Healthcare IT Today

JUNE 2, 2023

The following is a guest article by Bala Kumar, Chief Product Officer at Jumio The list of responsibilities for a CISO in healthcare is constantly growing. With those competing priorities, fraud prevention does not always make its way to the top of the list of considerations, even when it should. What Exactly is KYP?

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!

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Fraud Compliance Compliance Officers Licensing 94

Electronic Health Reporter

JUNE 10, 2020

This article is copyrighted strictly for Electronic Health Reporter. There is interesting research in Forbes’ recent article named “How E-Commerce’s Explosive Growth Is Attracting Fraud”. The article Fraud Detection with Machine Learning For e-Commerce and Retailers appeared first on electronichealthreporter.com.

Fraud 91

Fraud 91

AIHC

APRIL 22, 2025

This article illustrates how certified compliance professionals play a pivotal role in protecting whistleblowers and preventing retaliation. 37293733) is the federal governments primary tool for combating fraud against public programs. Healthcare fraud accounts for a significant portion of FCA activity.

Compliance 89

Compliance HIPAA Compliance Officers Fraud 89

Healthcare IT Today

APRIL 2, 2025

The following is a guest article by Rob Shavell, CEO at DeleteMe Healthcare cybersecurity is currently experiencing explosive growth. Bad actors can exploit PHI to commit medical fraud, insurance fraud, and identity theft. Experts believe that the size of the market will reach $35.3 billion by 2028.

Ransomware 75

Ransomware Fraud Hospitals 75

Healthcare IT Today

NOVEMBER 24, 2024

This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Cotiviti launched 360 Pattern Review , which combines pre-pay fraud, waste, and abuse prevention with post-pay review across the claim payment cycle.

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Nurses Fraud Telemedicine Hospitals 91

Healthcare IT Today

MARCH 19, 2025

The following is a guest article by Philipp Pointner, Chief of Digital Identity at Jumio The healthcare industry is increasingly vulnerable to advanced cyber threats, including AI-driven attacks like deepfakes that compromise sensitive patient information.

Fraud 60

Fraud Ransomware HIPAA Compliance 60

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 67

Fraud Medicare Medicare Overpayments 67

Electronic Health Reporter

JUNE 26, 2019

This article is copyrighted strictly for Electronic Health Reporter. These insurers do not possess the specialized knowledge needed to determine medical necessity, so they have to shift the responsibility to providers in order to minimize instances of fraud and abuse. Illegal copying is prohibited. Recently, major U.S.

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Fraud Health Insurance 117

Electronic Health Reporter

OCTOBER 6, 2022

This article is copyrighted strictly for Electronic Health Reporter. The Centers for Medicare and Medicaid Services (CMS) has made no secret of its intentions to crack down on fraud, abuse, and waste, throwing more budget dollars into audits, heightening program […]. Illegal copying is prohibited. By Dana Finnegan, MDaudit.

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Fraud Medicaid Medicaid Medicare 113

Hall Render

NOVEMBER 21, 2023

The United States District Court for the Eastern District of Wisconsin recently issued a decision involving protections for employees whose jobs involve the investigation of fraud. This category of individuals is sometimes called a “fraud alert employee.” Since 2009, the FCA’s anti-retaliation provision,(codified at 31 U.S.C.

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Fraud Compliance 72

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.

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Fraud Compliance Governance Compliance Officers 52

Electronic Health Reporter

JANUARY 31, 2024

This article is copyrighted strictly for Electronic Health Reporter. Matthew Hawley leads operations and content development for Cotiviti’s prospective payment integrity and fraud, waste, and abuse solutions. Illegal copying is prohibited. Responses from Matthew Hawley, EVP, payment integrity, Cotiviti.

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Fraud 103

Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. Some denials result from noncompliance with federal fraud, waste, and abuse laws. Such noncompliance can result in non compliance fines.

Fraud 52

Fraud Compliance Medicare Medicare 52

Electronic Health Reporter

SEPTEMBER 25, 2024

This article is copyrighted strictly for Electronic Health Reporter. Payers are increasing scrutiny and regulatory agencies are reinforcing fraud mitigation. Illegal copying is prohibited. Revenue integrity has become harder to maintain as audits grow in volume and complexity.

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Fraud 91

Healthcare IT Today

SEPTEMBER 21, 2022

The following is a guest article by Mandy Fogle, Healthcare Value Engineering at Shift Technology. New types of fraud are continually emerging, and it’s also become harder to uncover with traditional approaches. The telehealth market is growing at a significant rate, and fraud is continuing to grow with it.

Fraud 58

Fraud COVID-19 Medicare Medicare 58

HIPAA Journal

MARCH 30, 2022

Articles discussing the 3 major things addressed in the HIPAA law often tend to focus on the Administrative, Physical, and Technical Safeguards of the Security Rule. 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.

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HIPAA Fraud Health Insurance Health Care Reform 136

Health Law Advisor

MARCH 31, 2022

Department of Justice (DOJ) intend to leverage its enforcement authority under the False Claims Act to advance DOJ’s recently announced Civil Cyber-Fraud Initiative? For more information, read our recent article: “DOJ’s Civil Cyber-Fraud Initiative: What Contractors Need to Know About Novel Use of False Claims Act”.

Fraud 52

Fraud 52

AIHC

JUNE 14, 2024

Part 3 in a series of articles to support World Elder Abuse Awareness Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS of the American Institute of Healthcare Compliance ( AIHC ), a non-profit healthcare education organization. These scams are outlined in more detail below. 6:00 p.m.

Fraud 52

Fraud Elder Abuse Governance Compliance 52

Med Law Blog

FEBRUARY 10, 2022

Highmark Health issued a Press Release on February 7, 2022 announcing that it’s Financial Investigations and Provider Review (FIPR) department generated more than $245 million in savings related to fraud waste and abuse in 2021, the majority of which was in Pennsylvania–$184 million.

