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Compliance Fraud US Department of Health and Human Services 
MRO Compliance
JANUARY 7, 2025
As the healthcare industry faces increased scrutiny, especially in medical coding accuracy and regulatory compliance, recent surveys reveal that many professionals are concerned with issues like upcoding, audit discrepancies, and the integration of artificial intelligence in coding practices.
Healthcare IT News - Telehealth
JUNE 28, 2021
Department of Health and Human Services aims to protect the integrity of federal healthcare programs, in addition to the health of beneficiaries. "We believe health technology should be used in the service of care to achieve better health and value," said VanLandingham.
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Healthcare IT Today
DECEMBER 26, 2024
As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !
Verisys
MARCH 6, 2025
Technologies continue to transform the healthcare industrythe da Vinci Surgical Robot performs precise movements that enable minimally invasive surgeries, the CyberKnife delivers targeted radiotherapy, and smart devices provide practitioners with instantaneous updates to patient health. What Is AI in Healthcare Compliance?
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Healthcare IT Today
DECEMBER 30, 2024
As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !
Healthcare IT News - Telehealth
AUGUST 11, 2021
Department of Health and Human Services works to ensure the integrity of federal healthcare programs and to safeguard the health and welfare of those programs' beneficiaries. And I think it's important for us to recognize that we don't know a whole lot right now.
AIHC
APRIL 10, 2024
Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.
99 
Med-Net Compliance
OCTOBER 27, 2022
A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. The psychologist was convicted of four counts of healthcare fraud.
Med-Net Compliance
JUNE 22, 2022
A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Issue: Legitimate vaccination cards are being stolen from healthcare facilities and then used in a fraudulent manner. Participating in the fraud can result in the person(s) being prosecuted.
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.
The Health Law Firm
DECEMBER 4, 2023
On November 6, 2023, the US Department of Health and Human Services (HHS), Office of the Inspector General (OIG), released 91 pages of "General Compliance Program Guidance" (GCPG) on its website. This is the first compliance program guidance the OIG has released since 2008.
Med-Net Compliance
SEPTEMBER 20, 2022
million scheme to defraud Medicare by billing for services under another doctor’s name after Medicare revoked his privileges to participate in the program. Once the new business was set up, he continued to bill Medicare for services just as he had prior to his revocation, only now exclusively under the name of his partner.
59 
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.
52 
Total HIPAA
MARCH 22, 2023
Insurance agents who handle protected health information (PHI) are required to comply with the Health Insurance Portability and Accountability Act (HIPAA). In this blog post, we’ll discuss the potential consequences of HIPAA non-compliance for insurance agents. 104-191 Department of Health and Human Services.
Provider Trust
MARCH 21, 2023
US Department of Health and Human Services (HHS) Office of Inspector General Christi A. 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.
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Compliancy Group
MARCH 12, 2024
Because care requires using and exchanging sensitive patient information, adherence to U.S. When personal health information transcends international borders, vendors outside the U.S. must also be mindful of these healthcare compliance frameworks. A Compliance Framework for the U.S. law extends to you.
Compliancy Group
FEBRUARY 28, 2024
Many industries have compliance rules and regulations to meet and follow, but few would argue that healthcare is one of the most stringent. Privacy and security – Compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient privacy and data security is crucial.
52 
MedTrainer
JULY 29, 2024
Healthcare compliance is complicated for organizations of any size. However, the complexities grow exponentially for large or enterprise organizations with hundreds or thousands of employees who must complete and pass rigorous compliance training. What Is Corporate Compliance Training?
52 
Healthcare Compliance Blog
APRIL 26, 2022
The Office of Inspector General (OIG) for the US Department of Health and Human Services (HHS) has made educational resources available for healthcare providers to comply with federal healthcare laws and regulations. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.
Compliancy Group
MARCH 21, 2024
It’s challenging enough to stay on top of constantly changing compliance regulations in healthcare, including training. Instead of continuously working hard to maintain all these administrative and logistical functions, you can be more innovative by letting compliance training software do the heavy lifting.
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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? Department of Justice (DOJ), the U.S.
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Provider Trust
MARCH 13, 2023
Three schools across Broward County and Palm Beach County, Florida, were involved in this multimillion-dollar fake diploma scheme: Siena College of Health, Palm Beach School of Nursing, and Sacred Heart International Institute. In addition, an estimated 37 percent of student nurses with fake diplomas passed the NCLEX.
52 
Verisys
FEBRUARY 23, 2022
As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Accordingly, maintaining compliance has become a key focus for healthcare facilities. Training employees on compliance issues.
MedTrainer
OCTOBER 16, 2023
This is the essence of corporate compliance in healthcare. Just as every piece of the puzzle must fit perfectly, every compliance element in healthcare needs precise integration to ensure seamless, ethical, and effective operations. Dive with us as we explore the complexities and necessities of compliance in the healthcare sector.
