Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. This year’s 129-page report also includes information about the amounts deposited and appropriated to the Medicare Trust Fund, as well as the source of such deposits. Monetary Penalties. Of this $1.9

Fraud 52

Fraud Medicaid Medicaid Medicare 52

HIPAA Journal

APRIL 25, 2022

The Department of Health and Human Services’ Health Sector Cybersecurity Coordination Center (HCC) has recently issued a warning about the threat from within. According to the Verizon 2021 Data Breach Report, there was a decline in external threats between 2017 and 2020 and a corresponding rise in internal threats.

Fraud 126

Fraud HIPAA 126

HIPAA Journal

MAY 5, 2022

The Federal Bureau of Investigation (FBI) has issued a public service announcement warning about the threat of Business Email Compromise/Email Account Compromise (BEC/EAC) scams. Between June 2016 and December 2021, IC3 received 241,206 complaints about domestic and international BEC/EAC attacks with reported losses of more than $43.3

Fraud 124

Fraud HIPAA 124

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.

Fraud 62

Fraud Medicare Medicare Overpayments 62

HIPAA Journal

JANUARY 31, 2023

Affected individuals were notified about the cyberattack in August 2021 and were offered complimentary credit monitoring and identity theft protection services. Claims of up to $2,500 will be accepted for documented extraordinary losses due to identity theft and fraud. A lawsuit – Lopez, et al.

Ransomware 59

Ransomware Fraud Health Insurance HIPAA 59

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

HIPAA Journal

DECEMBER 19, 2022

Avem Health Partners, an Oklahoma City-based provider of administrative and technology services to healthcare organizations, has recently started notifying its healthcare clients about a data breach that occurred at one of its vendors, 365 Data Centers. Emory Healthcare was notified about the privacy breach by the U.S.

Fraud 91

Fraud Licensing HIPAA Health Insurance 91

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

The Health Law Firm

FEBRUARY 13, 2022

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. Read more about the sentencing here. By George F. Indest III, J.D.,

Fraud 52

Fraud 52

HIPAA Journal

MARCH 16, 2022

This is the first settlement to be reached under the DOJ Civil Cyber Fraud Initiative, which was launched in 2021. Some staff members expressed concern about the insecure storage of private medical information, but CHS took no action to address the issue and failed to ensure medical records were only stored in the EMR system.

Fraud 95

Fraud Electronic Medical Records Governance HIPAA 95

Verisys

FEBRUARY 24, 2023

A Story About Provider Data, And Why It Has Become So Complex While leaving her house to visit her grandson, Sue falls and twists her knee. Many health plans struggle to maintain correct, complete, and current information about providers in their network with today’s complex health landscape. Why Has Provider Data Become So Complex?

Fraud 52

Fraud Doctors Governance Licensing 52

Verisys

FEBRUARY 24, 2023

A Story About Provider Data, And Why It Has Become So Complex While leaving her house to visit her grandson, Sue falls and twists her knee. Many health plans struggle to maintain correct, complete, and current information about providers in their network with today’s complex health landscape. Why Has Provider Data Become So Complex?

Fraud 52

Fraud Doctors Governance Licensing 52

HIPAA Journal

AUGUST 5, 2022

Affected individuals were notified about the breach by mail on August 1, 2022, and have been offered complimentary identity theft protection services through IDX. Arlington Skin Notifies 17,468 Patients About Electronic Medical Record Data Breach. Notification letters started to be sent to affected individuals on July 8, 2022.

Electronic Medical Records 88

Electronic Medical Records Health Insurance Fraud HIPAA 88

Compliancy Group

MARCH 30, 2023

The 2022 Internet Crime Report has revealed alarming statistics about the rampant rise in cybercrime, making it more critical than ever to be aware of the dangers and take necessary precautions. According to the report, there were 847,376 complaints of suspected internet crime in 2021, representing a 7% increase compared to the previous year.

Ransomware 52

Ransomware Fraud HIPAA Compliance 52

Bill of Health

SEPTEMBER 2, 2022

But if scams are not a bounded problem of those who are in some sense more psychologically vulnerable (as older adults are thought of in, at least, the popular imagination ), we might want to rethink scams — what they are, how we fight them, and how we treat and think about their victims. But perhaps it’s worth trying.

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Fraud 293

Health Care Performance

JULY 20, 2022

The physician submitted claims totaling about $585,000 to Medicare and Medicaid and was paid roughly $191,000. Mole billing fraud scheme totals $4.1 million in fraudulent payments between 2015 and 2021. Outlier billing patterns will get you noticed! million in false claims over 7 years.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors?

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

HIPAA Journal

APRIL 8, 2024

Planned Parenthood Los Angeles, a provider of reproductive healthcare services in Los Angeles County, has proposed a $6 million settlement to resolve all claims related to a 2021 data breach that exposed the personal information of more than 409,437 patients.

Ransomware 74

Ransomware HIPAA Health Insurance Fraud 74

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The post CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance appeared first on Inovaare.

