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

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 101

Medicare Medicare Medicaid Medicaid 101

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. The second type, indirect fraud, involves several bad actors that coordinate their efforts.

Fraud 98

Fraud COVID-19 Public Health Medicare 98

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

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 103

HIPAA Compliance Medicare Medicare 103

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

Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How the OIG Exclusion Database Came to Be HHS oversees the CMS (Center for Medicare Services), which administers the Medicare program.

Medicare 52

Medicare Medicare Fraud HIPAA 52

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

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 84

US Department of Health and Human Services HIPAA Compliance Medicaid 84

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 90

Fraud HIPAA Compliance Medicare 90

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. Medicare, Medicaid, and private health insurers suffered losses of more than $4.7

Medicaid 83

Medicaid Medicaid Medicare Medicare 83

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 97

Compliance Fraud HIPAA Health Insurance 97

The Health Law Firm

FEBRUARY 17, 2021

Board Certified by The Florida Bar in Health Law In October 2020, Massachusetts federal prosecutors charged three individuals for their alleged roles in a multi-million dollar plot to defraud Medicare. Indest III, J.D., Both individuals obtaining the personal health information were located in Florida, wouldn't you know it.

Medicare 40

Medicare Medicare Fraud HIPAA 40

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. Providers also need an NPI to enroll in Medicare. Why Are NPI Numbers Necessary?

Fraud 97

Fraud HIPAA Medicare Medicare 97

Compliancy Group

AUGUST 30, 2024

HIPAA The Health Insurance Portability and Accountability Act (HIPAA) of 1996 governs how healthcare organizations handle protected health information (PHI). FWA Fraud, waste, and abuse (FWA) in healthcare primarily refer to the inefficient and inappropriate use of Medicare and Medicaid funds.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 52

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

Medisys Compliance

APRIL 27, 2022

The Health Insurance Portability and Accountability Act (HIPAA) was introduced in year 1996. Another goal was to prevent healthcare fraud. Healthcare providers, health plans, and healthcare clearinghouses are primarily covered under HIPAA. Whatever might be the reason, its important that your practice must be HIPAA compliant.

HIPAA 52

HIPAA Medical Billing Outsourcing Medical Billing Ransomware 52

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). This is just the beginning.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 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

APRIL 23, 2024

The HHS Office of Inspector General (HHS-OIG) has issued a warning to the public about a fraud scheme that targets Medicare enrollees and involves them setting up monthly payments for medically unnecessary remote patient monitoring (RPN). Scammers are targeting Medicare enrollees and convincing them to sign up for RPN.

Medicare 52

Medicare Medicare Fraud HIPAA 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 83

Hospitals Fraud Licensing HIPAA 83

HIPAA Journal

MARCH 30, 2023

This was in response to the growing level of healthcare fraud and abuse and an alleged “compliance disconnect” at the executive level in many hospitals and health systems. The biggest influence for the creation of the seven elements of a compliance program (fraud prevention) is sometimes overlooked.

Compliance 106

Compliance Compliance Officers Fraud HIPAA 106

HIPAA Journal

JUNE 9, 2023

Prosecutors argued that while the context of the fraud in Dubin’s case was relatively small, it was the correct reading of the statute and that the flat two-year jail term should stand regardless of the scale of the fraud. The post Supreme Court Ruling Narrows Reach of Identity Theft Law appeared first on HIPAA Journal.

Fraud 103

Fraud Medicaid Medicaid Doctors 103

Healthcare IT Today

MAY 10, 2022

Contract Enforcements Tie Cybersecurity to Financial Fraud and Liability The receptionist you yelled at for shopping online could turn you in and get a $900,000 reward. When it comes to compliance, ignoring the contracts you sign – including with Medicare and your insurance policies – can hit you really hard and really fast.

Fraud 106

Fraud Medicare Medicare Compliance 106

HIPAA Journal

OCTOBER 6, 2022

The information potentially accessed and stolen included names, addresses, birth dates, Social Security numbers, Medicare claim numbers, patient account numbers, health insurance information, medical record numbers, dates of service, provider names, claims information, and medical and clinical treatment information.

HIPAA 98

HIPAA Fraud Hospitals Health Insurance 98

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. and cybersecurity threats.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

HIPAA Journal

JUNE 13, 2023

Progress has been made in recovering from the attack over the past 7 weeks; however, the IT systems that support the Harvard Pilgrim Health Care commercial and Medicare Advantage Stride health plans have yet to be brought back online and Point32Health expects the recovery process to take a few more weeks. Another lawsuit – Tracie Wilson v.

Ransomware 100

Ransomware Fraud Health Insurance HIPAA 100

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. Accreditation.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

HIPAA Journal

AUGUST 31, 2023

As well as supplying private customers, the company works with more than five hundred health plans, managed care organizations, and other agencies to provide access to meals for people covered by Medicare and Medicare. At the time of publication, the company’s name does not appear on the HIPAA Breach Report.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

Compliancy Group

JULY 3, 2024

Mandatory compliance training for healthcare includes HIPAA and OSHA standards , which vary by healthcare specialty or job role. All employees should receive training that ensures that patient information remains confidential, through HIPAA privacy and security training.

Regulatory Compliance 59

Regulatory Compliance Compliance HIPAA Ransomware 59

Compliancy Group

SEPTEMBER 16, 2024

In November, updates for 2024 appeared in the OIG General Compliance Program Guidance, including recommendations for Medicare, nursing facilities, and other industry-specific entities. Organizations should ramp up their risk assessment efforts.

Compliance 52

Compliance Compliance Officers Fraud Electronic Medical Records 52

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

Health Care Performance

AUGUST 25, 2022

We summarize enforcement trends and deliver the latest compliance and HIPAA developments to your inbox with our Monthly Compliance News Report. MPA’s clients use the News Report to find ideas for compliance and HIPAA training, and identify areas where policies or audits are needed. Twelve new HIPAA enforcements.

Compliance 52

Compliance Nursing Homes HIPAA Fraud 52

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 109

Fraud Health Insurance Medicaid Medicaid 109

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-19 175

COVID-19 Medicare Medicare Medicaid 175

HIPAA Journal

SEPTEMBER 29, 2022

Humana has recently announced that the protected health information of 22,767 individuals has potentially been compromised in a security incident and data breach at one of its business associates – Choice Health – which Human used to sell Medicare products on its behalf.

Health Insurance 114

Health Insurance Medicare Medicare Fraud 114

AIHC

AUGUST 30, 2023

Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM Due to the high volume of fraud schemes involving telemarketing revealed by the Department of Justice (DOJ) over recent years, it is important that providers heed “buyer beware” when engaging with a telemarketing firm. “If If it is too good to be true it probably isn't.”

Compliance 52

Compliance Fraud Medicare Medicare 52