52 
Compliancy Group
MARCH 19, 2024
Hospitals and private practices aren’t the only enterprises with compliance obligations within this sector. Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations. name, phone number).
Compliancy Group
FEBRUARY 26, 2024
In the evolving healthcare industry, adhering to compliance rules and standards while staying on top of regulatory changes is paramount. A comprehensive hospital compliance work plan is pivotal for achieving these objectives. What Are Hospital Compliance Work Plans?
52 Medisys Compliance
JUNE 23, 2024
Introduction In the ever-evolving landscape of healthcare, compliance with the Health Insurance Portability and Accountability Act (HIPAA) is crucial for protecting patient information and maintaining trust. Enacted in 1996, HIPAA is a federal law designed to safeguard patient health information (PHI) from fraud and abuse.
American Medical Compliance
AUGUST 1, 2022
In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff.
American Medical Compliance
AUGUST 1, 2022
In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff.
Med-Net Compliance
SEPTEMBER 14, 2022
A Massachusetts home health aide, who was licensed as a Certified Nursing Assistant (CNA), has been indicted in connection with a home surveillance video showing her abusing an elderly patient, Attorney General Maura Healey announced. The aide was indicted by a grand jury on two charges of assault and battery on an elder by a caretaker.
Compliancy Group
JUNE 7, 2024
The onboarding process is pivotal in ensuring employees understand their job duties, engage in best cybersecurity practices, and comply with important regulations like the Health Insurance Portability and Accountability Act, Occupational Health and Safety Administration, and prevention of Fraud, Waste, and Abuse in healthcare.
AIHC
APRIL 10, 2024
Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.
52 
Med-Net Compliance
JULY 13, 2022
Both defendants also admitted that Defendant 1 stole at least 20 CDC Vaccination Record Cards in March of 2021, that he sent his brother, Defendant 2, some of the stolen vaccination record cards, and that they agreed to use them and sell them to others for $50. Participating in the fraud can result in the person(s) being prosecuted.?.
Healthcare Compliance Blog
MAY 10, 2022
According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application. The provider had created a business to provide home and community-based services to Medicaid recipients. List of Excluded Individuals/Entities ?(LEIE).
59 
Healthcare Compliance Blog
MAY 19, 2022
Following an internal review and audit, the hospital discovered irregularities regarding its billing of certain services, and proactively contacted the United States to self-disclose the issues.?The If the patient was going to receive ICR for longer than 30 days, a physician must complete and sign updates to the ITP every 30 days thereafter.?
YouCompli
SEPTEMBER 13, 2023
Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.
YouCompli
DECEMBER 7, 2022
Do your hiring managers and Human Resources colleagues know what to look for? Department of Health and Human Services Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. Provision of unnecessary or substandard services.
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Healthcare Compliance Blog
JUNE 9, 2022
His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”.
MedTrainer
JULY 21, 2022
These hackers are costing health organizations millions of dollars and threatening the safety of patients. However, unauthorized access is causing more than just identity fraud. In January of 2018, Hancock Health of Indiana experienced a serious ransomware attack that forced their entire network to shut down.
Total HIPAA
SEPTEMBER 11, 2019
This post aims to answer all of your HIPAA compliance questions. If you’re just learning about HIPAA compliance, or beginning the process of becoming HIPAA compliant, this article will guide you through the initial steps you must take to adhere to the law. What is HIPAA Compliance? Protected Health Information (PHI).
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Verisys
JANUARY 6, 2022
Federal payments for healthcare services account for 28% of all healthcare spending in the United States. The List of Excluded Individuals/Entities (LEIE) is maintained by the Department of Health and Human Services (HHS) Office of the Inspector General ( OIG) and dictates which providers are excluded from receiving federal funds.
Compliancy Group
JANUARY 17, 2024
The OIG Work Plan, sometimes referred to as “the Work Plan” or “the Plan,” is an essential tool in securing and maintaining healthcare regulatory compliance for patient safety, privacy, and quality care. The OIG Compliance Work Plan identifies significant risks and areas that require attention within the healthcare system.
YouCompli
AUGUST 22, 2023
In contrast, Medicare Advantage is provided through a private health plan and typically covers everything in one monthly premium. This is a major shift in coverage patterns – and with it comes a shift in compliance scrutiny as well. This is a major shift in coverage patterns – and with it comes a shift in compliance scrutiny as well.
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Verisys
JANUARY 20, 2022
Whether you use paper, spreadsheets, email, or fax, the credentialing process can be long and frustrating when you’re doing it internally. It saves time, reduces administrative burden, improves accuracy, and helps maintain compliance. With so many credentialing requirements, there is high potential for human error.
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