Fraud 52

Fraud Medicare Medicare Medicaid 52

HIPAA Journal

MAY 2, 2024

BioPlus Specialty Pharmacy Services has proposed a settlement to resolve a class action lawsuit that was filed in response to a 2021 data breach that exposed the data of up to 350,000 patients.

Fraud 94

Fraud HIPAA Health Insurance Compliance 94

Provider Trust

MARCH 13, 2023

Between 2016 and 2021, over 7,600 fake diplomas were sold to nursing students who used the fraudulent degrees to qualify for the National Council Licensure Exam (NCLEX). Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail.

Fraud 52

Fraud US Department of Health and Human Services Licensing Compliance Officers 52

Bill of Health

FEBRUARY 21, 2024

While Alabama may seem like an extreme example, the (un)intended consequences of the case, which originally sought to redress mistakes made in providing fertility care, can inform the ongoing debate about the role of law in assisted reproduction. Fertility Fraud TRIP Bills “Fertility fraud” bills are an illustrative example of TRIP laws.

Fraud 257

Fraud Licensing Medicaid Medicaid 257

HIPAA Journal

MARCH 3, 2023

AssistCare Home Health Services has agreed to settle a class action lawsuit, filed on behalf of individuals affected by a cyberattack and data breach in January 2021. Unauthorized individuals gained access to its network between January 8 and January 10, 2021, and exfiltrated files containing patient data.

Ransomware 80

Ransomware Fraud HIPAA 80

HIPAA Journal

APRIL 13, 2023

Insight Global LLC has agreed to settle a class action lawsuit that was filed in response to an April 2021 data breach that exposed the contact tracing data of more than 76,000 Pennsylvania residents. Insight Global said it discovered the security issue on April 21, 2021.

Fraud 90

Fraud COVID-19 HIPAA 90

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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Doctors Fraud COVID-19 Medicare 149

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.

Fraud 94

Fraud Health Insurance Ransomware HIPAA 94

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. the Transactions and Code Sets Rule) and address abuse and fraud in the health care industry to reduce costs to health insurance providers. 7 Billion Lost Each Year to Fraud.

HIPAA 119

HIPAA Fraud Health Insurance Health Care Reform 119

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

HIPAA Journal

MARCH 25, 2022

The forensic investigation revealed the email accounts were accessed by unauthorized individuals between April 7, 2021, and June 2, 2021. AHA provided notice about the attack on January 6, 2021. UMC was a victim of a REvil ransomware attack in June 2021 that resulted in the theft of the protected health information of 1.3

Health Insurance 104

Health Insurance Licensing Ransomware Fraud 104

HIPAA Journal

FEBRUARY 16, 2023

The Nashville, TN-based health system, Advent Health Partners, has proposed a $500,000 settlement to resolve claims related to a September 2021 data breach involving the protected health information of 61,072 patients. Advent Health Partners detected a breach of its email environment in early September 2021.

HIPAA 90

HIPAA Fraud Licensing Health Insurance 90

HIPAA Journal

MARCH 1, 2023

The Albuquerque, NM-based health insurance provider, True Health New Mexico, has proposed a settlement to resolve claims related to a 2021 data breach that affected 62,983 members of its health plans. True Health New Mexico proposed the settlement to resolve claims related to these lawsuits with no admission of wrongdoing.

Fraud 93

Fraud Ransomware Health Insurance HIPAA 93

Med Law Blog

DECEMBER 10, 2021

Mike Cassidy will be one of the panelists discussing “The Myths About Telehealth: Telefraud vs. Telemedicine Fraud” at the virtual CTeL Digital Health Summit on Thursday, December 16, 2021.

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Fraud Telemedicine 40

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.

Fraud 69

Fraud Health Insurance Ransomware HIPAA 69

HIPAA Journal

JANUARY 16, 2023

A settlement proposed by Rehoboth McKinley Christian Health Care Services to resolve claims related to February 2021 cyberattack has been approved by a New Mexico federal judge. Patients were notified about the data breach in May 2021. In June 2021, a lawsuit – Charlie et al. District Court Judge Steven C.

Fraud 95

Fraud Health Insurance HIPAA Hospitals 95

HIPAA Journal

APRIL 20, 2022

The notification letters, a copy of which was found on the Montana Attorney General website , state that the company recently became aware that an unauthorized individual had gained access to its system on or around October 17, 2021, and may have accessed “a limited amount of data stored on our systems.”.

US Department of Health and Human Services 136

US Department of Health and Human Services Fraud HIPAA 136

HIPAA Journal

FEBRUARY 15, 2023

The medical device manufacturer Electromed has proposed a $850,000 settlement to resolve claims related to a June 2021 ransomware attack and data breach involving the protected health information of 47,200 individuals. A lawsuit – Lutz, et al.

Ransomware 81

Ransomware Fraud Licensing Health Insurance 81

HIPAA Journal

OCTOBER 6, 2022

Mon Health is facing a class action lawsuit over a hacking incident that allowed unauthorized individuals to gain access to its network for an 11-day period in December 2021. Mon Health said it detected the breach on December 30, 2021, with the forensic investigation determining hackers accessed its network between December 9 and December 19.

HIPAA 89

HIPAA Fraud Hospitals Health Insurance 89