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. Healthcare compliance under HIPAA includes adhering to the Security Rule, which covers the handling, maintenance, and sharing of PHI.

Compliance 52

Compliance HIPAA Electronic Medical Records Fraud 52

HIPAA Journal

OCTOBER 21, 2022

There are – and always have been – gaps in HIPAA and, after more than a quarter of a century, some have yet to be addressed. Most of the gaps in HIPAA are attributable to omissions from the original Act, provisions of HIPAA and HITECH that have never been enacted, and the increasing use of technology in healthcare.

HIPAA 106

HIPAA Compliance Medicare Medicare 106

Compliancy Group

MAY 27, 2022

Here’s a roundup of recent HIPAA breach lawsuits and settlements. Lawsuits Increasing Following HIPAA Breaches – Facts and Figures. Let’s Simplify Compliance HIPAA and cybersecurity go hand-in-hand. × HIPAA Compliance Simplified. No damages have been claimed, but the lawsuit requests a jury trial.

HIPAA 98

HIPAA Ransomware Hospitals Health Insurance 98

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-19 182

COVID-19 Medicare Medicare Medicaid 182

Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. Some denials result from noncompliance with federal fraud, waste, and abuse laws. Such noncompliance can result in non compliance fines.

Fraud 52

Fraud Compliance Medicare Medicare 52

HIPAA Journal

JANUARY 30, 2023

The National HIPAA Summit is the leading forum on healthcare EDI, privacy, breach notification, confidentiality, data security, and HIPAA compliance, and the deadline for registration for the Virtual 40th National HIPAA Summit is fast approaching.

US Department of Health and Human Services 82

US Department of Health and Human Services HIPAA Compliance Medicaid 82

HIPAA Journal

JULY 4, 2024

SkinCure Oncology has notified 13,434 patients about an email attack that occurred in June 2023, and the Wisconsin Department of Health Services has announced a breach of the personal information of 19,150 Medicaid recipients. Further information can be contained by calling SkinCure Oncology’s helpline – (866) 528-8844.

Medicaid 118

Medicaid Medicaid Fraud Licensing 118

HIPAA Journal

MARCH 15, 2023

The United States Department of Justice has agreed to settle alleged False Claims Act violations with Jelly Bean Communications Design LLC and manager Jeremy Spinks related to the failure to protect HIPAA-covered data. FHKC receives Medicaid funds and state funds for providing health insurance programs for children in Florida.

Health Insurance 100

Health Insurance HIPAA Fraud Due Diligence 100

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

Fraud 106

Fraud Medicaid Medicaid Doctors 106

Verisys

MARCH 6, 2025

Department of Health and Human Services (HHS) Enforces regulations like the Health Insurance Portability and Accountability Act (HIPAA) to ensure patient data privacy and security. The Office of Inspector General (OIG) Monitors and enforces compliance with regulations that prevent fraud, waste, and abuse in healthcare programs.

Compliance 52

Compliance HIPAA Licensing Governance 52

Medisys Compliance

JANUARY 16, 2025

The Centers for Medicare & Medicaid Services (CMS) provides comprehensive behavioral health billing guidelines, which can be overwhelming due to their technical nature and breadth. Providers must use HIPAA-compliant telehealth platforms and ensure informed consent is documented in the patients record.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Fraud 59

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 105

Compliance Fraud HIPAA Health Insurance 105

Compliancy Group

NOVEMBER 25, 2024

The Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) helps prevent fraud, ensure high-quality levels of care, and keep businesses aligned with regulatory measurements. In cases like this, checking the employee’s information against Medicaid databases could also be helpful.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

HIPAA Journal

JULY 3, 2024

The HIPAA transactions and code sets rules have the objective of replacing non-standard descriptions of healthcare activities with standard formats for each type of activity in order to streamline administrative processes, lower operating costs, and improve the quality of data. diagnoses, procedures, and drugs). Health Care Claims Status.

HIPAA 56

HIPAA Medicaid Medicaid Compliance 56

HIPAA Journal

JANUARY 11, 2024

OIG in healthcare stands for the Department of Health and Human Services (HHS) Office of Inspector General (OIG) – the Office within the HHS responsible for reducing waste, fraud, and abuse in HHS programs and improving efficiency.

Fraud 98

Fraud HIPAA Compliance Medicare 98

HIPAA Journal

JULY 4, 2024

The HIPAA rules and regulations are the standards and implementation specifications adopted by federal agencies to streamline healthcare transactions and protect the privacy and security of individually identifiable health information. This guide explains why the HIPAA rules and regulations exist, what they consist of, and who they apply to.

HIPAA 56

HIPAA Compliance Fraud Medicare 56

HIPAA Journal

APRIL 27, 2023

The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.

Medicare 113

Medicare Medicare Medicaid Medicaid 113

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

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. A lawsuit – Young, et al.

Hospitals 101

Hospitals Fraud Licensing HIPAA 101

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

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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

HIPAA Journal

MARCH 6, 2023

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required the Centers for Medicare and Medicaid Services (CMS) to remove Social Security numbers from all Medicare cards as part of an effort to prevent fraud, combat identity theft, and safeguard taxpayer dollars and replace them with Medicare Beneficiary Identifiers.

