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

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 Compliance Officers 52

Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses. Provider credentialing confirms a provider’s qualifications.

Licensing 52

Licensing Governance Compliance Fraud 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 84

Fraud Licensing HIPAA Governance 84

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? Risk Assessment. Legislation and Congressional Requests.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Healthcare IT Today

FEBRUARY 9, 2024

government and leading medical associations call upon stakeholders to do their part. Yet due to their complex nature, health payers, third-party administrators, government agencies, and pharmacy benefits managers focus most of their constrained resources on auditing professional claims. In fact, studies by the U.S.

Fraud 107

Fraud Governance Hospitals Licensing 107

MedTrainer

FEBRUARY 12, 2024

In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare. Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

Compliance 52

Compliance Licensing Governance Fraud 52

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. According to the U.S.

Licensing 52

Licensing Fraud Compliance Nurses 52

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

HIPAA Journal

AUGUST 2, 2023

Notification letters will be sent to the affected individuals in the coming weeks and credit monitoring, fraud consultation, and identity theft restoration services will be offered. A third-party data review company was provided with the files on December 22, 2022, and provided the results of the analysis to SHS on May 16, 2023.

Licensing 71

Licensing Electronic Medical Records Ransomware Health Insurance 71

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Situation One: Before the Pandemic   In April 2019, government officials announced Operation Brace Yourself: a fraud takedown related to telemedicine and durable medical equipment (DME).

Fraud 52

Fraud Medicare Medicare COVID-19 52

Verisys

DECEMBER 5, 2023

State licensing boards verify practitioner license type and status. An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. Here are some examples: Medical schools verify completion of education.

Governance 52

Governance Licensing Malpractice Medicaid 52

Provider Trust

JULY 8, 2022

A holistic approach to exclusion monitoring and license verifications must include monitoring of disciplinary databases such as the National Practitioner Data Bank (NPDB). Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S. Healthcare Legislation & Regulations.

Licensing 52

Licensing Malpractice Fraud Compliance 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Department of Health and Human Services focuses on preventing fraud, abuse, and waste in federal healthcare programs. What is Healthcare Compliance?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Healthcare IT News - Telehealth

JUNE 8, 2022

While it is important to carefully consider the most effective methods of providing care and the intended purpose behind various reimbursement, privacy, and fraud and abuse regulations, it is also clear that healthcare delivery has always and continues to evolve, and the regulatory framework needs to do the same. Federal rules.

US Department of Health and Human Services 179

US Department of Health and Human Services Compliance Overpayments Overpayment 179

Verisys

MARCH 1, 2024

FACIS® for Compliance and Safety: Verisys, through its flagship product FACIS® (Fraud Abuse Control Information System) , provides a gold standard dataset for sanction and exclusion screening.

Compliance 52

Compliance Fraud Licensing Governance 52

Hall Render

FEBRUARY 8, 2023

Department of Justice (“DOJ”) charged over two dozen individuals with wire fraud and conspiracy to commit wire fraud in connection with leading the alleged fraudulent scheme – each defendant faces up to 20 years in prison. Fraudulent Scheme On January 25, 2023, the U.S.

Nurses 40

Nurses Licensing Fraud Governance 40

HIPAA Journal

SEPTEMBER 8, 2022

Notification letters were sent to affected individuals in August and information was provided on the steps that individuals can take to reduce the risk of identity theft and fraud, but it would appear that credit monitoring and identity theft protection services are not being offered. Gateway Diagnostic Imaging and Radiology Ltd.

Fraud 94

Fraud Health Insurance Ransomware HIPAA 94

MedTrainer

OCTOBER 4, 2023

These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. These requirements are designed to protect patient rights, privacy, and safety, as well as to prevent fraud, abuse, and other improper practices within healthcare organizations.

Compliance 52

Compliance Fraud HIPAA Governance 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52

Verisys

JULY 27, 2023

This includes licensed and unlicensed staff members, as well as partners, investors, contingent workers, agents, and contractors you do business with. The safety of your patients depends on making sound hiring decisions and ensuring that the licenses of your staff are current.

Compliance 52

Compliance Due Diligence Licensing Fraud 52

Verisys

JULY 5, 2023

This includes licensed and unlicensed staff members, as well as partners, investors, contingent workers, agents, and contractors you do business with. Not only does thorough screening and rigorous continuous monitoring help ensure quality employees, but it also provides 360-degree transparency.

Compliance 52

Compliance Due Diligence Licensing Fraud 52

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. License Verification & Monitoring. State Licensing Boards and Agencies. Learn more about how Verisys can assist your HCOs in meeting all government and regulatory standards. Credentialing.

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Medicaid 52

Pharmacy Law Blog

MARCH 13, 2018

The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner. The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

Fraud 52

Fraud Governance Licensing FDA 52

HIPAA Journal

FEBRUARY 8, 2024

Azura Vascular Care said individuals who had sensitive information exposed such as Social Security numbers have been offered complimentary identity protection, credit monitoring, and fraud resolution services.

Ransomware 79

Ransomware Electronic Medical Records Licensing Health Insurance 79

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Situation One: Before the Pandemic   In April 2019, government officials announced Operation Brace Yourself: a fraud takedown related to telemedicine and durable medical equipment (DME).

Fraud 52

Fraud Compliance Medicare Medicare 52

Provider Trust

AUGUST 16, 2023

Despite such mandates, OIG investigations over the past five years have found that vendors are accountable for much of the healthcare ecosystem’s fraud, waste, and abuse. Over the past several years, OIG has discovered that a significant amount of fraud, waste, and abuse occurs within the vendor domain.

Fraud 52

Fraud Compliance Licensing Compliance Officers 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

HIPAA Journal

JULY 27, 2023

The stolen information included names, addresses, email addresses, dates of birth, Social Security numbers, government identification ID numbers, driver’s license numbers, payment/financial institution information, health insurance providers, medical treatment information, medical diagnoses, medications, medical images, and lab test results.

Ransomware 52

Ransomware Fraud Licensing Health Insurance 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Licensing and credentialing were introduced to regulate healthcare professionals and ensure minimum standards of care. Compliance in healthcare began to encompass billing, fraud, and abuse prevention.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Health Law Blog

MAY 22, 2018

Substance Abuse Treatment Center Fraud Scheme Results in Guilty Plea. The Department of Justice recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.”

Fraud 52

Fraud Overpayments Overpayment Licensing 52

MedTrainer

AUGUST 31, 2023

Healthcare compliance refers to the process of adhering to the laws, regulations, and ethical standards that govern the healthcare industry. It also helps prevent fraud, abuse, and errors, ensuring the delivery of high-quality care and ethical decision-making. What Is Healthcare Compliance? What Are the Consequences of Non-Compliance?

Compliance 52

Compliance Compliance Officers HIPAA Fraud 52

Verisys

NOVEMBER 14, 2023

Primary source verification must be done to confirm a provider’s education, professional license and certifications, medical training, work history, references, and more. Provider information should be continuously monitored for any changes to exclusion or license status.

Licensing 52

Licensing Medicaid Medicaid Governance 52

HIPAA Journal

SEPTEMBER 8, 2022

Notification letters were sent to affected individuals in August and information was provided on the steps that individuals can take to reduce the risk of identity theft and fraud, but it would appear that credit monitoring and identity theft protection services are not being offered.

Fraud 69

Fraud Health Insurance Ransomware HIPAA 69

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. States also can revoke agents’ licenses. The group supports additional protections for consumers, she added.

ACA 71

ACA Health Insurance Licensing Governance 71