Healthcare IT Today

MARCH 26, 2025

As the sector adapts, telehealth providers must navigate new compliance challenges, particularly regarding controlled substances, data privacy, and multi-state licensing. While telehealth is federally recognized, each state maintains its own set of rules governing online prescribing , provider licensing, and telehealth modalities.

FDA 52

FDA Compliance Licensing Fraud 52

Verisys

APRIL 3, 2025

Licensure actions Disciplinary actions from state medical boards, like suspensions or revoked licenses. Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Civil judgments Lawsuits that reveal unethical behavior or misconduct.

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys.

Fraud 52

Fraud Telemedicine Licensing Doctors 52

Verisys

MARCH 6, 2025

All parties must adhere to both federal and state laws, including those set by governing bodies, and follow ethical standards that safeguard the well-being of patients. The primary governing bodies that set healthcare compliance standards include: The U.S.

Compliance 52

Compliance HIPAA Licensing Governance 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.

Governance 97

Governance Licensing Fraud Medicare 97

HIPAA Journal

APRIL 24, 2023

The new law applies to persons who own or license computerized data that includes the personal information of Utah residents. If a system security breach is discovered, a prompt investigation should be conducted to determine the likelihood that personal information has been or will be misused for identity theft or fraud.

Fraud 103

Fraud Licensing HIPAA Governance 103

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.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

AIHC

FEBRUARY 24, 2025

Part 2: When Criminal Behavior Infiltrates Your Audit Program Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) We Recommend Reading Part 1 Fraud Indicators and Red Flags When Audit Managers Knowingly Skew Audit Results as this article is Part 2, the rest of the story.

Fraud 52

Fraud Compliance Governance Compliance Officers 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

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.

Fraud 128

Fraud Governance Hospitals Licensing 128

HIPAA Journal

SEPTEMBER 8, 2022

Notification letters were sent to affected individuals in August and information was provided on the steps that individuals can take to reduce the risk of identity theft and fraud, but it would appear that credit monitoring and identity theft protection services are not being offered. Gateway Diagnostic Imaging and Radiology Ltd.

Fraud 114

Fraud Health Insurance Ransomware HIPAA 114

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

Healthcare IT News - Telehealth

JANUARY 26, 2022

The evergreen concern about virtual care is that of fraud, waste and abuse and how to balance it with the demonstrated value of extended medical services to patients who are either geographically or economically underserved. at the Orange County Convention Center in room W206A.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

Provider Trust

MARCH 13, 2023

State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment. In Delaware, 26 nursing licenses were revoked when the nurses’ credentials were tied to the scheme. ProviderTrust recommends conducting license verification monthly.

Fraud 52

Fraud US Department of Health and Human Services Licensing Nurses 52

HIPAA Journal

AUGUST 2, 2023

Notification letters will be sent to the affected individuals in the coming weeks and credit monitoring, fraud consultation, and identity theft restoration services will be offered. A third-party data review company was provided with the files on December 22, 2022, and provided the results of the analysis to SHS on May 16, 2023.

Licensing 96

Licensing Electronic Medical Records Ransomware Health Insurance 96

HIPAA Journal

SEPTEMBER 8, 2022

Notification letters were sent to affected individuals in August and information was provided on the steps that individuals can take to reduce the risk of identity theft and fraud, but it would appear that credit monitoring and identity theft protection services are not being offered.

Fraud 95

Fraud Health Insurance Ransomware HIPAA 95

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

Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. During the fiscal year 2021, the report states that the federal government won or negotiated over $5 billion in healthcare fraud judgments and settlements. Because of these efforts, close to $1.9

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Pharmacy Law Blog

MARCH 13, 2018

The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner. The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

Fraud 52

Fraud Governance Licensing FDA 52

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. States also can revoke agents’ licenses. The group supports additional protections for consumers, she added.

ACA 80

ACA Health Insurance Licensing Governance 80

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

HIPAA Journal

DECEMBER 7, 2022

In some cases, Social Security numbers, driver’s license numbers, or financial account information, were also exposed. Salud Family Health said impacted employees and patients have been offered free credit monitoring and identity fraud protection services.

COVID-19 Vaccine 103

COVID-19 Vaccine COVID-19 Department of Veterans Affairs Licensing 103

Healthcare IT News - Telehealth

JULY 19, 2021

It has nine licensed mental health professionals on staff, all committed to providing thorough delivery of psychiatric care based on the latest research. " Healthcare is one of the biggest targets for cybercriminals, alongside the government and the financial services industry. THE PROBLEM. " ADVICE FOR OTHERS.

COVID-19 167

COVID-19 HIPAA Ransomware Governance 167

Health Law Blog

MAY 22, 2018

Substance Abuse Treatment Center Fraud Scheme Results in Guilty Plea. The Department of Justice recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.”

Fraud 52

Fraud Overpayments Overpayment Licensing 52

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

MedTrainer

MARCH 17, 2025

Original source data is more difficult to access, there are more licensed professionals, and verification timelines are getting tighter. Original Source Verification For PSV credentialing to be reliable, verification must come directly from the issuing authority such as licensing boards, accreditation organizations, or government databases.

Licensing 52

Licensing Compliance Fraud Governance 52

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. According to the U.S.

Licensing 52

Licensing Fraud Compliance Nurses 52

HIPAA Journal

FEBRUARY 8, 2024

Azura Vascular Care said individuals who had sensitive information exposed such as Social Security numbers have been offered complimentary identity protection, credit monitoring, and fraud resolution services.

Ransomware 92

Ransomware Electronic Medical Records Licensing Health Insurance 92

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses. Provider credentialing confirms a provider’s qualifications.

Licensing 52

Licensing Governance Compliance Fraud 52

Provider Trust

JULY 8, 2022

A holistic approach to exclusion monitoring and license verifications must include monitoring of disciplinary databases such as the National Practitioner Data Bank (NPDB). Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S. Healthcare Legislation & Regulations.

Licensing 52

Licensing Malpractice Fraud Medicaid 52

Verisys

MAY 9, 2023

These regulatory programs ensure that reimbursement happens only for licensed practitioners and healthcare entities in good standing with the Office of Inspector General (OIG). Healthcare organizations must align their practices to comply with OIG regulations.

Compliance 52

Compliance Fraud Governance Licensing 52

Verisys

NOVEMBER 13, 2022

Compliance procedures and training programs define and monitor numerous areas for adherence to laws and regulations including patient care, physician license verification, billing, reimbursement, HIPAA privacy, and security. Felony convictions for other healthcare-related fraud, theft, or other financial misconduct.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Hall Render

JUNE 3, 2024

In addition to litigation, Katie focuses on matters related to government investigations, the False Claims Act and fraud and abuse. Her legal career began at the Indiana Attorney General’s Office, where she spent three years in the Licensing Enforcement Section during law school.

Malpractice 40

Malpractice Licensing Fraud Governance 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

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. License Verification & Monitoring. State Licensing Boards and Agencies. Learn more about how Verisys can assist your HCOs in meeting all government and regulatory standards. Credentialing.

Medicare 52

Medicare Medicare Regulatory Compliance Medicaid 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52