Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How the OIG Exclusion Database Came to Be HHS oversees the CMS (Center for Medicare Services), which administers the Medicare program.

Medicare 52

Medicare Medicare Fraud HIPAA 52

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4

Medicaid 77

Medicaid Medicaid Medicare Medicare 77

Compliancy Group

MAY 27, 2022

Almost as surely as summer follows spring, lawsuits follow breaches of protected health information. Here’s a roundup of recent HIPAA breach lawsuits and settlements. Lawsuits Increasing Following HIPAA Breaches – Facts and Figures. Let’s Simplify Compliance HIPAA and cybersecurity go hand-in-hand.

HIPAA 98

HIPAA Ransomware Compliance Hospitals 98

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). This is just the beginning.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

Verisys

NOVEMBER 8, 2023

CMS.gov The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the creation of a standard, unique health identifier for healthcare providers, which the NPI satisfies. Providers also need an NPI to enroll in Medicare.

Fraud 97

Fraud HIPAA Medicare Medicare 97

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. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

Medisys Compliance

APRIL 27, 2022

The Health Insurance Portability and Accountability Act (HIPAA) was introduced in year 1996. As the name suggests, it was created to ensure that all ‘protected health information’ was appropriately secured and restricted access to be given only to authorized individuals. Another goal was to prevent healthcare fraud.

HIPAA 52

HIPAA Medical Billing Outsourcing Medical Billing Ransomware 52

HIPAA Journal

JUNE 13, 2023

The forensic investigation confirmed the affected systems contained PHI such as names, addresses, phone numbers, birthdates, health insurance account information, Social Security numbers, provider taxpayer ID numbers, and clinical information and that information was in the files exfiltrated from its systems. and Point32Health, Inc.

Ransomware 96

Ransomware Fraud Health Insurance HIPAA 96

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

HIPAA Journal

JUNE 28, 2023

Individuals that have suffered identity theft, medical fraud, tax fraud, other forms of fraud, and other actual misuses of their personal information, can submit claims for documented, unreimbursed extraordinary losses that are reasonably traceable to the data breach of up to a maximum of $5,000. A lawsuit – Young, et al.

Hospitals 77

Hospitals Fraud Licensing HIPAA 77

HIPAA Journal

OCTOBER 6, 2022

Mon Health announced the security breach on February 28, 2022, and confirmed that the hackers had access to the personal and protected health information of 492,861 individuals , including information about patients, employees, providers, and contractors. The lawsuit, which names Monongalia Health Systems Inc.

HIPAA 94

HIPAA Fraud Hospitals Health Insurance 94

HIPAA Journal

MAY 25, 2023

In April 2023, Point32Health, the second-largest health insurer in Massachusetts and the parent company of Tufts Health Plan and Harvard Pilgrim Health Care, announced it suffered a ransomware attack that resulted in system outages, including the systems that serviced members, accounts, brokers, and providers.

Ransomware 81

Ransomware Health Insurance Fraud HIPAA 81

HIPAA Journal

SEPTEMBER 29, 2022

Humana has recently announced that the protected health information of 22,767 individuals has potentially been compromised in a security incident and data breach at one of its business associates – Choice Health – which Human used to sell Medicare products on its behalf.

Health Insurance 108

Health Insurance Medicare Medicare Fraud 108

MedTrainer

JANUARY 12, 2024

The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

HIPAA Journal

AUGUST 31, 2023

As well as supplying private customers, the company works with more than five hundred health plans, managed care organizations, and other agencies to provide access to meals for people covered by Medicare and Medicare. At the time of publication, the company’s name does not appear on the HIPAA Breach Report.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

HIPAA Journal

MARCH 21, 2023

During that time they exfiltrated files that contained sensitive patient data, including names, contact information, Social Security number, Medicare/Medicaid IDs, health information, and health insurance information.

Fraud 103

Fraud Health Insurance Medicaid Medicaid 103

Verisys

JANUARY 8, 2024

This includes adherence to standards set by the Health Insurance Portability and Accountability Act (HIPAA) , the Centers for Medicare & Medicaid Services (CMS), and other regulatory bodies. The audit evaluates if the healthcare organization follows billing and coding standards to prevent fraud and abuse.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

HIPAA Journal

OCTOBER 17, 2022

The exposed information included names, dates of birth, Social Security numbers, driver’s license numbers, clinical/diagnosis information, health insurance member ID numbers, medical record numbers, and Medicare or Medicaid numbers. No evidence of data theft or misuse of information has been detected.

Health Insurance 115

Health Insurance Licensing Fraud HIPAA 115

HIPAA Journal

MAY 10, 2023

The internal investigation concluded on March 15, 2023, that patient data may have been acquired, including names, dates of birth, Social Security numbers, medical treatment information, billing information, and health insurance information. Notification letters were sent in early May, almost 10 months after the attack.

