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. Medicare Advantage Matters Medicare Part C is the largest part of Medicare. While the $1.67

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

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. million, and $6.4 million, and $6.4

Medicaid 102

Medicaid Medicaid Medicare Medicare 102

HIT Consultant

DECEMBER 3, 2024

The number of HIPAA-compliant note-taking tools is growing every day. The Centers for Medicare & Medicaid Services (CMS) added codes for Digital Mental Health Treatment in its 2025 Medicare Physician Fee Schedules. The FDA is approving digital therapeutics tools (i.e.,

FDA 111

FDA Medicare Medicare Medicaid 111

Healthcare IT News - Telehealth

MARCH 18, 2020

The HHS Office for Civil Rights announced on Tuesday that during the coronavirus pandemic it will use discretion when enforcing HIPAA-compliance for telehealth communications tools. " Wherever possible, providers should use telehealth tools from vendors that are HIPAA compliant and will enter into business-associate agreements, said OCR.

COVID-19 218

COVID-19 HIPAA Nursing Homes Medicare 218

HIPAA Journal

FEBRUARY 23, 2022

What is HIPAA? HIPAA is an acronym for the Health Insurance Portability and Accountability Act. So how did HIPAA evolve from being a vehicle for improving the portability and continuity of health insurance coverage to being one of the most comprehensive and detailed federal privacy laws? What is HIPAA Title II?

HIPAA 103

HIPAA Fraud Health Insurance Medicaid 103

HIPAA Journal

MARCH 31, 2023

The reason the HIPAA retention requirements needs clarifying is that the distinction between HIPAA medical records retention and HIPAA record retention can be confusing. Throughout the Administrative Simplification Regulations of HIPAA, there are several references to HIPAA data retention.

HIPAA 128

HIPAA Medicare Medicare Compliance 128

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 114

Medicare Medicare Medicaid Medicaid 114

HIPAA Journal

DECEMBER 31, 2022

To best answer the question what is a HIPAA violation, it is necessary to explain what HIPAA is, who it applies to, and what constitutes a violation; for although most people believe they know what a HIPAA compliance violation is, evidence suggests otherwise. What is HIPAA and Who Does It Apply To?

HIPAA 133

HIPAA Due Diligence Compliance Fraud 133

HIPAA Journal

DECEMBER 15, 2022

HMS is a subcontractor of ASRC Federal Data Solutions, LLC (ASRC Federal), which is a business associate of the HHS’ Centers for Medicare and Medicaid Services (CMS). The CMS says up to 254,000 Medicare beneficiaries have potentially been affected and had some of their PII and PHI exposed.

Ransomware 117

Ransomware Medicare Medicare HIPAA 117

AIHC

NOVEMBER 12, 2024

This article addresses how these privacy rights extend beyond rules designated under HIPAA and States passing rules banning unauthorized pelvic exams. 1],[2] UIEs are training and education-related examinations, including, but not limited to, pelvic, breast, prostate, and rectal examinations.

Informed Consent 98

Informed Consent HIPAA Compliance Hospitals 98

HIPAA Journal

MARCH 6, 2023

The Department of Justice has announced one of its first prosecutions under the Medicare Access and CHIP Reauthorization Act of 2015 in a case involving the theft and sale of Medicare Beneficiary Identifiers. MACRA also made it illegal to buy, sell, or distribute Medicare Beneficiary Identifiers without proper authority.

Medicare 103

Medicare Medicare Fraud Medicaid 103

MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

Medicare 93

Medicare Medicare Compliance Medicaid 93

Fierce Healthcare

SEPTEMBER 11, 2023

million people in Medicaid, Medicare, and Affordable Care Act plans, was ordered to shore up its data protection systems. Care, which provides coverage for about 2.9

HIPAA 124

HIPAA Medicaid Medicaid Medicare 124

American Medical Compliance

OCTOBER 25, 2024

For instance, an individual who unknowingly violates HIPAA will pay a $100 fine per violation with an annual maximum of $25,000 for those who repeat violation, according to the National Institutes of Health. When conducted effectively, these audits can help healthcare providers avoid costly penalties.

Compliance 105

Compliance Fraud Compliance Framework HIPAA 105

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 107

HIPAA Compliance Medicare Medicare 107

HIPAA Journal

JANUARY 12, 2024

The HIPAA Omnibus Rule mandated modifications to the Privacy, Security, and Enforcement Rules in order to adopt measures passed in the HITECH Act, finalized the Breach Notification Rule, and added standards to account for the passage of the GINA Act. The adoption of a four-tired civil monetary penalty structure for violations of HIPAA.

HIPAA 110

HIPAA Compliance Health Insurance Medicaid 110

Compliancy Group

FEBRUARY 12, 2025

Using the ICPG to Maintain an Effective Compliance Program The Centers for Medicare & Medicaid Services (CMS) has issued participation requirements for nursing facilities in the Medicare and Medicaid programs (Requirements of Participation or ROPs). The ICP covers the areas listed below.

