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

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 85

US Department of Health and Human Services HIPAA Compliance Medicaid 85

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." "This is going to be a whole-of-government and whole-of-industry approach," he added. billion, with a B, of alleged fraud.

US Department of Health and Human Services 159

US Department of Health and Human Services Fraud Medicare Medicare 159

American Medical Compliance

JANUARY 9, 2024

This type of theft is just one example of healthcare fraud. Through Medicare, Medicaid, and the Children’s Health Insurance Program, the federal government and state governments offer health care coverage to nearly 100 million individuals. trillion in 2015. trillion in 2015.

Fraud 52

Fraud Medicare Medicare Compliance 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). FWA Fraud, waste, and abuse (FWA) in healthcare primarily refer to the inefficient and inappropriate use of Medicare and Medicaid funds. Under the direction of the U.S.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 52

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

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Department of Health and Human Services focuses on preventing fraud, abuse, and waste in federal healthcare programs. What is Healthcare Compliance?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

MedTrainer

OCTOBER 4, 2023

These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. These requirements are designed to protect patient rights, privacy, and safety, as well as to prevent fraud, abuse, and other improper practices within healthcare organizations.

Compliance 52

Compliance Fraud HIPAA Governance 52

Health Law RX

JUNE 2, 2023

2] Companies that regularly submit claims to the federal government are familiar with the complex maze of rules and regulations that often govern them. 6] These government payor programs limit the amount pharmacies can charge for generic medications to the “usual and customary” price. [7] A mistake is still a mistake, not fraud.

Fraud 52

Fraud Governance Medicaid Medicaid 52

Hall Render

FEBRUARY 23, 2024

Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, with qui tam actions accounting for over $2.3 Health Care Fraud Actions Medicare Advantage. million in connection with allegations of exchange of valuable credits and sporting event tickets in exchange for sales leads. billion of the $2.68

Compliance 71

Compliance Governance Medicare Medicare 71

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

Compliancy Group

NOVEMBER 28, 2023

By adhering to regulations and best practices, these programs help: Reduce Medical Errors Improve Quality of Care Minimize Adverse Events Through proper compliance training and monitoring processes, healthcare professionals become equipped with the knowledge and skills necessary for delivering safe and efficient care.

Compliance 52

Compliance Fraud Governance 52

Healthcare IT Today

AUGUST 15, 2024

All because of one faulty update, mass amounts of flights were delayed and canceled, businesses such as banks or news broadcasts were forced to temporarily close, and most importantly, vital operations such as government agencies, emergency services, and healthcare organizations were also impacted. The following are their answers.

US Department of Health and Human Services 123

US Department of Health and Human Services Ransomware Governance Hospitals 123

Compliancy Group

AUGUST 2, 2023

Healthcare GRC (Governance, Risk, and Compliance) is a crucial framework that helps healthcare providers navigate these complexities effectively. Governance: Establishing Accountability Effective governance forms the foundation of any robust healthcare GRC software.

Compliance 52

Compliance Regulatory Compliance Governance Fraud 52

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. Health Care Fraud Actions. That figure does not include even more funds recovered for state Medicaid programs. ” Medicare Part C.

Fraud 40

Fraud Governance Medicare Medicare 40

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

JANUARY 26, 2024

Tracking and reporting on employee compliance training and education can also decrease an organization’s liability in the event of noncompliance. By understanding what is required by role, you can structure training to be the most beneficial, which may mean reducing the number of courses your organization requires.

Compliance 52

Compliance Informed Consent Fraud HIPAA 52

HIPAA Journal

JANUARY 1, 2023

However, at the time, the healthcare insurance industry was governed by a hotchpotch of federal and state legislation. 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.

HIPAA 84

HIPAA Health Insurance Fraud Governance 84

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 68

Fraud HIPAA Governance 68

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Priorities for Massachusetts’s Medicaid Fraud Division.

Fraud 52

Fraud COVID-19 Compliance Medicaid 52

YouCompli

DECEMBER 11, 2023

These include the Federal Anti-Kickback Statute, the Physician Self-Referral Law, the False Claims Act, the Civil Monetary Penalty (CMP) Authorities, Exclusion Authority, Criminal Health Care Fraud Statute, and the HIPAA Privacy and Security Rules. The Auditing and Monitoring element now specifically includes Risk Assessment.

