American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. The Department of Justice recently revealed charges against 78 individuals involved in healthcare fraud schemes. However, they encounter numerous challenges in achieving this goal.

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Compliance Fraud HIPAA Health Insurance 105

HIT Consultant

OCTOBER 18, 2021

Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud. The second type, indirect fraud, involves several bad actors that coordinate their efforts.

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Fraud COVID-19 Public Health Medicare 98

Total Medical Compliance Resources

MAY 11, 2023

trillion is spent on healthcare in the United States, of which an estimated $60 billion is attributable to fraud and abuse. In order to combat this, HIPAA established the Healthcare Fraud and Abuse Control Program (HCFAC). Criminal Health Care Fraud Statute – 18 U.S.C. Every year a minimum of $4.3

Fraud 59

Fraud HIPAA Medicare Medicare 59

HIPAA Journal

FEBRUARY 8, 2024

Department of Health & Human Services Office of Inspector General (HHS-OIG) has published a Roadmap for New Physicians on avoiding Medicare and Medicaid fraud and abuse. As a result of dishonest healthcare providers, laws have been created to combat fraud and abuse.

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Fraud Medicaid Medicaid Medicare 40

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.

US Department of Health and Human Services 84

US Department of Health and Human Services HIPAA Compliance Medicaid 84

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. An example of this is the investigation into OCR’s governance of cybersecurity threats.

Fraud 86

Fraud HIPAA Compliance Medicare 86

Health Care Law Brief

JUNE 5, 2023

We previously wrote about the United States Department of Justice’s (“ DOJ ”) Civil Cyber-Fraud Initiative (“ CCFI ”), which “aims to hold accountable entities or individuals that put U.S. FHKC shut down its website’s application portal shortly thereafter. Follow us at [link] for updates as DOJ continues its CCFI enforcement efforts.

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Fraud Due Diligence Medicaid Medicaid 52

HIPAA Journal

MARCH 15, 2023

The United States Department of Justice has agreed to settle alleged False Claims Act violations with Jelly Bean Communications Design LLC and manager Jeremy Spinks related to the failure to protect HIPAA-covered data. Attorney’s Office for the Middle District of Florida, with assistance provided by HHS-OIG. “HHS-OIG

Health Insurance 75

Health Insurance HIPAA Due Diligence Fraud 75

HIPAA Journal

APRIL 24, 2023

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. The post Utah Updates Data Breach Notification Requirements appeared first on HIPAA Journal.

Fraud 89

Fraud Licensing HIPAA Governance 89

MedTrainer

MARCH 8, 2024

It educates employees on the laws, regulations, and policies governing their work and ensures they understand their responsibilities and obligations as healthcare professionals. Successful training is when team members understand and comply with various laws, regulations, and policies that govern the healthcare industry.

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Compliance Fraud Governance HIPAA 52

Compliancy Group

FEBRUARY 16, 2023

Open source is not particularly secure, and when your systems have the potential to access healthcare data, you have to think of how HIPAA factors in. HIPAA and ChatGPT ChatGPT is not HIPAA compliant. How ChatGPT uses and discloses consumer data is in direct contradiction with how HIPAA permits patient information to be used.

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HIPAA Compliance Fraud Governance 52

American Medical Compliance

JANUARY 9, 2024

Staying Compliant in Healthcare HIPAA plays a large role in healthcare compliance. Additionally, the HIPAA Privacy Rule applies to health plans, health care clearinghouses, and healthcare providers who perform specific electronic health care transactions. To become certified, please visit us at: American Medical Compliance (AMC).

Fraud 52

Fraud Compliance HIPAA Health Insurance 52

HIPAA Journal

JUNE 9, 2023

Prosecutors argued that while the context of the fraud in Dubin’s case was relatively small, it was the correct reading of the statute and that the flat two-year jail term should stand regardless of the scale of the fraud. The post Supreme Court Ruling Narrows Reach of Identity Theft Law appeared first on HIPAA Journal.

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Fraud Medicaid Medicaid Doctors 100

MedTrainer

JANUARY 31, 2024

federal government enacted the Federal False Claims Act (FCA) in 1863 during the American Civil War. It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. The need to combat fraud, waste, and abuse is what brought about the modern compliance program.

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Compliance Fraud Governance ACA 52

Compliancy Group

FEBRUARY 9, 2022

Specifically, are you using HIPAA compliant billing software? To help you decide, we’ve prepared an overview of what the HIPAA regulations state. We also reviewed some of the most popular payment apps available to determine whether or not they are HIPAA compliant payment apps. . How Does HIPAA Define Billing Software Compliance?

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HIPAA Compliance Fraud Doctors 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?

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Governance Compliance Regulatory Compliance Compliance Framework 52

AIHC

APRIL 10, 2024

HITECH is a critical aspect of the Health Insurance Portability & Accountability Act (HIPAA). Since 2009, HITECH has given “teeth” to HIPAA law. What’s the difference between HIPAA and HITECH? HIPAA guarantees patients access to their paper medical records. Understanding HIPAA is crucial.

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Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

HIPAA Journal

AUGUST 31, 2022

HC3 warns that Evil Corp may conduct attacks at the request of the Russian government, including attacks that steal intellectual property, and members of the group are known to cooperate with the Russian intelligence agencies. Cybercrime Syndicate appeared first on HIPAA Journal.

