Healthcare IT News - Telehealth

JULY 22, 2022

billion in alleged fraud involving telehealth, phony genetic testing and durable medical equipment. "The Department of Justice is committed to prosecuting people who abuse our healthcare system and exploit telemedicine technologies in fraud and bribery schemes," said Assistant Attorney General Kenneth A. WHY IT MATTERS.

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Fraud Telemedicine Medicare Medicare 166

Hall Render

MARCH 24, 2025

Court of Appeals (the Court) affirmed a district courts ruling that (1) a previous lawsuit had raised substantially the same allegations, triggering the FCAs public disclosure bar; and (2) the relators bringing the action were not original sources of the information. Background The FCA, codified at 31 U.S.C. 3730(e)(4)(A).

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Fraud Governance 52

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. This disparity highlights the difficulty in accurately assessing the risks and potential penalties associated with health care fraud violations.

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Fraud Compliance Medicaid Medicaid 40

American Medical Compliance

MARCH 6, 2025

Fraud, Waste, and Abuse (FWA) remain critical challenges in the healthcare industry, impacting patient care, financial integrity, and regulatory compliance. Staying informed about the latest policies, best practices, and reporting requirements is essential for healthcare professionals to mitigate risks and uphold ethical standards.

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Fraud Medicare Medicare Compliance 52

American Medical Compliance

JUNE 21, 2024

Fraud, waste, and abuse (FWA) in healthcare present significant challenges, causing substantial financial losses, eroding public trust, and compromising the quality of patient care. Unlike fraud, waste is not necessarily intentional but results from inefficiencies.

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Fraud Compliance Medicaid Medicaid 105

HIT Consultant

JUNE 6, 2024

Healthcare fraud is a significant issue in the U.S. the cost of healthcare fraud in the country is close to $100 billion a year. Recent advances in technology are now enabling government agencies to be more effective in their efforts to detect and prevent healthcare fraud. According to the U.S. Department of Justice (D.O.J.),

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Fraud Medicare Medicare Governance 94

Healthcare IT Today

APRIL 2, 2025

First, protected health information (PHI) is a valuable target for cybercriminals, more so than other types of data. Bad actors can exploit PHI to commit medical fraud, insurance fraud, and identity theft. A second major issue is the relentless nature, and extreme profitability, of ransomware.

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Ransomware Fraud Hospitals 75

MedTrainer

MAY 3, 2024

Healthcare fraud, waste, and abuse is a costly problem for both public and private payers. The National Health Care Anti-Fraud Association estimates financial losses due to healthcare fraud could be as much as $300 billion annually. Keep in mind that these are just examples of provider fraud!

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Fraud Compliance Compliance Officers Licensing 94

Healthcare IT Today

JUNE 2, 2023

With those competing priorities, fraud prevention does not always make its way to the top of the list of considerations, even when it should. According to the National Health Care Anti-Fraud Association, fraud costs the U.S. healthcare industry more than $50 billion each year. What Exactly is KYP?

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Fraud Ransomware Licensing Governance 107

Compliancy Group

DECEMBER 9, 2024

Details of the ransomware attack that exposed PHI, and that may have resulted in unauthorized parties obtaining protected health information, are provided below. The demographic information, including the names, social security numbers, addresses, driver license numbers, and birthdates, may also constitute ePHI.

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Ransomware Licensing HIPAA Compliance 98

HIT Consultant

OCTOBER 29, 2024

For example, payers can create and/or implement models that reduce claims processing times or accelerate fraud detection. For instance, if payers are trying to detect fraud, they must train their models on data that outlines typical fraud schemes such as double billing, upcoding, or identity fraud.

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Fraud Doctors Hospitals 98

HIT Consultant

FEBRUARY 27, 2025

The company will provide updates on the investigation as new information becomes available. Bias Capital is committed to cooperating with relevant authorities to conduct a thorough investigation into the potential misconduct at Parker Health.

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Due Diligence Fraud 52

Healthcare IT News - Telehealth

MARCH 2, 2021

Policymakers and stakeholders emphasized the importance of balancing access to care with addressing concerns around fraud and overutilization. When it comes to fraud – a frequently invoked fear in conversations around telehealth – some experts said the concern was overblown. Doris Matsui, D-Calif.

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Fraud Telemedicine COVID-19 Medicare 218

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.

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Compliance Fraud Compliance Framework HIPAA 105

AIHC

APRIL 22, 2025

37293733) is the federal governments primary tool for combating fraud against public programs. Healthcare fraud accounts for a significant portion of FCA activity. Under this statute, employees are protected from reprisal for reporting gross mismanagement, fraud, abuse of authority, or dangers to public health and safety.

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Compliance HIPAA Compliance Officers Fraud 89

Healthcare It News

DECEMBER 5, 2022

Community Health Network said it discovered on September 22 that the configuration of certain pixels on its digital properties allowed for a broader scope of patient information collection and transfer to third-party vendors, such as Meta and Google, than it realized. WHY IT MATTERS. THE LARGER TREND. This past week, the U.S.

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Fraud HIPAA Compliance Hospitals 297

HIT Consultant

NOVEMBER 4, 2024

Yigal Rozenberg, SVP Technology, Protegrity The healthcare IT sector faces significant challenges in ensuring the security and privacy of sensitive patient information. Personal health information (PHI) is especially vulnerable to ransomware and cyber attacks. billion and $2.45

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Ransomware Regulatory Compliance Compliance Fraud 98

HIT Consultant

DECEMBER 18, 2024

Data breaches, ransomware attacks, and system vulnerabilities have emerged as major disruptors, threatening sensitive patient information and the very foundation of patient care. The exposure of sensitive patient data, such as health records and insurance information, can lead to more insidious consequences. million in 2024.