Hospitals 97

Hospitals Ransomware Health Insurance Fraud 97

Compliancy Group

MARCH 19, 2024

Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations. It also reduces waste, fraud, and abuse that threaten the efficiency of healthcare delivery and services. name, phone number). healthcare.

Regulatory Compliance 52

Regulatory Compliance Compliance US Department of Health and Human Services ACA 52

HIPAA Journal

MARCH 25, 2022

Ultimate Care said no reports have been received that indicate there has been any misuse of patient information; however, as a precaution against identity theft and fraud, individuals whose Social Security numbers were impacted have been offered complimentary one-year memberships with a credit monitoring service.

Health Insurance 109

Health Insurance Licensing Ransomware Fraud 109

HIPAA Journal

NOVEMBER 15, 2022

– over the data breach that allege the company was negligent for failing to implement appropriate safeguards to ensure the confidentiality, integrity, and availability of patient information, that Somnia failed to comply with FTC guidelines and the HIPAA Rules and had not followed industry standards for data security. .

HIPAA 85

HIPAA Fraud Licensing Health Insurance 85

HIPAA Journal

SEPTEMBER 9, 2022

Those emails contained patient information such as names, dates of birth, Social Security numbers, medical information, health insurance information, driver’s license numbers, and state ID numbers. As a precaution against identity theft and fraud, complimentary memberships have been offered to a credit monitoring service for 12 months.

Licensing 101

Licensing Health Insurance Fraud HIPAA 101

Medisys Compliance

JANUARY 30, 2023

HIPAA: The Health Insurance Portability and Accountability Act( HIPAA) is a federal law that establishes the national standards for protecting the privacy and security of individuals’ personal health information ( PHI). We at Medisys Data Solutions understand the importance of HIPAA compliance.

Compliance 52

Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

Compliancy Group

MAY 15, 2024

OIG compliance and compliance training intends to help hospitals protect patient health and safety, prevent fraud and abuse, ensure legal and regulatory compliance, and safeguard patient privacy, making it an invaluable tool for success. Quality of Care and Safety The OIG continues to focus on the quality of care provided to patients.

Compliance 52

Compliance Hospitals Fraud Regulatory Compliance 52

HIPAA Journal

JUNE 15, 2022

The South Carolina-based health insurance company, Choice Health, now part of Alight Solutions, has recently announced that the protected health information of some of its members has been obtained by an unauthorized individual.

Ransomware 138

Ransomware Health Insurance Fraud HIPAA 138

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.

Compliance 99

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

Healthcare IT News - Telehealth

JULY 2, 2020

Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma to provide a written plan for permanent changes to Medicare, Medicaid and Children’s Health Insurance Program rules around telehealth.

COVID-19 165

COVID-19 Medicare Medicare Medicaid 165

HIPAA Journal

JULY 24, 2023

The team’s roles are to investigate and audit the Department’s operations to prevent fraud, waste, and abuse within the Department, and also to audit and investigate potential crimes against the Department. Subsequent Acts of Congress increased the OIG’s regulatory authority to prevent crimes against the Department.

Fraud 52

Fraud Medicare Medicare Medicaid 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

AIHC

AUGUST 30, 2023

Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM Due to the high volume of fraud schemes involving telemarketing revealed by the Department of Justice (DOJ) over recent years, it is important that providers heed “buyer beware” when engaging with a telemarketing firm. “If If it is too good to be true it probably isn't.”

Compliance 52

Compliance Fraud Medicare Medicare 52

MedTrainer

JANUARY 30, 2024

Compliance is Mandatory for Federal Programs One constant is that organizations and facilities that participate in federal healthcare programs, such as Medicare and Medicaid, must have a compliance program. Laboratories: Clinical laboratories that perform tests covered by Medicare or Medicaid.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

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

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.

Compliance 52

Compliance Fraud HIPAA Governance 52

Compliancy Group

SEPTEMBER 27, 2023

Sensitive Information Stolen The investigation revealed that personal information such as: Full names Social Security numbers Financial account details Passport numbers Medical records Health insurance policy information Dates of birth Credit or debit card information These had been removed from Lakeland’s network. Please Wait.

HIPAA 52

HIPAA Compliance Health Insurance Fraud 52

HIPAA Journal

APRIL 25, 2023

On February 13, 2023, NationsBenefits confirmed that the data compromised in the attack included protected health information such as name, address, phone number, gender, date of birth, health insurance number, medical ID number, Social Security number, date(s) of service, medical device or product purchased, and provider/caregiver name.

Health Insurance 84

Health Insurance Public Health Ransomware Fraud 84

Verisys

FEBRUARY 1, 2022

An NPI number is shared with other providers, employers, health plans, and payers for billing purposes. CMS.gov’s Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 ( HIPAA ) mandated the adoption of a standard, unique health identifier for each healthcare provider.

Fraud 52

Fraud Medicare Medicare HIPAA 52