

MedTrainer

MARCH 17, 2025

Original source data is more difficult to access, there are more licensed professionals, and verification timelines are getting tighter. Original Source Verification For PSV credentialing to be reliable, verification must come directly from the issuing authority such as licensing boards, accreditation organizations, or government databases.

Licensing 52

Licensing Compliance Fraud Governance 52

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

MedTrainer

MARCH 17, 2025

In a recent MedTrainer poll, 58% of poll respondents said that collecting and managing documents is their biggest challenge. Thats because you have to ask providers for the same document multiple times, there is a lot of tracking involved, and theres a lot of back and forth with printing or file saving.

Compliance 52

Compliance Licensing Fraud 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

Healthcare IT News - Telehealth

JULY 19, 2021

It has nine licensed mental health professionals on staff, all committed to providing thorough delivery of psychiatric care based on the latest research. Unsecure telehealth connections can open the door for fraud, phishing and ransomware attacks, with serious reputational and financial consequences. THE PROBLEM.

COVID-19 167

COVID-19 HIPAA Ransomware Governance 167

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

Verisys

DECEMBER 29, 2024

Credentialing services perform this verification by contacting primary sources, such as medical schools and licensing boards, to confirm the physician’s education and qualifications. Ensure Accuracy Double-check all documents for accuracy before submitting. Incomplete applications are a leading cause of delays.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

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

Healthcare Compliance Blog

JANUARY 17, 2022

Licensed staff who have access to controlled medications may commit fraud and theft of controlled substances if they develop a substance abuse problem. Document that the trainings occurred, and place the signed document in each employee’s education file. Drug diversion is a growing problem in healthcare.

Nurses 59

Nurses Fraud Licensing Governance 59

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

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 Stolen in Break-in.

Ransomware 81

Ransomware Health Insurance Fraud HIPAA 81

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