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. Implementing GRC for healthcare has substantial benefits for healthcare leaders.

Governance 52

Governance Compliance HIPAA Regulatory Compliance 52

Healthcare IT News - Telehealth

JANUARY 27, 2021

Department of Justice announced Monday that four people and one company have recently pleaded guilty in a telemedicine pharmacy healthcare-fraud conspiracy that allegedly lasted for years. "Telemarketing fraud is a major threat to the integrity of government and commercial insurance programs," said Derrick L.

Fraud 143

Fraud Telemedicine Ransomware COVID-19 143

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. Abuse of government healthcare programs is a federal offense with severe penalties. government or a government contractor.

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Fraud Medicaid Medicaid Medicare 52

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. Identification to Inform Action. Awareness is a crucial first step.

Fraud 98

Fraud COVID-19 Public Health Medicare 98

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. Some staff members expressed concern about the insecure storage of private medical information, but CHS took no action to address the issue and failed to ensure medical records were only stored in the EMR system.

Fraud 124

Fraud Electronic Medical Records Governance HIPAA 124

Med-Net Compliance

JULY 11, 2022

The report says that in FY 2021 the DOJ opened 831 new criminal healthcare fraud investigations. Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, and a total of 312 defendants were convicted of healthcare fraud related crimes during the year. 2,947 investigations were pending at the end of FY 2021.

Fraud 59

Fraud Compliance Medicaid Medicaid 59

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

Compliancy Group

AUGUST 31, 2022

A pair of government contractors recently agreed to settlements of alleged violations of the False Claims Act (FCA) for nearly $10 million as part of the U.S. Department of Justice’s (DOJ) Civil Cyber Fraud Initiative (CCFI). Details of DOJ Cyber Fraud Initiative Settlements. DOJ Cyber Fraud Initiative and the HIPAA Connection.

Fraud 52

Fraud HIPAA Electronic Medical Records Governance 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

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

Health Law RX

AUGUST 1, 2022

To facilitate the provision of care during the pandemic, the federal government and many state governments enacted changes that encouraged physicians and other nonphysician practitioners (collectively, Practitioners) to use telehealth services. On July 20, 2022, the U.S. Insufficient Physician-Patient Contact.

Fraud 59

Fraud Telemedicine Nurses Governance 59

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

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 118

Fraud Health Insurance Ransomware HIPAA 118

Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. In March 2020 she pleaded guilty to one count of healthcare fraud, one count of wire fraud, and one count of theft of government funds. She used the money instead for her own personal gain. US Attorney Ashley C.

Fraud 59

Fraud Compliance Governance Medicaid 59

Med-Net Compliance

JUNE 22, 2022

A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud.

COVID-19 Vaccine 59

COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

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. For more information, download the full report here. Report Background.

Fraud 98

Fraud COVID-19 Nurses Licensing 98

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Nursing Homes 59

Med-Net Compliance

JULY 20, 2022

He was convicted of one count of healthcare fraud and one count of making a false claim. Healthcare providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties can use the OIG’s Provider Self-Disclosure Protocol to voluntarily disclose self-discovered evidence of potential fraud.

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Fraud Doctors Medicare Medicare 59

Healthcare Compliance Blog

FEBRUARY 22, 2022

Two women, one from Colorado and the other from Houston, have been sentenced in federal court for their roles a multi-million dollar Medicare Fraud Scheme. Each woman pled guilty to one count of conspiracy to commit healthcare fraud. The post Two Women Sentenced for Conspiracy to Commit Healthcare Fraud appeared first on.

Fraud 59

Fraud Medicare Medicare Governance 59

Health Care Law Brief

JULY 21, 2022

On July 20, 2022, the Office of Inspector General for the Department of Health and Human Services (“ OIG ”) issued a special fraud alert (“ Alert ”) advising “practitioners to exercise caution when entering into arrangements with purported telemedicine companies.” OIG Flags Seven Characteristics of Telehealth Fraud.

Fraud 52

Fraud Telemedicine COVID-19 Governance 52

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 124

Doctors Governance Fraud Hospitals 124

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Trust is core to the provider-patient relationship.

Fraud 52

Fraud Medicare Medicare Compliance 52

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 93

Fraud Health Insurance Ransomware HIPAA 93

Florida Health Care Law Firm

APRIL 18, 2022

Fraud in these cases is generally easy to prove. Simply verifying inventory, orders and dispensing records yields incredible data that when combined with comparative data from peer pharmacies can be used by law enforcement to establish that fraud has been committed. So what information did the DOJ have at its disposal in this case?

