Healthcare IT Today

FEBRUARY 9, 2024

government and leading medical associations call upon stakeholders to do their part. Currently, in-patient and facility claims (such as extended hospital stays) account for a significant portion of costs in healthcare — as high as 45%. Even worse, up to 10% of this spending is rife with waste, abuse, and fraud.

Fraud 128

Fraud Governance Hospitals Licensing 128

Healthcare IT News - Telehealth

JULY 16, 2020

" Segalla described two sides of the discussion: providers and hospitals wondering if reimbursement rates will remain steady, and payers wondering if telehealth will improve healthcare outcomes and reduce overall spending. "Currently there's parity between in-person and telehealth visits," Leary pointed out.

COVID-19 155

COVID-19 Medicare Medicare Governance 155

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

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

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.

Fraud 123

Fraud Governance Ransomware Compliance 123

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. Key Allegations The lawsuit alleged that TRG engaged in improper billing practices related to radiology services provided to hospitals and other healthcare providers across the country.

Governance 97

Governance Licensing Fraud Medicare 97

American Medical Compliance

MAY 22, 2023

million to settle allegations that it paid kickbacks to healthcare providers committing fraud violations. Department of Justice accused the company of violating the False Claims Act by paying kickbacks to physicians and hospitals in exchange for using their products. DePuy Synthes recently agreed to pay $9.75 DePuy Synthes, Inc.

Fraud 52

Fraud Compliance Governance Doctors 52

HIT Consultant

MAY 4, 2023

Monitoring and maintaining the security of IT infrastructure is often overemphasized within hospitals and health systems, while the human side of reducing risk is often under-emphasized. The answer is training, continual training to help create a culture of security within your hospital or health system.

Hospitals 97

Hospitals HIPAA Regulatory Compliance Compliance 97

The Health Law Firm

MARCH 13, 2013

Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. In many cases the activity may amount to fraud on the government. Often they are even asked to participate in it.

Fraud 40

Fraud Governance Nursing Homes Nurses 40

The Health Law Firm

MARCH 14, 2013

Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. In many cases the activity may amount to fraud on the government. Often they are even asked to participate in it.

Fraud 40

Fraud Governance Nursing Homes Nurses 40

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

Healthcare IT News - Telehealth

JANUARY 26, 2022

Ain Shams University Virtual Hospital (ASUVH) in Cairo, Egypt, employs a model of care where they reach patients throughout the continent by connecting with local clinics. Further, telehealth providers can help reduce the chance for fraud, waste and abuse by implementing risk-management policies and mechanisms.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

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? Risk Assessment. Legislation and Congressional Requests.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

The Health Law Firm

JANUARY 23, 2019

On January 23, 2019, a Miami woman pled guilty to conspiring to defraud the government and paying and receiving kickbacks as part of a $1 billion health care fraud scheme. The former Director of Outreach Programs at Larkin Community Hospital will face a prison sentence of up to five years on the single count. Indest III, J.D.,

Fraud 40

Fraud Governance Hospitals 40

Healthcare Compliance Blog

MAY 19, 2022

An acute care hospital in Oklahoma has paid over $1.1 Following an internal review and audit, the hospital discovered irregularities regarding its billing of certain services, and proactively contacted the United States to self-disclose the issues.? Throughout the investigation, the hospital cooperated with the above entities.

US Department of Health and Human Services 59

US Department of Health and Human Services Hospitals Medicare Medicare 59

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicare Medicare Governance 40

Kaiser Health News

NOVEMBER 11, 2021

She won’t answer the phone unless her caller ID displays a number she recognizes, but this call showed the number of the hospital where her doctor works. She contacted the 1-800-MEDICARE helpline to get a new Medicare number and called the AARP Fraud Watch Network Helpline and the Federal Trade Commission.

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Medicare Medicare Doctors Fraud 145

HIPAA Journal

MARCH 30, 2023

Medical device cybersecurity is of significant concern as the number of devices used by hospitals continues to increase. Synthetic accounts have been a problem in several sectors for many years but there is growing evidence that synthetic accounts are being used for healthcare fraud.

Ransomware 106

Ransomware Fraud Governance Medical Billing 106

Healthcare IT News - Telehealth

JUNE 8, 2022

But even now, hospitals and health systems should be preparing proactively to meet the regulatory demands of a post-PHE future. State government executive orders. But sooner or later, that provision of the Public Health Service Act will draw to a close. Providers have been promised at least 60 days' notice.

US Department of Health and Human Services 198

US Department of Health and Human Services Compliance COVID-19 Overpayments 198

Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Compliancy Group

JANUARY 25, 2022

This is the second-largest number of records reported breached on the government site since 2015. nonprofit organization established to empower and guide consumers, victims, businesses, and governments to minimize risk and mitigate the impact of identity compromise and crime. . Protected health information (PHI) from more than 45.7

HIPAA 98

HIPAA Ransomware Governance Fraud 98

HIT Consultant

DECEMBER 10, 2021

Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know. 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.

