Compliancy Group

JANUARY 23, 2025

A classic example is Medicare fraud. Providers who bill Medicare for services they did not actually provide and who present the bill with the knowledge that the service was not performed have committed Medicare fraud. The DOJ has focused much of its anti-fraud efforts on pursuing these cases, litigating several of them in 2024.

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

Compliancy Group

DECEMBER 9, 2024

The demographic information, including the names, social security numbers, addresses, driver license numbers, and birthdates, may also constitute ePHI. Jefferson Dental has also notified patients that they may place an initial or extended fraud alert on their credit files at no cost.

Ransomware 98

Ransomware Licensing HIPAA Compliance 98

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. a driver’s license, passport, or other ID card) via their smartphone or computer’s webcam.

Fraud 107

Fraud Ransomware Licensing Governance 107

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

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

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. Report Background. Physician/Psychiatry.

Fraud 98

Fraud COVID-19 Nurses Licensing 98

HIPAA Journal

APRIL 11, 2025

Additional identifiers such as Social Security Numbers, driver’s license/state ID numbers, passport numbers, dates of birth, demographic data, student ID numbers, and other government identifiers.

Ransomware 78

Ransomware Fraud HIPAA Licensing 78

Compliancy Group

FEBRUARY 16, 2024

This month, fraud in the medical industry has been making headlines fairly frequently. In one case, the dentist himself was involved, practicing on a revoked license. We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received.

Fraud 52

Fraud Licensing Medicaid Medicaid 52

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. See how it works!

Fraud 59

Fraud Medicare Medicare Compliance 59

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

Fierce Healthcare

JUNE 28, 2024

Attorney General Merrick Garland announced Thursday a two-week operation in which 193 people across the country, including 76 licensed healthcare providers, were charged for their alleged participa | The cases highlighted by law enforcement involved medically unnecessary amniotic wound grafts, diverted HIV medications, online distribution of Adderall (..)

Fraud 85

Fraud Telemedicine Licensing 85

Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys.

Fraud 52

Fraud Telemedicine Licensing Doctors 52

The Health Law Firm Blog

JULY 13, 2023

Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.]

Licensing 52

Licensing Medicaid Medicaid Fraud 52

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 16, 2025

The hackers encrypted files and stole data such as names, addresses, telephone numbers, email addresses, dates of birth, demographic information, Social Security numbers, drivers license numbers, medical record numbers, health information, payment information, and health insurance information.

Ransomware 55

Ransomware Fraud Licensing HIPAA 55

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

Verisys

APRIL 3, 2025

Licensure actions Disciplinary actions from state medical boards, like suspensions or revoked licenses. Criminal convictions related to healthcare Felonies or misdemeanors involving fraud, patient abuse, or drug-related offenses. Other adverse actions Things like voluntarily giving up a license while under investigation.

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

Verisys

NOVEMBER 3, 2023

Healthcare Fraud Crackdown! Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc. Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc.

Fraud 52

Fraud Compliance Medicare Medicare 52

Compliancy Group

DECEMBER 15, 2023

Differentiating Fraud, Abuse, and Waste Detecting and stopping fraud, abuse, and waste rely on distinguishing these behaviors in the healthcare context. What is Healthcare Fraud? Providers commit Medicare and Medicaid fraud when they knowingly submit or contribute to the submission of a false claim for financial gain.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

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. During that time, files containing patient data were exfiltrated from its network.

Fraud 117

Fraud Health Insurance HIPAA Licensing 117

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

Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). This year’s report also shows greater participation from managed care organizations (MCOs) as a key trend.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

HIPAA Journal

APRIL 24, 2023

The new law applies to persons who own or license computerized data that includes the personal information of Utah residents. If a system security breach is discovered, a prompt investigation should be conducted to determine the likelihood that personal information has been or will be misused for identity theft or fraud.

Fraud 102

Fraud Licensing HIPAA Governance 102

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

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

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

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

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.

Compliance 52

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

Provider Trust

MARCH 13, 2023

State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment. In Delaware, 26 nursing licenses were revoked when the nurses’ credentials were tied to the scheme. ProviderTrust recommends conducting license verification monthly.

Fraud 52

Fraud US Department of Health and Human Services Licensing Nurses 52

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

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. But what exactly is considered fraud, waste, and abuse? These complaints can trigger an audit. Data Analysis and Trends.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Verisys

APRIL 8, 2025

However, most clients opt for the FACIS Level 3 background check as it is all-inclusive and protects them from employing individuals or vendors who are sanctioned by a state-level licensing board. A Guide to the Fraud Abuse Control Information System appeared first on Verisys. The post What is FACIS?

Fraud 52

Fraud Medicaid Medicaid Compliance 52

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.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

The Health Law Firm Blog

JULY 17, 2023

Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,

Fraud 52

Fraud FDA Licensing Nurses 52

The Health Law Firm Blog

JUNE 26, 2023

Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,

Fraud 52

Fraud FDA Licensing Nurses 52

The Health Law Firm Blog

AUGUST 22, 2023

Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,

Fraud 52

Fraud FDA Licensing Nurses 52