HIPAA Journal

MARCH 15, 2023

FHKC is a state-created entity that offers health and dental insurance to children in Florida between the ages of 5 and 18. FHKC receives Medicaid funds and state funds for providing health insurance programs for children in Florida.

Health Insurance 69

Health Insurance HIPAA Due Diligence Fraud 69

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. 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

The Health Law Firm Blog

FEBRUARY 23, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 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. 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

The Health Law Firm Blog

MARCH 14, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

Fraud 59

Fraud COVID-19 Health Insurance Compliance 59

The Health Law Firm Blog

FEBRUARY 1, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

HIPAA Journal

OCTOBER 21, 2022

A pharmaceutical sales rep has pleaded guilty to conspiring to commit healthcare fraud and wrongfully disclosing and obtaining patients’ protected health information in an elaborate healthcare fraud scheme involving criminal HIPAA violations. Ritson identified the patients through the medical practice of Dr. Frank Alario.

Fraud 57

Fraud HIPAA FDA Health Insurance 57

HIPAA Journal

JULY 9, 2024

The data compromised in the incident included names, addresses, phone numbers, Social Security numbers, birth dates, diagnoses, treatment information, prescriptions, physician names, medical record numbers, device serial numbers, and health insurance information. Another lawsuit was filed by plaintiff Arthur Podroykin in the U.S.

Fraud 97

Fraud Health Insurance HIPAA Compliance 97

The Health Law Firm Blog

JANUARY 8, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 40

Fraud Medicaid Medicaid Overpayments 40

The Health Law Firm Blog

NOVEMBER 29, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

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. Compliance with physician self-referral law requires strict adherence to its provisions.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

The Health Law Firm Blog

DECEMBER 19, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

OCTOBER 14, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

NOVEMBER 7, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

HIPAA Journal

APRIL 25, 2024

The exposed and stolen data included contact information, Social Security numbers, driver’s license numbers, financial information, health insurance information, medical records, medical histories, diagnoses/conditions, and health insurance information.

Fraud 97

Fraud Health Insurance HIPAA Licensing 97

The Health Law Firm

NOVEMBER 4, 2021

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District of New York. Indest III, J.D.,

Fraud 40

Fraud Health Insurance 40

HIT Consultant

JULY 26, 2023

What You Should Know: HealthLock , a leading medical fraud and overbilling protection solution, today unveiled insightful findings from a recent attitudinal study exploring how adults in the United States feel about healthcare, from claims and billing to medical fraud and privacy.

Medical Billing 98

Medical Billing Fraud Health Insurance Doctors 98

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. To resolve these allegations, Jelly Bean and Spinks agreed to pay $293,771.

Fraud 52

Fraud Due Diligence Medicaid Medicaid 52

MedTrainer

JULY 25, 2024

Adhering to the Health Insurance Portability and Accountability Act (HIPAA) standards is crucial to uphold compliance and regulatory requirements for any health organization. This act safeguards patients’ protected health information (PHI) and health plans and defines security and privacy regulations regarding patient data.

HIPAA 52

HIPAA Compliance Health Insurance Fraud 52

Compliancy Group

JUNE 13, 2024

Since the start of the data privacy rule in 2003 alone, there have been at least 350,000 Health Insurance Portability and Accountability Act complaints with 1,188 compliance reviews. Being placed on this list means that an individual or entity has committed fraud or harmed a patient(s).

Compliance 59

Compliance Fraud Regulatory Compliance Health Insurance 59

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 Medicaid Medicaid 52

Compliancy Group

JULY 10, 2024

If you hold this position, you likely understand what’s at stake in protecting health information and preventing fraud, abuse, and adverse incidents. Ensuring compliance with critical regulations falls on the compliance officer. We also discuss the steps and best practices that can guide you on how to be a good compliance officer.

Compliance Officers 64

Compliance Officers Compliance Fraud Electronic Medical Records 64

American Medical Compliance

JULY 9, 2024

The Medicare FWA Compliance Training aims to educate healthcare providers (HCP) on the definitions of fraud, waste, and abuse in the context of Medicare. Medicare is a federal health insurance program in the United States primarily for individuals aged 65 and older. Reach out for other courses by visiting the AMC Course Library.

