MedTrainer

JANUARY 10, 2024

It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. The OIG is making major investments to systematically detect and prosecute fraud. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024.

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

Compliancy Group

FEBRUARY 16, 2024

This month, fraud in the medical industry has been making headlines fairly frequently. We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. Two recent cases involved dental offices. Dentist Ordered to Pay $8.5M He is also responsible for paying $8.5

Fraud 52

Fraud Licensing Medicaid Medicaid 52

Verisys

FEBRUARY 9, 2024

January 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 The post January 2024 Bad Actors Roundup appeared first on Verisys.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. and cybersecurity threats.

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Compliance Officers Compliance Medicare Medicare 52

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] By George F. Indest III, J.D.,

Nursing Homes 52

Nursing Homes Nurses Fraud Medicare 52

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] By George F. Indest III, J.D.,

Nursing Homes 52

Nursing Homes Nurses Fraud Medicare 52

The Health Law Firm Blog

MARCH 4, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] By George F. Indest III, J.D.,

Nursing Homes 52

Nursing Homes Nurses Fraud Medicare 52

Compliancy Group

FEBRUARY 26, 2024

Here, we review the function and components of hospital compliance work plans and focus on important updates to the law effective in 2024. Manage My Compliance The post Your Hospital Compliance Work Plan: New Issues for 2024 appeared first on Compliancy Group. What Are Hospital Compliance Work Plans?

Compliance 52

Compliance US Department of Health and Human Services Hospitals Compliance Officers 52

HIPAA Journal

APRIL 23, 2024

According to the notification letters mailed to the affected individuals in April 2024, a cyberattack was detected on June 6, 2023, when its network was disrupted. It took more than 10 months (April 10, 2024) to determine the types of information involved and the number of individuals affected.

Ransomware 97

Ransomware Fraud Licensing HIPAA 97

HIPAA Journal

APRIL 30, 2024

On February 27, 2024, Bay Oral identified suspicious activity in an employee’s email account. The forensic investigation confirmed that an unauthorized individual had installed software and gained access to an employee’s email account on January 18, 2024.

Fraud 59

Fraud HIPAA 59

HIPAA Journal

MAY 2, 2024

If they were, class members can claim a cash payment of $50 and can claim up to $7,500 for documented expenses incurred as a result of the data breach, including 3 hours of lost time at $25 per hour, and any unreimbursed losses to identity theft and fraud.

Fraud 94

Fraud HIPAA Health Insurance Compliance 94

HIPAA Journal

APRIL 25, 2024

City of Hope National Medical Center issued notification letters on April 2, 2024, and offered the affected individuals complimentary credit monitoring services. Class action lawsuits started to be filed soon after notification letters were mailed. The plaintiffs allege that injuries have been sustained as a result of the data breach.

Fraud 103

Fraud Health Insurance Licensing HIPAA 103

Compliancy Group

MAY 15, 2024

As we move deeper into 2024, hospitals must increasingly focus on compliance with regulations set forth by the Office of Inspector General (OIG). Understanding OIG Compliance Program for Hospitals The OIG compliance program for hospitals intends to prevent fraud, waste, and abuse while ensuring high-quality care.

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Compliance Hospitals Fraud Regulatory Compliance 52

Provider Trust

MAY 16, 2024

MAY 15, 2024 Contact: Morgan Smith , Director of Brand Strategy NASHVILLE, TN – ProviderTrust, the healthcare industry’s leading data and technology company for automated exclusion list monitoring and primary source verifications, is now monitoring more than 10,000,000 individuals and entities on an ongoing basis.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

Health Care Law Brief

FEBRUARY 7, 2024

Department of Health and Human Services Office of Inspector General’s (OIG) core responsibility is to promote efficiency and economy in myriad programs by eliminating fraud, waste and abuse. Copyright 2024 Compliance Today , a publication of the Health Care Compliance Association (HCCA).

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Compliance Fraud Regulatory Compliance 52

HIPAA Journal

APRIL 8, 2024

Claims will be accepted up to a maximum of $10,000 to recover documented losses incurred as a result of the data breach, including bank costs, credit expenses, fraudulent charges, and losses to identity theft and fraud.

Ransomware 74

Ransomware HIPAA Health Insurance Fraud 74

HIPAA Journal

JANUARY 11, 2024

OIG in healthcare stands for the Department of Health and Human Services (HHS) Office of Inspector General (OIG) – the Office within the HHS responsible for reducing waste, fraud, and abuse in HHS programs and improving efficiency. The post What is OIG in Healthcare? appeared first on HIPAA Journal.

Fraud 84

Fraud HIPAA Compliance Medicare 84

Health Law Attorney

AUGUST 11, 2023

Prior to becoming Chair, Adrienne has served in several leadership roles for the Health Law Section, including serving as the Chair-Elect, Budget Officer, and Chair of the Dobbs Task Force, Publications Committee, Health eSource, Physicians Legal Issues Conference, and ABA Fraud and Abuse Toolkit. Congratulations, Adrienne!

