Electronic Health Reporter

JUNE 26, 2019

health insurance companies have begun implementing prior authorization processes. These insurers do not possess the specialized knowledge needed to determine medical necessity, so they have to shift the responsibility to providers in order to minimize instances of fraud and abuse. Recently, major U.S.

Fraud 117

Fraud Health Insurance 117

HIPAA Journal

APRIL 25, 2024

The exposed and stolen data included contact information, Social Security numbers, driver’s license numbers, financial information, health insurance information, medical records, medical histories, diagnoses/conditions, and health insurance information.

Fraud 117

Fraud Health Insurance HIPAA Licensing 117

HIPAA Journal

JULY 9, 2024

The data compromised in the incident included names, addresses, phone numbers, Social Security numbers, birth dates, diagnoses, treatment information, prescriptions, physician names, medical record numbers, device serial numbers, and health insurance information. Another lawsuit was filed by plaintiff Arthur Podroykin in the U.S.

Fraud 118

Fraud Health Insurance HIPAA Compliance 118

Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

HIPAA Journal

OCTOBER 21, 2022

A pharmaceutical sales rep has pleaded guilty to conspiring to commit healthcare fraud and wrongfully disclosing and obtaining patients’ protected health information in an elaborate healthcare fraud scheme involving criminal HIPAA violations. Ritson identified the patients through the medical practice of Dr. Frank Alario.

Fraud 63

Fraud HIPAA FDA Health Insurance 63

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

HIT Consultant

JULY 26, 2023

What You Should Know: HealthLock , a leading medical fraud and overbilling protection solution, today unveiled insightful findings from a recent attitudinal study exploring how adults in the United States feel about healthcare, from claims and billing to medical fraud and privacy.

Medical Billing 98

Medical Billing Fraud Health Insurance Doctors 98

HIPAA Journal

OCTOBER 7, 2022

Questions are often sent to HIPAA Journal about the Health Insurance Portability and Accountability Act, one of which is how HIPAA has improved healthcare. In this article, I explain some of the main ways that healthcare has been improved by HIPAA for healthcare providers, health plans, and patients.

HIPAA 96

HIPAA Fraud Health Insurance Compliance 96

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. Compliance with physician self-referral law requires strict adherence to its provisions.

Compliance 88

Compliance Fraud HIPAA Health Insurance 88

Kaiser Health News

APRIL 16, 2024

“Health insurance is important for people to have, but it’s also important to be sold properly,” said Doss, who said both consumers and legitimate agents can suffer when it’s not. Some consumers were switched multiple times or had duplicative policies.

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ACA Health Insurance Governance Medical Billing 141

HIPAA Journal

FEBRUARY 23, 2022

HIPAA is an acronym for the Health Insurance Portability and Accountability Act. When the Health Insurance Portability and Accountability Act was passed by Congress in 1996, the establishment of federal standards for safeguarding PHI was not one of the primary objectives. What is HIPAA? What is HIPAA Title II?

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HIPAA Fraud Health Insurance Medicaid 99

The Health Law Firm Blog

FEBRUARY 23, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

MAY 6, 2024

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] Indest III, J.D.,

Fraud 40

Fraud Health Insurance Overpayment Overpayments 40

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.

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Fraud Health Insurance Ransomware HIPAA 109

HIPAA Journal

FEBRUARY 22, 2023

The database included names, addresses, dates of birth, Social Security numbers, health insurance information, medical record numbers, and patient account numbers. CentraState confirmed that the hackers gained access to part of its systems that contained an archived database, and stole that database.

Ransomware 107

Ransomware Fraud Health Insurance HIPAA 107

HIPAA Journal

SEPTEMBER 30, 2022

The plaintiffs alleged the security failures were in violation of the Health Insurance Portability and Accountability Act, although the lawsuit was filed over the violation of state laws. The plaintiffs also took issue with how Magellan Health handled the data breach and the delay in issuing notifications.

Fraud 105

Fraud HIPAA Health Insurance 105

The Health Law Firm Blog

MARCH 14, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

FEBRUARY 1, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

HIPAA Journal

MARCH 30, 2023

On November 14, 2022, a hacker gained access to Rise’s network and accessed files containing sensitive patient data, including names, email addresses, phone numbers, provider information, diagnoses, expected delivery dates, and health insurance information.

Health Insurance 104

Health Insurance Fraud HIPAA 104

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

HIPAA Journal

OCTOBER 17, 2022

The exposed information included names, dates of birth, Social Security numbers, driver’s license numbers, clinical/diagnosis information, health insurance member ID numbers, medical record numbers, and Medicare or Medicaid numbers. Valle De Sol said it has not received any reports from patients to suggest any misuse of their data.