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Ransomware Fraud Doctors HIPAA 105

HIPAA Journal

APRIL 11, 2025

million people that some of their personal and health information has been exposed or stolen in a recent hacking incident. Health insurance information such as plan names, plan types, insurance companies, and member/group ID numbers. The call center – 1-855-549-2662 is open Monday through Friday from 9:00 AM to 9:00 PM ET.

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Ransomware Fraud HIPAA Licensing 78

Healthcare IT Today

MARCH 19, 2025

The following is a guest article by Philipp Pointner, Chief of Digital Identity at Jumio The healthcare industry is increasingly vulnerable to advanced cyber threats, including AI-driven attacks like deepfakes that compromise sensitive patient information.

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Fraud Ransomware HIPAA Compliance 60

Bill of Health

NOVEMBER 17, 2024

by Rebekah Ninan A recent lawsuit in the Southern District of New York has alleged that the health insurance company Anthem Blue and Cross Blue Shield violated state laws and committed fraud by maintaining “ghost networks” of mental health providers.

Licensing 124

Licensing COVID-19 Fraud Health Care Access 124

Verisys

APRIL 8, 2025

This information provides organizations with detailed reports for making well-informed hiring decisions. A Guide to the Fraud Abuse Control Information System appeared first on Verisys. jurisdictions across all provider types. The post What is FACIS?

Fraud 52

Fraud Medicaid Medicaid Compliance 52

HIPAA Journal

APRIL 16, 2025

A settlement has been agreed to resolve a class action lawsuit against Retina Group of Washington over a March 2023 data breach that involved unauthorized access to the protected health information of 455,935 individuals. Under the terms of the settlement, a $3.6

Ransomware 55

Ransomware Fraud Licensing HIPAA 55

Compliancy Group

DECEMBER 20, 2024

In May of 2015, the NYPD informed Montefiore Medical Center that there was evidence that patient information had been stolen from the hospitals database – leading Montefiore to investigate and discover that the theft had taken place two years earlier. Monitor and safeguard its health information systems activity.

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Ransomware HIPAA Fraud Electronic Medical Records 98

Compliancy Group

APRIL 18, 2025

Patients deserve to know their sensitive information is safe from unauthorized access and misuse. This is why healthcare administrators and compliance professionals must stay informed and engaged, because at the center of it all is the patient, and their safety, dignity, and well-being must always come first.

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Regulatory Compliance Compliance Fraud HIPAA 52

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

HealthIT Answers

APRIL 8, 2025

By Jim Tate - DOGE has certainly been burning the midnight oil as it moves forward on eliminating waste, fraud, and abuse in federal spending. So many contracts are being terminated that even those with eagle eyes are having trouble keeping up. But one caught my eye.

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Fraud 64

Healthcare IT News - Telehealth

MAY 13, 2022

The owners of a national telehealth company pleaded guilty this week to charges of conspiracy to violate the federal Anti-Kickback Statute and to commit healthcare fraud. Law enforcement agencies have ramped up the pressure on telehealth fraud, particularly amid the COVID-19 pandemic. According to a statement released by the U.S.

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Fraud Doctors COVID-19 Medicare 172

HIPAA Journal

MARCH 30, 2022

Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. 1028 ) suggested improved privacy and security of health care data, increased patients´ rights, or streamlining the flow of information. 7 Billion Lost Each Year to Fraud.

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HIPAA Fraud Health Insurance Health Care Reform 136

Medisys Compliance

MARCH 31, 2025

If a patient has a Medigap plan, you will typically bill Medicare first, and then Medicare will automatically forward the claim information to the Medigap insurer for secondary payment. This online system is mandatory, and it’s crucial to keep your enrollment information accurate and up-to-date.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 59

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.

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Fraud Compliance Governance Compliance Officers 52

Healthcare IT Today

NOVEMBER 24, 2024

Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job. Canvas Medical launched Anova , an EMR system specifically designed for longevity medicine.

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Nurses Fraud Telemedicine Hospitals 91

Healthcare IT News - Telehealth

SEPTEMBER 12, 2024

The InterSystems integration also allows didgUgo to leverage AI for fraud prevention. NSW's Far West GPs get access to patient data General practitioners and practices around NSW's Far West region can now have view-only access to patient-consented medical information via the state-developed clinical portal Healthenet.

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Doctors Governance Fraud Hospitals 163

Compliancy Group

NOVEMBER 6, 2024

With workforce compliance software and other digital tools, organizations can centralize and streamline their compliance activities, making it easier for employees to stay informed and actively maintain the highest healthcare standards. Non-compliance damages your financial stability and could lead to fewer contracts, patients, or customers.

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Compliance Compliance Officers Fraud Health Insurance 52

HIPAA Journal

JULY 9, 2024

The Houston, TX-based medical device company, LivaNova, is facing multiple class action lawsuits over an October 2023 cyberattack that exposed the protected health information of 180,000 patients. At least two lawsuits have now been filed by patients whose information was exposed in the incident.

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Fraud Health Insurance HIPAA Compliance 119

Healthcare IT News - Telehealth

AUGUST 11, 2021

Grimm: "It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse or misuse." " DME fraud has been around since Medicare started reimbursing for it, of course. billion, with a B, of alleged fraud.

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US Department of Health and Human Services Fraud Medicare Medicare 167

HIPAA Journal

APRIL 25, 2024

Several class action lawsuits have been filed against City of Hope National Medical Center, a National Cancer Institute (NCI)-designated cancer treatment and research center, over a recently disclosed data breach that exposed the protected health information of more than 827,000 individuals.

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Fraud Health Insurance HIPAA Licensing 117