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!

Fraud 94

Fraud Compliance Compliance Officers Licensing 94

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 112

Fraud Health Insurance Ransomware HIPAA 112

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

HIT Consultant

DECEMBER 10, 2021

What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Licensed Clinical Social Worker. For more information, download the full report here.

Fraud 98

Fraud COVID-19 Nurses Licensing 98

Provider Trust

SEPTEMBER 29, 2022

Mendez, who was a physician assistant at CCI Therapy Counseling Centers International, was working with a suspended medical license. However, despite his suspended medical license, Mendez continued to treat patients at various mental health clinics in Brownsville, Harlingen, and Pharr, TX. How Often Should You Verify Employee Licenses?

Licensing 52

Licensing Fraud Medicaid Medicaid 52

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 94

Fraud Health Insurance Ransomware HIPAA 94

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.

Ransomware 57

Ransomware Fraud HIPAA Licensing 57

Healthcare IT Today

MARCH 26, 2025

As the sector adapts, telehealth providers must navigate new compliance challenges, particularly regarding controlled substances, data privacy, and multi-state licensing. While telehealth is federally recognized, each state maintains its own set of rules governing online prescribing , provider licensing, and telehealth modalities.

FDA 52

FDA Compliance Licensing Fraud 52

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.

Fraud 117

Fraud Health Insurance HIPAA Licensing 117

Compliancy Group

APRIL 25, 2024

Components of Medicare Fraud, Waste, and Abuse Training One of the most important elements of CMS Medicare fraud, waste, and abuse training is defining and differentiating these three terms : Fraud is the deliberate attempt to obtain financial gain through deceptive means, such as providing false information.

Fraud 59

Fraud Medicare Medicare Compliance 59

Verisys

APRIL 3, 2025

For healthcare organizations, the NPDB is more than just a screening toolits a safeguard for crucial and confidential information. Licensure actions Disciplinary actions from state medical boards, like suspensions or revoked licenses. Other adverse actions Things like voluntarily giving up a license while under investigation.

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

HIPAA Journal

APRIL 24, 2023

Utah has updated its data breach regulations and from May 3, 2023, will require a breached entity to send a notification to the Utah Attorney General in the event of a breach of the personal information of 500 or more Utah residents. The post Utah Updates Data Breach Notification Requirements appeared first on HIPAA Journal.

Fraud 102

Fraud Licensing HIPAA Governance 102

HIPAA Journal

OCTOBER 17, 2022

Phoenix, AZ-based Valle del Sol Community Health has notified 70,268 patients that some of their protected health information has been exposed. Valle de Sol said the investigation indicated unauthorized individuals had access to files containing sensitive patient data and that patient information may have been acquired.

Health Insurance 134

Health Insurance Licensing Fraud HIPAA 134

Verisys

DECEMBER 29, 2024

Credentialing services perform this verification by contacting primary sources, such as medical schools and licensing boards, to confirm the physician’s education and qualifications. Physician credentialing is required not only for initial hiring but also for obtaining admitting privileges at hospitals or joining a medical practice.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

AIHC

SEPTEMBER 25, 2024

Government agencies expect your organization to stay informed. Stay Informed Through Training & Education Engage by receiving news through ListServ offered by organizations such as AIHC, CMS, OIG, etc. These are free ways to stay informed of lessons learned. You may unsubscribe at any time. Enroll in Low-Cost Short Courses.

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

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 117

Medicaid Medicaid Fraud Licensing 117

HIPAA Journal

NOVEMBER 16, 2022

Unauthorized individuals have gained access to the email system of the Administrative Fund of the Detectives’ Endowment Association of the Police Department of the City of New York (NYCDEA) and potentially viewed or obtained the protected health information of 21,544 individuals.

HIPAA 108

HIPAA Licensing Health Insurance Fraud 108

HIPAA Journal

SEPTEMBER 9, 2022

Birmingham, AL-based Henderson & Walton Women’s Center (HWWC) has recently notified 34,306 patients that some of their protected health information may have been compromised as a result of a hacker gaining access to the email account of one of its employees. The information exposed varied from patient to patient.

Licensing 117

Licensing Health Insurance Fraud HIPAA 117

HIPAA Journal

DECEMBER 19, 2022

A review of the files on the compromised servers confirmed that protected health information such as patient names, dates of birth, Social Security numbers, driver’s license numbers, health insurance information, and diagnosis and treatment information had been exposed. The DOL and the U.S.

