Healthcare IT News - Telehealth

AUGUST 11, 2021

Grimm: "It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse or misuse." " DME fraud has been around since Medicare started reimbursing for it, of course. billion, with a B, of alleged fraud.

US Department of Health and Human Services 167

US Department of Health and Human Services Fraud Medicare Medicare 167

Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. Whether a business is facing civil penalties or monetary losses, each penalty can have a domino effect on adverse events for the business.

Fraud 52

Fraud Compliance Medicare Medicare 52

HIPAA Journal

MARCH 30, 2022

Had HIPAA not addressed these issues, subsequent events in HIPAA history may never have happened. Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. Abuse and Fraud in the Health Care Industry. $7 In March 1996, Rep.

HIPAA 136

HIPAA Fraud Health Insurance Health Care Reform 136

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

HIPAA Journal

MARCH 11, 2025

While the risks associated with the incident are believed to be low, all affected individuals have been advised to be vigilant against phishing attempts and other fraud. On January 30, 2025, a program office inadvertently attached a spreadsheet to an email, when the intention was to attach a flyer for an upcoming event.

Department of Veterans Affairs 81

Department of Veterans Affairs Licensing Ransomware Fraud 81

American Medical Compliance

FEBRUARY 21, 2025

This global event brought together top healthcare leaders, policymakers, and innovators to shape the future of healthcare across the region. At the forefront of this initiative, AMC President Mark Gutweiler led the companys participation in Arab Health 2025 , one of the worlds most prestigious healthcare exhibitions , held in Dubai.

Compliance 71

Compliance ADA Governance Medical Billing 71

Innovaare Compliance

JULY 19, 2024

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

Fraud 52

Fraud Medicare Medicare Compliance 52

HIPAA Journal

APRIL 25, 2022

Insider threats include healthcare employees who abuse their access rights to steal patient data to commit identity theft and financial fraud, inside agents that steal sensitive data and provide that information to third parties, and disgruntled employees that wish to cause harm to their employers.

Fraud 134

Fraud HIPAA 134

HIPAA Journal

APRIL 24, 2023

Utah has updated its data breach regulations and from May 3, 2023, will require a breached entity to send a notification to the Utah Attorney General in the event of a breach of the personal information of 500 or more Utah residents.

Fraud 102

Fraud Licensing HIPAA Governance 102

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The post CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance appeared first on Inovaare.

Fraud 52

Fraud Medicare Medicare Medicaid 52

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 112

Fraud Ransomware Health Insurance HIPAA 112

Compliancy Group

AUGUST 23, 2023

In a shocking turn of events, a dental office manager from Worcester has been sentenced for participating in a scheme to defraud the Massachusetts Medicaid program, MassHealth. Prosecutors Evan Panich and Chris Looney from the Health Care Fraud Unit, alongside Special Assistant U.S. Senior District Court Judge Timothy S.

Fraud 52

Fraud Medicaid Medicaid Governance 52

Verisys

DECEMBER 29, 2024

It plays a key role in reducing malpractice risks, preventing fraud, and verifying that healthcare professionals have the necessary training and clinical experience to perform their duties. Ongoing Monitoring and Recredentialing Credentialing is not a one-time event.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

C&M Health Law

NOVEMBER 25, 2020

Earlier this month, OIG issued a Special Fraud Alert on Speaker Programs warning drug and device companies and health care providers that it has significant concerns about payments for “speaker programs.” Therefore, all providers should evaluate their speaker programs to mitigate risks that are raised under the AKS.

Fraud 40

Fraud COVID-19 Health Care Reform ACA 40

HIPAA Journal

FEBRUARY 1, 2023

In 2022, 747 of the 1,802 data breaches for which ITRC had information did not specify the root cause of the event, even though 1,595 compromises were linked to cyberattacks. “A The reason for the sudden decline in transparency is unclear, although there are several theories.

Fraud 120

Fraud HIPAA Ransomware Compliance 120

Compliancy Group

APRIL 27, 2022

Healthcare employees who misuse access rights to steal patient data to commit some other form of financial fraud. These actors steal data, commit fraud, or sabotage systems. Implementing a security information and event management (SIEM) system to assist with logging, monitoring, and auditing employee actions.

Fraud 98

Fraud Compliance HIPAA Public Health 98

Healthcare Law Blog

MARCH 24, 2022

The Program technology establishes the schedule of expected target behavioral health events, objectively validates whether each expected event has occurred, and, if it has, promptly disburses the exact, protocol-specified incentive to the Member, using (where appropriate) a progressive reinforcement schedule.

Fraud 96

Fraud Licensing 96

HIPAA Journal

JANUARY 10, 2024

As well as its payment processing activities, Stripe provides billing, identity verification, and fraud management services. and its services can be configured to comply with the Technical Safeguards of the Security Rule (access controls, event logs, encryption, etc.). CCPA , GDPR , PIPEDA , EU-US Data Privacy Framework, etc.)

HIPAA 92

HIPAA US Department of Health and Human Services Fraud Telemedicine 92

HIPAA Journal

APRIL 1, 2022

We have a strong commitment to safeguard personal information, and we are working diligently to reduce the likelihood of future events.”. In this instance, staff fell prey to a phishing scam which exposed confidential information to data thieves,” said SRHD Deputy Administrative Officer, Lola Phillips. “We

Fraud 141

Fraud HIPAA Licensing Health Insurance 141

HIPAA Journal

JANUARY 30, 2023

The event provides a tremendous opportunity for learning through HIPAA workforce training sessions and keynote speeches from top government officials and leading industry professionals. Tennant, MA The full schedule for the event can be downloaded here – HIPAA Summit Schedule (PDF).