Health Insurance 124

Health Insurance Licensing Fraud HIPAA 124

HIPAA Journal

MARCH 25, 2022

Ultimate Care said no reports have been received that indicate there has been any misuse of patient information; however, as a precaution against identity theft and fraud, individuals whose Social Security numbers were impacted have been offered complimentary one-year memberships with a credit monitoring service.

Health Insurance 118

Health Insurance Licensing Ransomware Fraud 118

HIPAA Journal

JUNE 15, 2022

The South Carolina-based health insurance company, Choice Health, now part of Alight Solutions, has recently announced that the protected health information of some of its members has been obtained by an unauthorized individual.

Ransomware 142

Ransomware Health Insurance Fraud HIPAA 142

HIPAA Journal

MARCH 11, 2022

Hackers gained access to a single file server housing files that contained patients’ protected health information such as names, contact information, insurance claim information, date(s) of service, medical bill account number, and health insurance informa­tion.

HIPAA 120

HIPAA Health Insurance Medical Billing Fraud 120

HIPAA Journal

MARCH 7, 2023

The cyberattack was detected on December 8, 2022, by which time the hackers had access to a huge amount of sensitive patient data, including full names, contact information, Social Security numbers, diagnoses, treatment information, medications, lab test results, radiology reports, and health insurance information.

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Fraud Health Insurance HIPAA Doctors 120

HIPAA Journal

APRIL 15, 2022

The incident involved the exposure and potential theft of the protected health information of 318,400 patients, including names, addresses, birth dates patient account numbers, medical record numbers, health insurance information, testing, diagnostic, treatment, and claims information.

Electronic Medical Records 124

Electronic Medical Records HIPAA Health Insurance Fraud 124

HIPAA Journal

APRIL 23, 2024

Kisco Senior Living said additional security features have been implemented to prevent similar breaches in the future and the affected individuals have been offered 12 months of complimentary credit monitoring services, which include a $1 million identity fraud loss reimbursement policy.

Ransomware 110

Ransomware Fraud Licensing HIPAA 110

HIPAA Journal

SEPTEMBER 7, 2023

The information accessed in the attack included names, addresses, dates of birth, Social Security numbers, financial account information, medical record numbers, health insurance plan member IDs, and claims data. The affected individuals were notified by mail on August 11, 2023.

HIPAA 99

HIPAA Health Insurance Fraud 99

Healthcare IT News - Telehealth

JULY 2, 2020

Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma to provide a written plan for permanent changes to Medicare, Medicaid and Children’s Health Insurance Program rules around telehealth.

COVID-19 179

COVID-19 Medicare Medicare Medicaid 179

HIPAA Journal

AUGUST 5, 2022

The cyberattack was discovered by VPN Solutions on or around October 31, 2021, and the forensic investigation confirmed that the information potentially compromised in the attack included names, addresses, dates of birth, diagnostic and treatment information, health insurance information, and Social Security numbers.

Electronic Medical Records 101

Electronic Medical Records Health Insurance Fraud HIPAA 101

HIPAA Journal

MAY 2, 2024

Hackers gained access to the BioPlus network for more than 2 weeks between October and November 2021, and potentially stole names, dates of birth, contact information, health insurance information, prescription information, and Social Security numbers.

Fraud 108

Fraud HIPAA Health Insurance Compliance 108

HIPAA Journal

NOVEMBER 12, 2024

The affected systems contained information such as names, addresses, dates of birth, billing and claims information, health insurance claims information, diagnoses, medications, test results, x-ray images, and other treatment information. Passwords were reset and policies and procedures have been reviewed.

Health Insurance 81

Health Insurance Fraud Licensing HIPAA 81

HIPAA Journal

NOVEMBER 23, 2022

A comprehensive review of all files potentially compromised in the attack revealed they contained the protected health information of 877,584 current and former patients, employees, and job applicants.

Ransomware 117

Ransomware Fraud Licensing HIPAA 117

HIPAA Journal

JUNE 13, 2023

The forensic investigation confirmed the affected systems contained PHI such as names, addresses, phone numbers, birthdates, health insurance account information, Social Security numbers, provider taxpayer ID numbers, and clinical information and that information was in the files exfiltrated from its systems. and Point32Health, Inc.

Ransomware 102

Ransomware Fraud Health Insurance HIPAA 102

HIPAA Journal

JULY 4, 2024

The exposed information varied from individual to individual and may have included names, birth dates, medical record numbers, medical histories, and health insurance information. SkinCure Oncology believes files in those email accounts were viewed and potentially obtained in the attack. to 5:30 p.m.

Medicaid 115

Medicaid Medicaid Fraud Licensing 115

HIPAA Journal

FEBRUARY 21, 2022

EHRs usually contain all the information required for multiple types of fraud, including names, addresses, dates of birth, Social Security numbers, other government and state ID numbers, health data, and health insurance information. Cyberattacks on EHRs can be extremely profitable for cyber threat actors.

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Ransomware Fraud HIPAA Health Insurance 133