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Ransomware Fraud Governance HIPAA 119

MedTrainer

JUNE 29, 2023

Healthcare is an industry governed by countless regulations. While it can sometimes feel like there’s dozens and dozens of different healthcare standards, the biggest governing policies really boil down to four major regulations. The Office of Civil Rights (OCR) is responsible for HIPAA enforcement.

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Fraud HIPAA Compliance Governance 52

Verisys

FEBRUARY 12, 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 GRC in Healthcare?

Compliance 52

Compliance Governance Health Insurance HIPAA 52

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.

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Compliance Fraud HIPAA Governance 52

MedTrainer

FEBRUARY 1, 2024

These programs help to promote lawful and ethical conduct within healthcare organizations and minimize the risk of legal violations, such as fraud, abuse, and other unethical behaviors. Prevent Fraud and Abuse: Helps avoid improper billing and monitors for potential fraudulent or waste activities.

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

Healthcare IT Today

DECEMBER 21, 2023

Predominantly, the risk of fraud, theft, or abuse of customer or company information increases, which can cause regulatory violations resulting in significant fines and penalties. Regulatory compliance, such as adherence to HIPAA, becomes even more critical in the digital landscape, where the risk of data exposure is heightened.

Records Management 101

Records Management Regulatory Compliance Compliance HIPAA 101

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.

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Fraud Compliance Medicaid Medicaid 98

HIPAA Journal

OCTOBER 6, 2022

Sebastien Vachon-Desjardins, 34, from Quebec, a former IT consultant who worked for the Public Works and Government Services in Canada, was arrested in Canada in January 2021 on suspicious of conducting ransomware attacks as part of a law enforcement crackdown on the Netwalker ransomware gang. A ransom of $1.14

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Ransomware Fraud COVID-19 HIPAA 104

Health Blawg

JANUARY 16, 2019

HIPAA, everyone’s favorite scapegoat for all (OK, most) of the ills of the modern healthcare-industrial complex, is perpetually called out as being in dire need of a rewrite. The HIPAA RFI came next. A digression: As the health wonks and policy nerds reading this are already aware, HIPAA is a horse of a different color.

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HIPAA Fraud Governance Payment Systems 60

Health Blawg

JANUARY 16, 2019

HIPAA, everyone’s favorite scapegoat for all (OK, most) of the ills of the modern healthcare-industrial complex, is perpetually called out as being in dire need of a rewrite. The HIPAA RFI came next. A digression: As the health wonks and policy nerds reading this are already aware, HIPAA is a horse of a different color.

HIPAA 60

HIPAA Fraud Governance Payment Systems 60

Medisys Compliance

JANUARY 30, 2023

The medical billing industry is a complex and ever-changing field, and it is crucial for healthcare providers and billing companies to stay compliant with government regulations. Violations of the False Claims Act can result in significant financial penalties, including fines and exclusion from government healthcare programs.

Compliance 52

Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

HIPAA Journal

JANUARY 3, 2023

This year’s report shows more than 200 large organizations in the United States have been attacked in the government, education, and healthcare verticals. The post 290 Hospitals Potentially Affected by Ransomware Attacks in 2022 appeared first on HIPAA Journal.

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Ransomware Hospitals HIPAA Governance 112

Total Medical Compliance Resources

JUNE 9, 2023

An HCC is a set of guidelines and principles that govern the behavior and actions of healthcare professionals – it serves as a moral compass that defines standards and expectations for those in the industry. It encompasses healthcare compliance, fraud prevention, ethics, adherence to rules and laws, and safeguarding patient information.

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Fraud Compliance HIPAA Governance 59

Compliancy Group

MARCH 30, 2023

The report also identified several trends in cybercrime, including the increased use of social media platforms as a tool for scams and fraud, the rise of ransomware attacks, and the exploitation of virtual currency transactions. Make Sure You’re HIPAA Compliant HIPAA and cybersecurity go hand-in-hand. Find Out More!

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Ransomware Fraud HIPAA Compliance 52

Compliancy Group

JULY 6, 2023

With various regulations like HIPAA (Health Insurance Portability and Accountability Act), OSHA (Occupational Safety and Health Administration), and FWA (Fraud, Waste, and Abuse) in place, it is crucial for healthcare providers to adhere to these guidelines to ensure patient safety, privacy, and ethical practices. Get Started! ×

Compliance 52

Compliance HIPAA Fraud 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. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. What is Healthcare Compliance?

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Compliance HIPAA Telemedicine ACA 52

HIPAA Journal

FEBRUARY 21, 2022

EHRs usually contain all the information required for multiple types of fraud, including names, addresses, dates of birth, Social Security numbers, other government and state ID numbers, health data, and health insurance information. All data sent to cloud services must be properly protected to comply with HIPAA.

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Ransomware Fraud HIPAA Health Insurance 128

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 100

Fraud Health Insurance Ransomware HIPAA 100

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.

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Fraud Health Insurance Compliance Medicaid 52

MedTrainer

OCTOBER 23, 2023

Who Governs Healthcare Compliance? Office of Inspector General (OIG): Prevents fraud, waste, and abuse within the department’s vast array of Department of Health and Human Services (HHS) initiatives. This agency enforces HIPAA rules. Technology is sure to play a critical role in the future of healthcare compliance.

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Compliance Compliance Officers Fraud Governance 52