Medicare 102

Medicare Medicare Fraud Medicaid 102

HIPAA Journal

FEBRUARY 8, 2024

Department of Health & Human Services Office of Inspector General (HHS-OIG) has published a Roadmap for New Physicians on avoiding Medicare and Medicaid fraud and abuse. As a result of dishonest healthcare providers, laws have been created to combat fraud and abuse.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

American Medical Compliance

AUGUST 7, 2024

These regulations protect patient privacy, ensure quality care, and prevent fraud and abuse. Here are the key areas of healthcare compliance. HIPAA (Health Insurance Portability and Accountability Act) This compliance is crucial for safeguarding patient health information. It ensures its confidentiality and maintains security.

Compliance 105

Compliance HIPAA Medicaid Medicaid 105

Verisys

NOVEMBER 8, 2023

CMS.gov The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the creation of a standard, unique health identifier for healthcare providers, which the NPI satisfies. While health plans may use other numbers internally, the NPI is mandatory for HIPAA transactions.

Fraud 97

Fraud HIPAA Medicare Medicare 97

HIPAA Journal

NOVEMBER 11, 2024

The post Healthcare Providers Fined for Failing to Check the HHS-OIG Exclusions List appeared first on The HIPAA Journal.

Fraud 78

Fraud Medicaid Medicaid HIPAA 78

HIPAA Journal

MARCH 21, 2023

During that time they exfiltrated files that contained sensitive patient data, including names, contact information, Social Security number, Medicare/Medicaid IDs, health information, and health insurance information. The post Independent Living Systems Sued Over 4 Million-Record Data Breach appeared first on HIPAA Journal.

Fraud 116

Fraud Health Insurance Medicaid Medicaid 116

HIPAA Journal

MAY 25, 2022

SAC Health said it is unaware of any actual or attempted misuse of patient data as a result of the break-in; however, as a precaution against identity theft and fraud, affected individuals have been offered complimentary credit monitoring services. Notification letters were sent to those individuals on May 3, 2022.

Ransomware 137

Ransomware Fraud HIPAA Licensing 137

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. Legacy Post Acute Care Announces Breach of Employee Email Accounts.

Health Insurance 135

Health Insurance Licensing Fraud HIPAA 135

MedTrainer

JANUARY 10, 2024

The OIG is making major investments to systematically detect and prosecute fraud. In this guidance it’s clear the OIG expects healthcare organizations and suppliers to understand their role and responsibilities to fight fraud, waste, and abuse. We all should be a LOT more prepared!

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

Compliancy Group

JANUARY 3, 2025

There are a variety of reasons that a provider can end up on this list, from committing fraud, providing care with a suspended license, or being involved in patient abuse cases. Aside from monetary losses, employing or contracting someone on these exclusion lists can result in the loss of Medicaid reimbursements. There has been a 4.2%

Medicaid 52

Medicaid Medicaid Compliance Fraud 52

HIPAA Journal

SEPTEMBER 9, 2022

As a precaution against identity theft and fraud, complimentary memberships have been offered to a credit monitoring service for 12 months. appeared first on HIPAA Journal. The information exposed varied from patient to patient. Notification letters were sent to all affected individuals in August.

Licensing 118

Licensing Health Insurance Fraud HIPAA 118

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 119

Health Insurance Licensing Ransomware Fraud 119

HIPAA Journal

DECEMBER 30, 2022

It should be noted that the HIPAA Breach Notification Rule requires the HHS and affected individuals to be notified about breaches of protected health information within 60 days of the discovery of a data breach. The investigation of the breach took six months, but it then took a further four months for affected individuals to be notified.

Electronic Medical Records 109

Electronic Medical Records HIPAA Fraud Medicaid 109

Total Medical ComplianceHIPAA

JANUARY 11, 2024

HIPAA stands as a beacon of privacy and security standards within the industry. These screenings search through various databases containing records of individuals or organizations barred from participating in Medicaid, Medicare, or other federal/state healthcare programs due to fraud, abuse, or other offenses.

HIPAA 52

HIPAA Malpractice Regulatory Compliance Compliance 52

HIPAA Journal

NOVEMBER 12, 2024

Orthopedics Rhode Island said it is unaware of any misuse of that information but has advised all affected individuals to be vigilant against identity theft and fraud. The post Data Breaches Announced by New Jersey Rehabilitation Center & Rhode Island Orthopedic Practice appeared first on The HIPAA Journal.

Health Insurance 84

Health Insurance Fraud Licensing HIPAA 84

Healthcare IT News - Telehealth

SEPTEMBER 9, 2020

During the public health emergency, the Centers for Medicare and Medicaid Services temporarily expanded that coverage – for example, allowing clinicians to provide services to patients in their homes and in non-rural settings. And last but not least, large-scale fraud.

Medicare 173

Medicare Medicare Public Health HIPAA 173