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 81

US Department of Health and Human Services HIPAA Compliance Medicaid 81

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 105

Compliance Fraud HIPAA Health Insurance 105

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. Medicare, Medicaid, and private health insurers suffered losses of more than $4.7

Medicaid 75

Medicaid Medicaid Medicare Medicare 75

HIPAA Journal

OCTOBER 21, 2022

There are – and always have been – gaps in HIPAA and, after more than a quarter of a century, some have yet to be addressed. Most of the gaps in HIPAA are attributable to omissions from the original Act, provisions of HIPAA and HITECH that have never been enacted, and the increasing use of technology in healthcare.

HIPAA 95

HIPAA Compliance Medicare Medicare 95

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.

Fraud 84

Fraud HIPAA Compliance Medicare 84

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

Fraud 95

Fraud Medicaid Medicaid Doctors 95

MedTrainer

JANUARY 10, 2024

The OIG is making major investments to systematically detect and prosecute fraud. In this guidance it’s clear the OIG expects healthcare organizations and suppliers to understand their role and responsibilities to fight fraud, waste, and abuse. We all should be a LOT more prepared!

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

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.

Fraud 52

Fraud Due Diligence Medicaid Medicaid 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. While health plans may use other numbers internally, the NPI is mandatory for HIPAA transactions.

Fraud 97

Fraud HIPAA Medicare Medicare 97

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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

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. FHKC receives Medicaid funds and state funds for providing health insurance programs for children in Florida.

Health Insurance 72

Health Insurance HIPAA Due Diligence Fraud 72

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). These audits should occur once per year.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

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

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 76

Hospitals Fraud Licensing HIPAA 76

HIPAA Journal

MARCH 6, 2023

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required the Centers for Medicare and Medicaid Services (CMS) to remove Social Security numbers from all Medicare cards as part of an effort to prevent fraud, combat identity theft, and safeguard taxpayer dollars and replace them with Medicare Beneficiary Identifiers.

Medicare 89

Medicare Medicare Fraud Medicaid 89

HIPAA Journal

APRIL 27, 2023

The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.

Medicare 91

Medicare Medicare Medicaid Medicaid 91

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. Accreditation.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

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.

Compliance 52

Compliance Hospitals Fraud Regulatory Compliance 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.

Compliance 99

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

HIPAA Journal

AUGUST 31, 2023

At the time of publication, the company’s name does not appear on the HIPAA Breach Report. It is also providing credit monitoring, fraud consultation, and identity theft restoration services for a year. The post PHI Included in Mom’s Meals Data Breach appeared first on HIPAA Journal.

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. The post Independent Living Systems Sued Over 4 Million-Record Data Breach appeared first on HIPAA Journal.

Fraud 98

Fraud Health Insurance Medicaid Medicaid 98

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

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 81

HIPAA Fraud Licensing Health Insurance 81

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

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

Compliancy Group

MARCH 8, 2023

How do people end up on the Medicaid Exclusion List, what are the consequences of being on the list, and can you ever get off the list? The Medicare Exclusion Database can trace its roots to 1996, when HIPAA (Health Insurance Portability and Accountability Act) was signed into law.

Medicare 52

Medicare Medicare Fraud HIPAA 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

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

Total Medical ComplianceHIPAA

APRIL 12, 2024

Furthermore, per the OIG, no payments will be made for any items or services furnished by excluded parties, which includes Medicare/Medicaid and all other Federal health benefit programs. Non-compliance with these requirements could result in financial penalties and jeopardize participation in Federal healthcare programs.

Compliance 72

Compliance Fraud Medicaid Medicaid 72

MedTrainer

JANUARY 12, 2024

The protection of patient data, adherence to privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the United States, and the prevention of cyber threats have become paramount concerns. Compliance in healthcare began to encompass billing, fraud, and abuse prevention.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Compliancy Group

MARCH 19, 2024

It also reduces waste, fraud, and abuse that threaten the efficiency of healthcare delivery and services. Also, all insurance and Medicare or Medicaid claims must only include charges for services and treatments ordered and deemed necessary. Regulatory compliance in healthcare ensures quality care for patients. name, phone number).

Regulatory Compliance 52

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

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. In the healthcare landscape, it’s crucial to have strict regulations and guidelines in place to ensure quality care, patient safety, and ethical conduct within the medical field.

Compliance 52

Compliance Compliance Officers Fraud Compliance Framework 52

MedTrainer

JANUARY 26, 2024

Here are some common non-compliance activities: Failure to Maintain HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) sets strict guidelines for safeguarding patient health information. Significant fines also can be levied by the Office of Inspector General (OIG) for overbilling Medicare and Medicaid.

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 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

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. and cybersecurity threats. and cybersecurity threats. Medicare Advantage (M.A.): Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

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-19 173

COVID-19 Medicare Medicare Medicaid 173

HIPAA Journal

JULY 4, 2023

As a precaution against identity theft and fraud, affected individuals have been offered 24 months of complimentary credit monitoring services. The post 559,000 Individuals Affected by Murfreesboro Medical Clinic & SurgiCenter Cyberattack appeared first on HIPAA Journal.

Medicaid 72

Medicaid Medicaid Health Insurance Licensing 72