US Department of Health and Human Services 81

US Department of Health and Human Services HIPAA Compliance Medicaid 81

Healthcare Law Blog

APRIL 13, 2022

Maintain Support for Consulting Arrangements: In November 2020, the Office of Inspector General for the Department of Health and Human Services (“OIG”) issued a Special Fraud Alert on company-conducted speaker programs (the “Fraud Alert”). beer and wine only), or disallow alcohol at certain events[.]”.

Fraud 52

Fraud Medical Device Industry COVID-19 Compliance 52

Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. The toolkits include: Measuring Compliance Program Effectiveness: A Resource Guide Adverse Events Trigger Tools Handout: A Toolkit for Healthcare Boards.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Compliance Medicaid 59

HIPAA Journal

MAY 10, 2023

The lawsuit claims UIHC manages or controls two websites that are used for booking appointments, locating treatment facilities and physicians, and registering patients for events and classes. University of Iowa Hospitals & Clinics – was filed on behalf of plaintiff Eileen Yeisley and similarly situated individuals.

Hospitals 98

Hospitals HIPAA Fraud 98

Compliancy Group

JUNE 27, 2024

The following are the most common types of compliance incidents that warrant reporting: Workplace injury or illness Workplace violence Patient safety issue Improper use or disclosure of protected health information (PHI) Hacking or phishing incidents Fraud, waste, or abuse How to File a Compliance Incident Report An incident report must include all (..)

Compliance 64

Compliance Compliance Officers Fraud Nurses 64

HIT Consultant

MAY 9, 2023

As a result, patients feared an increased risk of fraud. While it was not publicized how the attacker gained initial access to the company’s network, plaintiffs argued that it was the DCA’s poor cybersecurity practices that exposed them to the risk of identity theft and fraud.

Ransomware 95

Ransomware Fraud Health Insurance HIPAA 95

Compliancy Group

FEBRUARY 7, 2024

CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary. Given their significant impact, healthcare organizations must take UPIC audits seriously.

Fraud 52

Fraud Compliance Medicare Medicare 52

Med-Net Compliance

OCTOBER 13, 2022

The case was investigated and prosecuted by the Medicaid Fraud Control Unit, a division of the North Dakota Attorney General’s Office, with assistance from the local police department. I want to thank the Medicaid Fraud Control Unit for thoroughly investigating this crime and successfully pursuing justice.

Nursing Homes 59

Nursing Homes Nurses Fraud Medicaid 59

Healthcare IT Today

DECEMBER 30, 2024

Additionally, AI can be a game-changer for risk and design; predictive analytics can reshape trials by identifying high-impact patient populations and preventing adverse events, thus, offering practical strategies to reduce inefficiencies and align trials with real-world patient needs.

US Department of Health and Human Services 88

US Department of Health and Human Services Nurses Medicare Medicare 88

HIPAA Journal

JANUARY 1, 2023

The bill included provisions to tackle the cost implications of HIPAA by standardizing the administration of health insurance claims in order to increase efficiency, and to tackle abuse and fraud. The scale of abuse and fraud at was time was astounding. 3103 Evolved into What HIPAA Means Today. The route from the introduction of HR.3103

HIPAA 97

HIPAA Health Insurance Fraud Governance 97

HIT Consultant

JULY 25, 2024

Created by five major credit card companies (Visa, Mastercard, Discover, JCB, and American Express) with guidelines developed by the PCI Security Standards Council, PCI DSS was designed to prevent cybersecurity breaches of sensitive data and reduce the risk of fraud for organizations that handle payment card information.

Compliance 111

Compliance HIPAA Regulatory Compliance Ransomware 111

HIT Consultant

JUNE 21, 2023

I was excited to attend this luminary event in Las Vegas and speak face-to-face with leaders in the healthcare field. Patients expect the convenience of digital healthcare, but healthcare providers and payers must balance service expectations with the need to protect patient’s privacy, reduce the risk of fraud, and maintain compliance.

Fraud 98

Fraud Health Insurance Compliance 98

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). Such providers must still separately report Reportable Events to the OIG pursuant to the CIA.

Fraud 52

Fraud Overpayments Overpayment Governance 52

NY Health Law

JANUARY 3, 2025

These allegations involved: (1) speaker events with few or no legitimate attendees; (2) excessive compensation of speakers for canceled events; and (3) the selection of speakers to reward and influence high prescribers.

Fraud 52

Fraud FDA Doctors Medicaid 52

Healthcare IT Today

JUNE 29, 2022

They make an AI solution that helps ensure the integrity of claims (ie: they find errors, optimize payments, and flag potential fraud). I came away from the event very encouraged. Another is to build a simple solution that works well, then out-hustle competitors to land customers and ensure they love your product.

Fraud 98

Fraud Doctors Nurses Hospitals 98

HIPAA Journal

AUGUST 31, 2023

According to a Notice of Data Event on the company’s website, Mom’s Meals experienced a cyberattack between January 16, 2023, and February 22, 2023, that resulted in customer, employee, and contractor data being encrypted. It is also providing credit monitoring, fraud consultation, and identity theft restoration services for a year.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

HIPAA Journal

JULY 28, 2022

38% of respondents said they visit those sites for streaming sporting events, 37% use the sites to download songs and video games that are hard to find, and 36% said they would visit those sites if they offered good discounts on purchases. The risks from bad cybersecurity practices are not just theoretical.

Fraud 62

Fraud HIPAA Governance 62

AIHC

APRIL 10, 2024

What is your procedure to notify patients in the event of a data breach? Does your organization have materials for patient education and risks of identity theft and medical fraud? In the event of a data breach, when the data was encrypted, the breach is not required to be reported. How are security breaches prevented?

Compliance 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99