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Florida Health Care Law Firm

DECEMBER 7, 2021

Telemedicine pharmacy arrangements continue to be of significant interest to fraud enforcement. The federal jury trial in the billion-dollar telehealth pharmacy fraud scheme resulted in conviction on 22 counts of mail fraud, conspiracy to commit health care fraud and introduction of misbranded drugs into interstate commerce.

Fraud 40

Fraud Telemedicine Governance Compliance 40

C&M Health Law

AUGUST 3, 2023

Under the final rule, enforcement of the information blocking penalties will begin September 1, 2023. Other than the information blocking penalties, the rest of the final rule’s provisions are effective August 2, 2023.

Fraud 52

Fraud HIPAA Governance Compliance 52

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

Fraud 52

Fraud Medicare Medicare Compliance 52

Health Law RX

JULY 18, 2023

On June 27, 2023, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its long-anticipated final rule amending the OIG’s civil monetary penalty (CMP) regulations as they relate to information blocking (CMP Final Rule or Rule). The CMP Final Rule was published in the Federal Register on July 3, 2023.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Hall Render

AUGUST 22, 2023

Rather, liability under the FCA may still be established if any misrepresentations made by a provider influenced decision-makers and resulted in the submission of false claims to the government. Walgreens learned of the fraud as early as 2016. Practical Takeaways Altering a patient’s medical information is fraudulent under the FCA.

Medicaid 40

Medicaid Medicaid Governance Fraud 40

American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. The Department of Justice recently revealed charges against 78 individuals involved in healthcare fraud schemes. However, they encounter numerous challenges in achieving this goal.

Compliance 92

Compliance Fraud HIPAA Health Insurance 92

Health Care Law Brief

JUNE 5, 2023

We previously wrote about the United States Department of Justice’s (“ DOJ ”) Civil Cyber-Fraud Initiative (“ CCFI ”), which “aims to hold accountable entities or individuals that put U.S. FHKC shut down its website’s application portal shortly thereafter. Follow us at [link] for updates as DOJ continues its CCFI enforcement efforts.

Fraud 52

Fraud Due Diligence Medicaid Medicaid 52

Healthcare IT Today

JANUARY 19, 2024

This is mainly due to misuse, such as unintentionally compromising consumer credentials, Personal Identifiable Information (PII), and Personal Health Information (PHI). Governments are starting to act in response to the growing amount of cyber threats in the healthcare industry. AI should also be used for identity governance.

Fraud 114

Fraud Governance Ransomware Compliance 114

Hall Render

SEPTEMBER 15, 2022

This study comes on the heels of a recent Press Release issued July 20, 2022 (“Press Release”), in which the Department of Justice (“DOJ”) announced criminal charges against 36 defendants in 13 federal districts across the United States largely alleging fraud in the telemedicine space. Inspector General Christi A.

Telemedicine 40

Telemedicine Fraud Medicare Medicare 40

Hall Render

SEPTEMBER 12, 2022

Healthsouth of Sarasota Limited Partnership, et al , the Eleventh Circuit held that for a plaintiff to qualify as engaging in “protected activity,” the plaintiff must demonstrate that they had both a subjectively reasonable belief of fraud and an objectively reasonable belief of fraud. Background. 3730(h)(1). Practical Takeaways.

Fraud 40

Fraud Governance Compliance 40

Compliancy Group

NOVEMBER 6, 2024

With workforce compliance software and other digital tools, organizations can centralize and streamline their compliance activities, making it easier for employees to stay informed and actively maintain the highest healthcare standards. Non-compliance damages your financial stability and could lead to fewer contracts, patients, or customers.

Compliance 52

Compliance Compliance Officers Fraud Health Insurance 52

HIPAA Journal

NOVEMBER 7, 2024

ORM Fertility said there was no unauthorized access to its electronic medical records (EMR), email, or customer relationship management system (CRM), and financial and insurance information was not exposed. The review of the affected files is ongoing; however, it appears that only limited patient data was exposed, such as names and lab data.

Electronic Medical Records 60

Electronic Medical Records Fraud HIPAA Health Insurance 60

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.

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Fraud Licensing HIPAA Governance 105