Nurses 52

Nurses Compliance Medicare Medicare 52

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-19 180

COVID-19 Medicare Medicare Medicaid 180

Compliancy Group

NOVEMBER 1, 2024

HIPAA The Health Insurance Portability and Accountability Act (HIPAA) requires protecting the security and privacy of medical records and all patient data. 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

JANUARY 2, 2023

The settlements pursued by the Department of Health and Human Services’ Office for Civil Rights (OCR) are for egregious violations of HIPAA Rules. Settlements are also pursued to highlight common HIPAA violations to raise awareness of the need to comply with specific aspects of HIPAA Rules. Are Data Breaches HIPAA Violations?

HIPAA 107

HIPAA Compliance Hospitals Medicare 107

HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

Medicaid 98

Medicaid Medicaid Ransomware Health Insurance 98

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. It is not mandatory that an employer extend their HIPAA special enrollment period beyond the existing 60-day requirement.

Medicaid 100

Medicaid Medicaid Compliance COVID-19 100

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. It is not mandatory that an employer extend their HIPAA special enrollment period beyond the existing 60-day requirement.

Medicaid 100

Medicaid Medicaid Compliance COVID-19 100

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. In another case, Californias Providence Medical Institute was fined $240,000 for violating HIPAA Security Rules, which led to a data breach.

Compliance 52

Compliance HIPAA Licensing Governance 52

HIPAA Journal

DECEMBER 31, 2022

One of the questions we are sometimes asked is how to report a HIPAA violation anonymously. Consequently, it is not possible to report a HIPAA violation anonymously via the OCR Complaints Portal. HHS´ Office for Civil Rights is not the only “enforcer” of HIPAA. How Else to Report a HIPAA Violation Anonymously.

HIPAA 98

HIPAA Medicaid Medicaid Medicare 98

Healthcare IT News - Telehealth

JUNE 3, 2020

He noted the moves by the Centers for Medicare and Medicaid Services to reimburse providers for services and allow telehealth care between states , and the relaxed HIPAA regulations around technology use , as important contributors to the uptick in telehealth availability.

Telemedicine 213

Telemedicine COVID-19 HIPAA Medicare 213

HIPAA Journal

SEPTEMBER 11, 2023

Care Health Plan, has settled multiple violations of the HIPAA Privacy and Security Rules with the HHS’ Office for Civil Rights (OCR) and will pay a $1,300,000 penalty and adopt a robust corrective action plan. OCR determined that there had been several failures to fully comply with the requirements of the HIPAA Privacy and Security Rules.

HIPAA 97

HIPAA Compliance Medicaid Medicaid 97

Healthcare IT News - Telehealth

JUNE 29, 2020

Until regulatory changes, such as those enacted by the Centers for Medicare and Medicaid Services, had made telehealth provision more financially feasible, a doctor "had every economic incentive to require the patient to come to the office in person," he explained.

Telemedicine 218

Telemedicine HIPAA Medicaid Medicaid 218

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

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 ensure that these services meet Medicares criteria for medical necessity.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Fraud 59

Medisys Compliance

DECEMBER 24, 2024

Medicare Reimbursement Medicare covers teletherapy under specific guidelines: Eligible Providers: Includes licensed clinical social workers (LCSWs), clinical psychologists, and other licensed professionals. Check state-specific Medicaid guidelines to ensure compliance. HIPAA-compliant Zoom) and any technical difficulties.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medicaid Medicaid Medical Billing 59

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 83

US Department of Health and Human Services HIPAA Compliance Medicaid 83

Healthcare IT News - Telehealth

MAY 13, 2020

Although research supported the efficacy of video telepsychiatry, the National Institute of Mental Health-funded study notes, only 5% of psychiatrists in the Medicare program had ever provided a telemedicine visit. " This was particularly important, Uscher-Pines noted, as many HIPAA compliant software became overwhelmed with users.

Telemedicine 218

Telemedicine COVID-19 HIPAA Medicare 218

Healthcare IT News - Telehealth

JUNE 15, 2020

This past week, Centers for Medicare and Medicaid Services Administrator Seema Verma said she "can't imagine going back" to making beneficiaries return to in-person visits after the agency's relaxation of telehealth regulations in response to the coronavirus pandemic.

Telemedicine 218

Telemedicine Licensing HIPAA COVID-19 218

Healthcare IT News - Telehealth

JULY 22, 2020

" This past week, a bipartisan group of House representatives introduced the Protecting Access to Post-COVID-19 Telehealth Act , which would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare.

COVID-19 161

COVID-19 HIPAA Medicare Medicare 161

Healthcare IT News - Telehealth

NOVEMBER 2, 2020

More than 85% of the patients served by Temple are covered by government programs, including Medicare and Medicaid. Patients dually eligible for both Medicare and Medicaid make up roughly half of the Medicare inpatient base. More than 40% of total inpatient cases include a behavioral health diagnosis.

Telemedicine 176

Telemedicine COVID-19 Nurses Medicare 176

Healthcare IT News - Telehealth

JANUARY 23, 2023

Budget leaders have asked, "How do you really know what the impact on the Medicare population and the Medicare Trust Fund will be? We now have three years of data on the impact to the Medicare Trust Fund," he said. Part 2 – with HIPAA. Creating standards synergy for 'Interoperability 3.0'

Medicare 189

Medicare Medicare Governance Medicaid 189