Compliance 52

Compliance Compliance Officers Fraud HIPAA 52

Compliancy Group

AUGUST 17, 2023

Responsibilities of a Healthcare Compliance Manager: How to Have Effective Compliance A healthcare compliance manager is responsible for developing, implementing, and maintaining an effective compliance program within a healthcare organization to ensure they comply with local, state, and federal laws governing healthcare practices.

Compliance 52

Compliance Fraud Health Insurance HIPAA 52

Verisys

MAY 3, 2023

These standards help mitigate an organization’s risk by preventing waste, fraud, and abuse. According to government authorities , including the Department of Justice (DOJ), an effective healthcare compliance program achieves the outcomes outlined in their compliance plan. What is an effective healthcare compliance program?

Compliance 52

Compliance Compliance Officers ADA Governance 52

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

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

HIPAA Journal

JANUARY 16, 2023

AI is used by the finance industry to detect potential credit card fraud. In post-acute environments, healthcare providers dedicate a lot of resources to checking vital signs to identify postoperative adverse events. For example: Most people have played a video game against an AI-driven computer. Predictive Equipment Maintenance.

Governance 68

Governance HIPAA World Health Informed Consent 68

HIT Consultant

JANUARY 3, 2023

But they have also expanded the attack surface at these organizations and increased the level of risk and vulnerabilities that could result in direct loss of proprietary information, direct financial damage including theft and fraud, and potential loss of life (in addition to regulatory fines and brand damage) the healthcare sector faces.

Compliance 52

Compliance Ransomware Fraud Regulatory Compliance 52

Healthcare IT Today

SEPTEMBER 19, 2023

This critical information can help identify or avoid serious adverse events, including hospital readmissions. I would continue to advance CMS’ directive that by 2030 all Medicare and the bulk of Medicaid beneficiaries be in care engagements governed under a value-based contract.

Hospitals 137

Hospitals HIPAA Nurses Governance 137

Health Law Advisor

JULY 14, 2023

Under this initiative the DOJ will expand efforts to “identify, pursue, and deter knowing failures to comply with cybersecurity requirements in Federal contracts and grants[.]” The completion date is 1QFY24.

Regulatory Compliance 52

Regulatory Compliance Fraud Compliance Governance 52

AIHC

JUNE 6, 2023

Due-diligence is necessary to ensure their system has been tested, is compliant to government and payer standards and is affordable moving forward as AI evolves and our system or contract service with the company advances. AI technology would empower these professionals. Beware of new companies offering such services.

Compliance 59

Compliance Medical Billing HIPAA Due Diligence 59

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 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

MedTrainer

OCTOBER 28, 2024

Safety (Patient and Workplace) Required by: General The Joint Commission (FQHC) Patient safety is one of the most common deficiencies for organizations, especially those that lack processes for reporting and investigating adverse events, near misses, and sentinel events.

Compliance 52

Compliance Informed Consent Patient Satisfaction Hospitals 52

AIHC

JUNE 6, 2023

Due-diligence is necessary to ensure their system has been tested, is compliant to government and payer standards and is affordable moving forward as AI evolves and our system or contract service with the company advances. AI technology would empower these professionals. Beware of new companies offering such services.

Compliance 52

Compliance Medical Billing HIPAA Due Diligence 52

Healthcare IT Today

DECEMBER 15, 2023

Confidentiality Laws and regulations govern the confidentiality of medical data. Medical records remain a desirable target for cybercriminals as they can be used for fraud or ransom demands. This will prevent information loss in the event of cyberattacks or malfunctions. However, the best solution is to install new equipment.

Electronic Medical Records 117

Electronic Medical Records Doctors HIPAA Hospitals 117

HIT Consultant

DECEMBER 18, 2023

Confidentiality Laws and regulations govern the confidentiality of medical data. Medical records remain a desirable target for cybercriminals as they can be used for fraud or ransom demands. This will prevent information loss in the event of cyberattacks or malfunctions. However, the best solution is to install new equipment.

Electronic Medical Records 105

Electronic Medical Records Doctors HIPAA Pharmaceutical Industry 105

C&M Health Law

SEPTEMBER 11, 2023

The proposed rule represents the first time the federal government has proposed comprehensive nationwide nursing home staffing requirements, although various states have already enacted their own staffing requirements. Proposed Staffing Standard – 3.0 hours of nursing staff per resident per day, or 3.0 1] This figure would include 0.55

Nursing Homes 98

Nursing Homes Nurses Medicaid Medicaid 98