Medicare 52

Medicare Medicare Compliance Fraud 52

HIPAA Journal

JULY 4, 2024

The exposed information varied from individual to individual and may have included names, birth dates, medical record numbers, medical histories, and health insurance information. SkinCure Oncology believes files in those email accounts were viewed and potentially obtained in the attack. to 5:30 p.m.

Medicaid 93

Medicaid Medicaid Fraud Licensing 93

HIPAA Journal

OCTOBER 7, 2022

Questions are often sent to HIPAA Journal about the Health Insurance Portability and Accountability Act, one of which is how HIPAA has improved healthcare. In this article, I explain some of the main ways that healthcare has been improved by HIPAA for healthcare providers, health plans, and patients.

HIPAA 77

HIPAA Fraud Health Insurance Compliance 77

Electronic Health Reporter

JUNE 26, 2019

health insurance companies have begun implementing prior authorization processes. 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. Recently, major U.S.

Fraud 117

Fraud Health Insurance 117

HIPAA Journal

APRIL 23, 2024

Kisco Senior Living said additional security features have been implemented to prevent similar breaches in the future and the affected individuals have been offered 12 months of complimentary credit monitoring services, which include a $1 million identity fraud loss reimbursement policy.

Ransomware 92

Ransomware Fraud Licensing HIPAA 92

HIPAA Journal

MAY 2, 2024

Hackers gained access to the BioPlus network for more than 2 weeks between October and November 2021, and potentially stole names, dates of birth, contact information, health insurance information, prescription information, and Social Security numbers.

Fraud 89

Fraud HIPAA Health Insurance Compliance 89

HIPAA Journal

SEPTEMBER 7, 2023

The information accessed in the attack included names, addresses, dates of birth, Social Security numbers, financial account information, medical record numbers, health insurance plan member IDs, and claims data. The affected individuals were notified by mail on August 11, 2023.

HIPAA 81

HIPAA Health Insurance Fraud 81

Kaiser Health News

APRIL 16, 2024

“Health insurance is important for people to have, but it’s also important to be sold properly,” said Doss, who said both consumers and legitimate agents can suffer when it’s not. Some consumers were switched multiple times or had duplicative policies.

ACA 131

ACA Health Insurance Governance Medical Billing 131

Provider Trust

OCTOBER 10, 2023

With new regulations and a changing payer demographic—marked by health plans entering new contracts such as Medicare Advantage—the demands for credentialing support can quickly outpace an organization’s available resources. See the Complete Report Reporting from a Survey of 150 Respondents from Health Insurance Companies

Licensing 52

Licensing Health Insurance Fraud Medicare 52

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Compliance audits aren’t a “one size fits all” process.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

HIPAA Journal

MARCH 30, 2023

On November 14, 2022, a hacker gained access to Rise’s network and accessed files containing sensitive patient data, including names, email addresses, phone numbers, provider information, diagnoses, expected delivery dates, and health insurance information.

Health Insurance 86

Health Insurance Fraud HIPAA 86

HIPAA Journal

JUNE 2, 2023

An Arizona man has been sentenced to 54 months in jail for aggravated identity theft and criminal violations of the Health Insurance Portability and Accountability Act (HIPAA). His co-conspirators have already been sentenced for their roles in the identity theft scheme.

HIPAA 54

HIPAA Fraud Health Insurance Compliance 54

American Medical Compliance

JANUARY 9, 2024

Provider Compliance and Responsibilities Additionally, the federal government’s False Claims Act (FCA) of 1986 explicitly targeted fraud and abuse in the healthcare industry in an effort to eliminate it. HCFAC received $248,459,000 from HHS and the Attorney General in 2007 to combat healthcare fraud and abuse.

Fraud 52

Fraud Compliance HIPAA Health Insurance 52

HIPAA Journal

FEBRUARY 22, 2023

The database included names, addresses, dates of birth, Social Security numbers, health insurance information, medical record numbers, and patient account numbers. CentraState confirmed that the hackers gained access to part of its systems that contained an archived database, and stole that database.

Ransomware 85

Ransomware Fraud Health Insurance HIPAA 85