Fraud 106

Fraud Licensing HIPAA Health Insurance 106

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

APRIL 23, 2024

A cybersecurity firm was engaged to investigate the disruption and confirmed that unauthorized individuals accessed its network and exfiltrated files containing the personal information of residents. It took more than 10 months (April 10, 2024) to determine the types of information involved and the number of individuals affected.

Ransomware 109

Ransomware Fraud Licensing HIPAA 109

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. The psychologist was convicted of four counts of healthcare fraud.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

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

NOVEMBER 23, 2022

Third-party security experts were engaged to investigate the nature and scope of the attack, with the investigation concluding on or around May 2, 2022, that files containing the protected health information of patients and employees may have been accessed and exfiltrated from its network.

Ransomware 120

Ransomware Fraud Licensing HIPAA 120

Verisys

MARCH 6, 2025

Identifying Compliance Risks in Real Time AI-powered surveillance tools work around the clock, scanning data to catch red flags or suspicious patterns that indicate: Fraud Security threats Regulatory violations Credential discrepancies Take electronic health records (EHRs), for example. AI acts as a built-in safety net.

Compliance 52

Compliance US Department of Health and Human Services Regulatory Compliance Fraud 52

HIPAA Journal

JUNE 28, 2023

Good Samaritan Hospital in San Jose, CA, has agreed to settle a class action lawsuit that was filed in response to a data breach that exposed the protected health information of up to 233,835 individuals. A lawsuit – Young, et al.

Hospitals 100

Hospitals Fraud Licensing HIPAA 100

Provider Trust

JUNE 1, 2022

Organizations across the healthcare continuum have experienced several workforce trends that are creating gaps in license monitoring and verifications. In this post, we’ll explore three current challenges impacting the healthcare license and credential verification process. See our Telehealth Credentialing Guide for more information.

Licensing 52

Licensing Nurses COVID-19 Compliance 52

HIPAA Journal

MAY 25, 2022

Social Action Community Health System (SAC Health) has recently notified 149,940 patients that documents containing their protected health information were stolen in a break-in at an off-site storage location where patient records were stored. Notification letters were sent to those individuals on May 3, 2022.

Ransomware 136

Ransomware Fraud HIPAA Licensing 136

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

Verisys

DECEMBER 8, 2022

A professional career can take a provider across state lines, and through an evolution of various license types. In order to see the full picture of an individual, the comprehensive whole of each state licensing board across all license types must be searched. Take the process back another step.

Licensing 52

Licensing Medicaid Medicaid Fraud 52

HIPAA Journal

APRIL 1, 2022

Last week, SRHD confirmed that the email account contained the protected health information of 1,260 individuals. That information may have been ‘previewed’ by an unauthorized individual, although no evidence was found to suggest information had been accessed or downloaded.

Fraud 141

Fraud HIPAA Licensing Health Insurance 141

HIPAA Journal

FEBRUARY 14, 2023

The compromised email accounts contained patient names, medical record numbers, driver’s license numbers, financial account information, Social Security numbers, health insurance information, and clinical or treatment information. Class members will also be provided with two years of credit monitoring services.

Fraud 112

Fraud Licensing Health Insurance HIPAA 112

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 122

Electronic Medical Records HIPAA Health Insurance Fraud 122

Healthcare Law Today

DECEMBER 22, 2022

Department of Health and Human Services Office of Inspector General (HHS-OIG) Special Fraud Alert on telefraud, and the rise of asynchronous telehealth, among other topics. In July 2022, HHS-OIG published a Special Fraud Alert about arrangements with telemedicine companies to serve as an extra level of guidance to the industry at large.

Telemedicine 119

Telemedicine Fraud Doctors COVID-19 119

Provider Trust

APRIL 26, 2023

However, this solution comes with its share of compliance risks, especially if interstate licenses are involved. A travel nurse could be hired to work at a hospital located in a state where they are not licensed to practice. For starters, each state has its own process, rules, and regulations for monitoring licensed nurses.

Licensing 52

Licensing Nurses Compliance COVID-19 52

HIPAA Journal

JULY 20, 2022

While data theft could not be determined, the affected email accounts contained the protected health information of patients of 19 of its hospitals, including names, birth dates, health insurance information, Social Security numbers, driver’s license, and healthcare data.

Fraud 126

Fraud Licensing HIPAA Health Insurance 126

HIPAA Journal

MARCH 22, 2023

Cardiovascular Associates in Alabama is facing a class action lawsuit over a recently reported hacking incident in which patients protected health information (PHI) was stolen. The plaintiff and class members now face an increased risk of identity theft and fraud as their private information is now in the hand of cybercriminals.

HIPAA 109

HIPAA Fraud Licensing Health Insurance 109