Fraud 52

Fraud 52

Healthicity

APRIL 2, 2024

March was a busy month for new additions to the OIG’s Work Plan. Some of the items fit nicely into two broad categories which we’ve grouped together and summarized below. The selected items relate to (1) nursing homes and (2) medications.

Nursing Homes 52

Nursing Homes Nurses Fraud Compliance 52

Provider Trust

OCTOBER 19, 2023

Add complicating factors, such as a new generation of pandemic-era fraud, virtual care regulations, labor shortages, financial volatility, and underlying goals surrounding care quality and equity, and the role of credentialing has ballooned into a larger organizational strategy around risk mitigation and provider data accuracy.

Fraud 52

Fraud Medicare Medicare Licensing 52

HIPAA Journal

MARCH 29, 2024

The breach notices sent to the affected individuals on December 6, 2023, December 22, 2023, and March 22, 2024, all include the following statement, “We have also notified Microsoft of the vulnerability in the Microsoft Office 365 multifactor authentication that was exploited by the malicious actor or actors.

Fraud 61

Fraud HIPAA Health Insurance Nurses 61

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. Parts 417, 422, 423, 455, and 460.

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Medicare Medicare Overpayments Overpayment 52

Hall Render

APRIL 29, 2024

On April 15, 2024, the Criminal Division of the Department of Justice (“DOJ”) issued a new pilot program (“Program”) to incentivize individuals to come forward with voluntary disclosures (the “Program”). Practical Takeaways Health care fraud is specifically listed as a key enforcement area for the DOJ.

Fraud 40

Fraud Compliance Governance 40

HIT Consultant

MAY 20, 2022

– LifeChain will leverage blockchain technology to solve healthcare’s biggest problems, including fraud, inefficiency in payments and antiquated processes. Tokenize Healthcare Claims On-Chain.

Fraud 94

Fraud Medicaid Medicaid Medicare 94

HIT Consultant

MAY 15, 2024

Tom Liddell, CEO at Healthcare Harmony IT As we step into the promising terrain of 2024 and beyond, the healthcare industry stands at the cusp of a transformative era, propelled by advanced technology solutions. AI’s ability to process and analyze vast datasets at unprecedented speeds positions it as a guardian of patient information.

Healthcare information Technology 88

Healthcare information Technology Compliance Fraud 88

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

Healthcare IT Today

MARCH 24, 2024

DrFirst released TrueRx , a prescription monitoring product that provides standardized alerts to protect against prescriber identity and prescription fraud. Real-world data vendor Komodo Health unveiled MapView , a no-code analytics application for the company’s Healthcare Map.

Medicare 83

Medicare Medicare Fraud Nurses 83

MedTrainer

JANUARY 31, 2024

It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. These laws require healthcare providers to establish internal controls and compliance programs to prevent fraud and abuse in the healthcare system. Who started the first healthcare compliance program?

Compliance 52

Compliance Fraud Governance ACA 52

Compliancy Group

FEBRUARY 28, 2024

CMS Compliance Requirements CMS compliance requirements are extensive, covering a wide range of topics: Billing and coding – healthcare providers must accurately code and bill for services rendered to ensure proper reimbursement and prevent fraud and abuse. Compliance audits aren’t a “one size fits all” process.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

Healthcare Law Blog

MAY 11, 2023

ICPGs are expected to be published in 2024, and the OIG has announced the first two likely ICPGs will be for Medicare Advantage plans and skilled nursing facilities. When to Expect New CPG The OIG expects to issue updated GCPG by the end of calendar year 2023.

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Compliance Fraud Nurses Medicare 52

Healthcare IT Today

APRIL 25, 2024

On the morning of February 21, 2024, a ransom group, BlackCat, directed a cyberattack at Change Healthcare, owned by healthcare conglomerate UnitedHealth. As of mid-March, 117 other healthcare organizations have experienced a cybersecurity breach in 2024, potentially affecting around 13 million patients, according to the HHS.

Ransomware 103

Ransomware Compliance Fraud Governance 103

Provider Trust

APRIL 18, 2024

Impact Compliance represents a shift in the organization’s market approach, establishing a compliance spectrum that measures healthcare organizations’ exclusion monitoring and license and credential verification processes against gold-standard practices to demonstrate their tangible impact on eradicating fraud, waste, and abuse.

Compliance 52

Compliance Licensing Fraud Medicaid 52

Healthcare IT Today

JANUARY 19, 2024

Healthcare organizations must prioritize implementing robust identity security measures in 2024 to safeguard both their operational integrity and the well-being of their patients and consumers. This is due to the fact that predicting whether fraud is possible requires context.

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Fraud Governance Ransomware Compliance 87