HIPAA Journal

MARCH 30, 2022

For example: Had the health insurance industry been allowed to continue operating as it did prior to HIPAA, tens of millions of Americans would be excluded from health plan benefits. Had the momentum to improve health care not been given a kickstart by HIPAA, subsequent health care initiatives may never have happened.

HIPAA 136

HIPAA Fraud Health Insurance Health Care Reform 136

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 (..)

Medicare 132

Medicare Medicare Fraud Governance 132

American Medical Compliance

OCTOBER 25, 2024

These regulations secure sensitive health information and uphold the financial integrity of healthcare organizations. Audits serve as a critical defense against fraud and inefficiency while fostering trust in your practice. A powerful way to ensure this is through regular compliance audits.

Compliance 105

Compliance Fraud Compliance Framework HIPAA 105

Bill of Health

OCTOBER 30, 2023

In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. In health care, complexity is everywhere. Health insurance is confusing. Notes about our health can be difficult to understand. This year a “thumbs-up” emoji was found to be part of a legally binding contract.

Doctors 290

Doctors Hospitals Fraud Health Insurance 290

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 120

Fraud Health Insurance HIPAA Compliance 120

Medisys Compliance

MARCH 31, 2025

Understanding Medicare for Physicians Medicare, the federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease, is divided into several parts. Practices must be vigilant in preventing Medicare fraud, waste, and abuse (FWA).

Medicare 59

Medicare Medicare Medical Billing Medical Billing Outsourcing 59

Compliancy Group

NOVEMBER 6, 2024

Importance of Workforce Compliance Compliance with workforce requirements in healthcare involves ensuring the organization and its members comprehend and adhere to laws governing patient safety and privacy, maintaining secure working conditions, and preventing fraud, waste, and abuse.

Compliance 52

Compliance Compliance Officers Fraud Health Insurance 52

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 107

HIPAA Fraud Health Insurance Compliance 107

HIPAA Journal

APRIL 11, 2025

Health insurance information such as plan names, plan types, insurance companies, and member/group ID numbers. The affected individuals should be vigilant against identity theft and other fraud by monitoring their accounts and Explanation of Benefits statements carefully.

Ransomware 58

Ransomware Fraud HIPAA Licensing 58

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

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

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 105

Compliance Fraud HIPAA Health Insurance 105

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

MARCH 11, 2025

The file review confirmed that the types of data compromised in the cyberattack included names, addresses, dates of birth, Social Security numbers, drivers license numbers, medical information, and health insurance information.

Department of Veterans Affairs 81

Department of Veterans Affairs Licensing Ransomware Fraud 81

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 116

Fraud HIPAA Health Insurance 116

Compliancy Group

NOVEMBER 1, 2024

When you work in healthcare, you must comply with the most rigorous regulations that safeguard patient health and privacy, protect workers, and prevent fraud, waste, and abuse of federal funds. Anyone in this industry should know the healthcare compliance laws and regulations that guide how they do their jobs and provide quality care.

Compliance 52

Compliance HIPAA Electronic Medical Records Fraud 52

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 114

Ransomware Fraud Health Insurance HIPAA 114

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 134

Health Insurance Licensing Fraud HIPAA 134

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 133

HIPAA Health Insurance Medical Billing Fraud 133

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?

HIPAA 102

HIPAA Fraud Health Insurance Medicaid 102

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.

ACA 141

ACA Health Insurance Governance Medical Billing 141

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 114

Electronic Medical Records Health Insurance Fraud HIPAA 114

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 112

Fraud Health Insurance Ransomware HIPAA 112

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 106

Health Insurance Fraud HIPAA 106

HIPAA Journal

JANUARY 1, 2023

Most state that HIPAA is an acronym of the Health Insurance Portability and Accountability Act of 1996 and that it led to the development of standards for the privacy of Protected Health Information. However, at the time, the healthcare insurance industry was governed by a hotchpotch of federal and state legislation.

HIPAA 98

HIPAA Health Insurance Fraud Governance 98

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 105

HIPAA Health Insurance Fraud 105

HIPAA Journal

SEPTEMBER 7, 2022

Before file encryption, the attackers potentially accessed or acquired documents from its systems that contained names, addresses, dates of birth, Social Security numbers, health insurance information, and medical treatment information.

HIPAA 128

HIPAA Ransomware Fraud Health Insurance 128

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 117

Health Insurance Licensing Ransomware Fraud 117

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 144

Ransomware Health Insurance Fraud HIPAA 144

HIPAA Journal

SEPTEMBER 29, 2022

Choice Health worked with its service provider to ensure the database was secured and additional data security measures have been implemented to prevent similar occurrences in the future.

Health Insurance 128

Health Insurance Medicare Medicare Fraud 128

HIPAA Journal

JUNE 28, 2023

Individuals that have suffered identity theft, medical fraud, tax fraud, other forms of fraud, and other actual misuses of their personal information, can submit claims for documented, unreimbursed extraordinary losses that are reasonably traceable to the data breach of up to a maximum of $5,000.

Hospitals 100

Hospitals Fraud Licensing HIPAA 100

HIPAA Journal

MARCH 11, 2025

An investigation was launched, and it was confirmed that RIPTAs previous health insurance provider, UnitedHealthcare of New England, had provided RIPTA with files containing the data of non-RIPTA employees, and that data was compromised in the attack.

Ransomware 50

Ransomware Fraud HIPAA Health Insurance 50

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 83

Health Insurance Fraud Licensing HIPAA 83

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.

Fraud 120

Fraud Health Insurance Doctors HIPAA 120

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-19 180

COVID-19 Medicare Medicare Medicaid 180