Fierce Healthcare

FEBRUARY 15, 2024

Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months. ACOs could face lasting financial difficulties because of a recent, alleged $2 billion Medicare catheter fraud scheme.

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Fraud Medicare Medicare Governance 127

HIT Consultant

JUNE 6, 2024

Healthcare fraud is a significant issue in the U.S. the cost of healthcare fraud in the country is close to $100 billion a year. Recent advances in technology are now enabling government agencies to be more effective in their efforts to detect and prevent healthcare fraud. According to the U.S.

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Fraud Medicare Medicare Governance 94

Healthcare IT Today

JUNE 2, 2023

With those competing priorities, fraud prevention does not always make its way to the top of the list of considerations, even when it should. According to the National Health Care Anti-Fraud Association, fraud costs the U.S. healthcare industry more than $50 billion each year. What Exactly is KYP?

Fraud 111

Fraud Ransomware Licensing Governance 111

HIT Consultant

OCTOBER 18, 2021

Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud. The second type, indirect fraud, involves several bad actors that coordinate their efforts.

Fraud 98

Fraud COVID-19 Public Health Medicare 98

Fierce Healthcare

SEPTEMBER 19, 2024

Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower | A newly unsealed lawsuit alleges major health insurers and health systems defrauded Indiana Medicaid by hundreds of millions of dollars, with the government (..)

Medicaid 137

Medicaid Medicaid Fraud Hospitals 137

HIPAA Journal

MARCH 16, 2022

This is the first settlement to be reached under the DOJ Civil Cyber Fraud Initiative, which was launched in 2021. We will continue to ensure that those who do business with the government comply with their contractual obligations, including those requiring the protection of sensitive government information.”. “We

Fraud 109

Fraud Electronic Medical Records Governance HIPAA 109

Healthcare Dive

JUNE 10, 2024

From 2020 to 2022, CityMD falsely documented insured patients as uninsured before fraudulently billing the federal government for their COVID-19 care, according to regulators. CityMD denies the allegations.

Fraud 113

Fraud COVID-19 Governance 113

Fierce Healthcare

AUGUST 27, 2024

A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars—only to abruptly back off amid an “uproar” fr | Filings and testimonies in a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group outline industry pressure that led the (..)

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Medicare Medicare Fraud Governance 132

HIT Consultant

DECEMBER 10, 2021

What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Report Background.

Fraud 98

Fraud COVID-19 Nurses Licensing 98

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.

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Fraud Medicare Medicare Overpayments 72

Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Secure your success by choosing Verisys.

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Fraud Telemedicine Licensing Compliance 52

Healthcare IT News - Telehealth

JANUARY 30, 2023

FINDINGS Based on the state audit , the department fell short in governance, risk management, and evaluation of the telehealth expansion. It also did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, before implementing the temporary and permanent MBS telehealth items.

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COVID-19 Governance Medicare Medicare 162

Compliancy Group

APRIL 8, 2024

The complex nature of the healthcare industry calls for a robust framework to ensure governance, mitigate risks, and maintain compliance with various regulations. Let’s delve into Healthcare Governance Risk and Compliance (GRC) and explore its significance, key components, and the imperative role it plays in safeguarding the health industry.

Governance 52

Governance Compliance Regulatory Compliance Fraud 52

American Medical Compliance

JUNE 11, 2023

Alongside the health crisis, there has been an alarming rise in fraud, waste, and abuse related to COVID-19 relief efforts. As governments and organizations allocate substantial resources to address the pandemic’s impact, unscrupulous individuals and entities have taken advantage of the situation.

Governance 52

Governance COVID-19 Fraud Compliance 52

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. Governance, risk management, and compliance programs can all be automated, providing significant benefits to healthcare organizations.

Governance 52

Governance Compliance Fraud HIPAA 52

The Health Law Firm

MARCH 14, 2022

Board Certified by The Florida Bar in Health Law On March , 2022, a New York ophthalmologist was sentenced to 96 months in prison for fraudulently obtaining two government-guaranteed small business loans and for a seven-year fraudulent healthcare billing scheme, the Justice Department announced. Indest III, J.D.,

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COVID-19 Fraud Governance Doctors 98

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?

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Fraud Compliance Governance Compliance Officers 52

Total Medical Compliance Resources

MAY 11, 2023

trillion is spent on healthcare in the United States, of which an estimated $60 billion is attributable to fraud and abuse. In order to combat this, HIPAA established the Healthcare Fraud and Abuse Control Program (HCFAC). Criminal Health Care Fraud Statute – 18 U.S.C. Every year a minimum of $4.3

Fraud 59

Fraud HIPAA Medicare Medicare 59

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 165

US Department of Health and Human Services Fraud Medicare Medicare 165

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Compliance 59

Healthcare IT Today

JANUARY 19, 2024

Governments are starting to act in response to the growing amount of cyber threats in the healthcare industry. Artificial intelligence (AI)-powered threat protection also helps healthcare security leaders prevent account takeover (ATO) and fraud at all points of authentication. AI should also be used for identity governance.