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Fraud 52

Med Law Blog

JULY 21, 2022

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”.

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Telemedicine Fraud 52

Healthcare IT Today

FEBRUARY 7, 2025

The following is a guest article by Muhammad Shujja, Digital Marketing Lead at AltuMED Artificial Intelligence is making waves by redefining processes and streamlining operations in the evolving healthcare industry. This article examines how AI is changing medical billing. And it is just the beginning.

Medical Billing 52

Medical Billing Medical Billing Services Fraud Compliance 52

Hall Render

MARCH 12, 2025

However, if a complaint alleges specific, geographically limited fraud that does not suggest a broader scheme, claims against different subsidiaries may not be precluded. This decision ensures that whistleblowers can still bring new and distinct allegations of fraud even if similar cases were filed previously.

Fraud 52

Fraud Governance Medicaid Medicaid 52

Medisys Compliance

JANUARY 16, 2025

Avoid fraud: Ensure billing accurately reflects services rendered. Fraud and Abuse Prevention: Providers should routinely review their billing practices to avoid unintentional upcoding or errors that could be perceived as fraudulent. Disclaimer: CPT codes, descriptions, and other data are copyright American Medical Association (AMA).

Medicare 59

Medicare Medicare Medical Billing Outsourcing Fraud 59

HIPAA Journal

MARCH 31, 2023

Ramirez (2021), which held that a risk of future harm standing alone does not constitute a concrete Article III injury in damages actions.” The lawsuit alleged breach of contract and violations of consumer protection laws in Maryland and Virginia. As such, the motion for class certification was denied.

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Fraud HIPAA 105

Hall Render

MARCH 11, 2025

Government fraud enforcement remains aggressive : Despite this ruling, health care providers should continue prioritizing compliance with Medicare and Medicaid billing regulations. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 52

Medicare Medicare Governance Fraud 52

Hall Render

APRIL 28, 2025

In the relevant Advisory Opinions, OIG concluded that, while the fee structure implicated the AKS, it would present a low risk of fraud and abuse, and therefore OIG issued favorable Advisory Opinions. Hall Render blog posts and articles are intended for informational purposes only.

Governance 52

Governance Fraud 52

Med Law Blog

MARCH 18, 2024

Attached are links to the remarks of Attorney General Garland and Deputy Attorney General Monaco.

Fraud 52

Fraud Compliance 52

The Health Law Firm

OCTOBER 23, 2012

To read the entire article from the Miami Herald, click here. Peter Budetti, the Medicare anti-fraud czar states that the goal is to catch the fraud before the fraudsters "can successfully bill Medicare. Payment of bribes and kickbacks, as well as payments to patient recruiters were an issue in this investigation.

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Fraud Medicare Medicare 40

Healthcare IT Today

OCTOBER 23, 2024

The following is a guest article by David Lareau, CEO at Medicomp Systems A couple of years ago, we predicted an impending “explosion” of Medicare Advantage (MA) fraud and penalties. The Failure of Reactive Approaches The current approach to combating Medicare fraud is woefully inadequate.

Medicare 75

Medicare Medicare Fraud Doctors 75

The Health Law Firm

OCTOBER 26, 2012

According to The Texas Tribune, the Texas Attorney General’s (AG) Office and the Office of Inspector General (OIG) at the Health and Human Services Commission (HHSC) have teamed up to increase investigations of fraud in the state’s Medicaid dental program for children.

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Fraud Medicaid Medicaid 40

Healthcare IT Today

FEBRUARY 9, 2024

Even worse, up to 10% of this spending is rife with waste, abuse, and fraud. For health payers and agencies, AI so far has been mostly applied to claims processing, member engagement, and identification of suspected cases of fraud, waste, and abuse. In other words, nearly half of all U.S. healthcare spending goes unaudited today.

Fraud 124

Fraud Governance Hospitals Licensing 124

Hall Render

SEPTEMBER 15, 2022

This study comes on the heels of a recent Press Release issued July 20, 2022 (“Press Release”), in which the Department of Justice (“DOJ”) announced criminal charges against 36 defendants in 13 federal districts across the United States largely alleging fraud in the telemedicine space. Inspector General Christi A.

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Telemedicine Fraud Medicare Medicare 40

Healthcare IT Today

JANUARY 10, 2022

The following is a guest article by Mike Noshay, MSE, Founder and Chief Strategy & Marketing Officer at Verinovum. This time last year, we healthcare leaders were excited to be looking ahead to 2021 and leaving 2020 firmly behind us. But our dreams of putting the pandemic in the past were put on pause. Now, […].

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COVID-19 Fraud Telemedicine 145

Healthcare IT Today

NOVEMBER 22, 2024

The following is a guest article by Cody Hall, Product Manager at Synology Cybercriminals are attacking our healthcare systems at an alarming rate. This data is incredibly valuable to attackers and can be used to steal identities, commit fraud, or be sold on the black market to the highest bidder.

Ransomware 67

Ransomware Hospitals COVID-19 Compliance 67

The Health Law Firm

MARCH 10, 2014

The lawsuit alleged more than a decade of illegal compensation to doctors, violating the federal Stark Law, and Medicare fraud. To read the entire article from the Orlando Sentinel, click here.

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Fraud Doctors Medicare Medicare 40

Healthcare IT Today

MARCH 26, 2025

The following is a guest article by Josh Rosaasen , Chief Operating Officer at Locke Bio The rise of direct-to-consumer ( DTC ) telehealth services has revolutionized how patients access medical care and prescriptions. The rise of telehealth has also led to increased scrutiny over prescription fraud and misuse.

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FDA Compliance Licensing Fraud 52