COVID-19 98

COVID-19 Fraud Nurses Licensing 98

Healthcare IT Today

SEPTEMBER 19, 2023

For example, depending on whether physicians are sitting in their hospital office or their clinic office (and many doctors work in both), the insights they have into the medications their patients take can vary greatly. This critical information can help identify or avoid serious adverse events, including hospital readmissions.

Hospitals 139

Hospitals HIPAA Nurses Governance 139

Healthcare IT Today

DECEMBER 21, 2023

Predominantly, the risk of fraud, theft, or abuse of customer or company information increases, which can cause regulatory violations resulting in significant fines and penalties. If healthcare providers fail to comply, the consequences can be costly.

Records Management 128

Records Management Regulatory Compliance Compliance HIPAA 128

HIT Consultant

DECEMBER 18, 2024

Identity theft, fraud, and long-term financial harm are just a few examples of the personal fallout patients may face following a data breach. He is among the top thought leaders in Cyber Security and has participated in various policy programs with Government of India and other industry bodies. However, AI is not a silver bullet.

Ransomware 95

Ransomware Fraud Doctors HIPAA 95

AIHC

SEPTEMBER 25, 2024

There is value in learning from another organization’s lessons publicly posted by a government authority, such as the Department of Justice (DOJ), Centers for Medicare & Medicaid Services (CMS), the HIPAA enforcement agency, the Office of Civil Rights (OCR) or the Federal Bureau of Investigations (FBI).

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

Healthcare IT Today

APRIL 23, 2020

While the federal government has relaxed some patient privacy rules in response to the coronavirus pandemic, there are still avoidable mistakes healthcare professionals make when it comes to protecting patient data. The following is a guest article by Mark LaRow, CEO at Verato.

Public Health 124

Public Health Governance COVID-19 Fraud 124

Compliancy Group

DECEMBER 11, 2024

Unfortunately, such incidents of fraud happen, which is the reason for the False Claims Act in Healthcare. Department of Justice (DOJ) is diverting more attention to cyber-related fraud by federal contractors and funded researchers. In addition to False Claims Act healthcare penalties, there are incentives for reporting fraud.

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare IT Today

APRIL 25, 2024

For a healthcare entity, the data and information are viewed as extremely valuable as it includes PII as well as other health information that can be used for insurance fraud and identity theft. Troy serves clients in a variety of industries including communications and media, technology, health care, and higher education.

Ransomware 126

Ransomware Compliance Fraud Governance 126

HIPAA Journal

NOVEMBER 21, 2022

The payments were intended for hospitals for providing covered medical services. The arrests were related to a series of scams that spoofed hospital email accounts. million in losses were caused to federal government agencies, private companies, and individuals. million, and $6.4

Medicaid 86

Medicaid Medicaid Medicare Medicare 86

HIPAA Journal

JANUARY 1, 2023

However, at the time, the healthcare insurance industry was governed by a hotchpotch of federal and state legislation. Group health insurance as we know it today started in the 1920s with the Baylor University in Texas guaranteeing teachers twenty-one days of hospital care for $6 per year. 3103 Evolved into What HIPAA Means Today.

HIPAA 83

HIPAA Health Insurance Fraud Governance 83

Healthcare Law Blog

FEBRUARY 9, 2024

Following the resolution of this case, hospitals are encouraged to revisit their arrangements with private physician groups to ensure that proper safeguards are in place to mitigate FCA risk. Hospitals may also want audit rights to ensure that it has the ability to monitor billing compliance by private physicians on a regular basis.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Hall Render

FEBRUARY 25, 2022

Under the Donors’ agreement with the Children’s Hospital (“Agreement”), the Hospital and the Fund would pay all out-of-pocket costs incurred by qualified families for their child’s medical care in the cancer, cardiac or neurosurgical programs, referred to as the “Initial Supported Programs.”

Fraud 40

Fraud Hospitals Medicare Medicare 40

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

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 billion is attributed to cases involving the health care industry, including managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities and physicians.

Compliance 71

Compliance Governance Medicare Medicare 71

Healthcare IT Today

FEBRUARY 17, 2023

government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. They expect to recoup 4.7

Overpayments 89

Overpayments Overpayment COVID-19 Medicare 89

Healthcare IT News - Telehealth

SEPTEMBER 25, 2023

By Mike Miliard | September 19, 2023 News Guardrails, data governance key to solid generative AI outcomes IT leaders need to take a step back and ensure they are truly prepared to use large language models. The process.

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Nurses Governance Fraud Health Outcomes 112