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Fraud Governance Ransomware Compliance 123

Bill of Health

AUGUST 2, 2022

However, characteristics that make UBI attractive, particularly the direct support it provides, sans bureaucratic red tape, can be applied to other government programs. The government could directly provide all citizens with food or, more simply, with nutrients. With UBNI, government funds are only used for required nutrients.

Governance 147

Governance COVID-19 Fraud Public Health 147

Healthcare IT Today

SEPTEMBER 21, 2022

New types of fraud are continually emerging, and it’s also become harder to uncover with traditional approaches. The telehealth market is growing at a significant rate, and fraud is continuing to grow with it. This kind of fraud isn’t new, but the explosion in telehealth as a whole has made it much more common.

Fraud 61

Fraud COVID-19 Medicare Medicare 61

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.

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Fraud Medicaid Medicaid Medicare 52

AIHC

JUNE 14, 2024

Understanding Elder Abuse and Financial Exploitation Statutes The federal government, states, commonwealths, territories and the District of Columbia all have laws designed to protect older adults from elder abuse and guide the practice of adult protective services agencies, law enforcement agencies, and others.

Fraud 52

Fraud Elder Abuse Governance Compliance 52

Healthcare Law Blog

JUNE 9, 2023

We have seen a growing trend of the government adding aggravated identity theft in healthcare fraud cases. The government argued that use of the patient’s Medicaid number triggered the aggravated identity theft statute. See Dubin v. United States. As a result of this decision, we may see that statute far less.

Fraud 52

Fraud Governance Medicaid Medicaid 52

MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

American Medical Compliance

MAY 22, 2023

million to settle allegations that it paid kickbacks to healthcare providers committing fraud violations. US Efforts to Crack Down on Fraud Violations Kickbacks are illegal under the False Claims Act because they can lead to overuse or misuse of medical products, harming patients and increasing healthcare costs. DePuy Synthes, Inc.

Fraud 52

Fraud Compliance Governance Doctors 52

The Health Law Firm

DECEMBER 4, 2023

At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. Indest III, J.D., He was ordered to pay $187 million in restitution. I have to say it.

Fraud 52

Fraud Medicare Medicare Governance 52

The Health Law Firm

DECEMBER 4, 2023

At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. Indest III, J.D., He was ordered to pay $187 million in restitution. I have to say it.

Fraud 52

Fraud Medicare Medicare Governance 52

HIPAA Journal

AUGUST 31, 2022

HC3 warns that Evil Corp may conduct attacks at the request of the Russian government, including attacks that steal intellectual property, and members of the group are known to cooperate with the Russian intelligence agencies.

Ransomware 126

Ransomware Fraud Governance Public Health 126

Healthcare IT News - Telehealth

SEPTEMBER 12, 2024

Queensland to pilot telestroke service at Hervey Bay Hospital The Queensland government has designated Hervey Bay Hospital as the pilot site for the upcoming statewide telestroke service. The state government has committed A$5.8 The InterSystems integration also allows didgUgo to leverage AI for fraud prevention. million ($3.8

Doctors 130

Doctors Governance Fraud Hospitals 130

HIPAA Journal

JUNE 9, 2023

Prosecutors argued that while the context of the fraud in Dubin’s case was relatively small, it was the correct reading of the statute and that the flat two-year jail term should stand regardless of the scale of the fraud.

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Fraud Medicaid Medicaid Doctors 107

Healthcare IT News - Telehealth

JULY 16, 2020

Though interstate licensure is a hot-button issue for providers who care for patients in other states, he said it's more likely that the federal government will work closely with state medical associations on a path forward there.

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COVID-19 Medicare Medicare Governance 153

MedTrainer

JULY 31, 2024

Healthcare organizations of all sizes and types are increasingly adopting governance, risk, and compliance (GRC) frameworks to address the industry’s complex regulatory landscape and evolving challenges. The integration of GRC programs in healthcare has been significantly bolstered by technological advancements.

Governance 52

Governance Compliance HIPAA Regulatory Compliance 52

HIT Consultant

APRIL 1, 2024

to settle a civil fraud lawsuit filed by the U.S. will be divided between the US government and various states. The government alleges that TRG radiologists did not adequately review these drafts before finalizing the reports sent to healthcare providers. Attorney’s Office for the Southern District of New York.

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Governance Licensing Fraud Medicare 97

Healthcare IT Today

FEBRUARY 9, 2024

government and leading medical associations call upon stakeholders to do their part. Yet due to their complex nature, health payers, third-party administrators, government agencies, and pharmacy benefits managers focus most of their constrained resources on auditing professional claims. In fact, studies by the U.S.

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Fraud Governance Hospitals Licensing 128