HIT Consultant

APRIL 1, 2024

to settle a civil fraud lawsuit filed by the U.S. Key Allegations The lawsuit alleged that TRG engaged in improper billing practices related to radiology services provided to hospitals and other healthcare providers across the country. Attorney’s Office for the Southern District of New York. – The settlement amount of $3.1M

Governance 97

Governance Licensing Fraud Medicare 97

Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 52

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? These complaints can trigger an audit. Data Analysis and Trends.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Health Care Performance

FEBRUARY 21, 2023

The scheme 25 people were charged with wire fraud – administrators and employees of three Florida nursing schools as well as recruiters. The buyers wanted to take licensing exams to become registered nurses, licensed practical nurses, or licensed vocational nurse licenses. What to do?

Nurses 52

Nurses Licensing Fraud Hospitals 52

Healthcare IT Today

FEBRUARY 9, 2024

Currently, in-patient and facility claims (such as extended hospital stays) account for a significant portion of costs in healthcare — as high as 45%. Even worse, up to 10% of this spending is rife with waste, abuse, and fraud. In other words, nearly half of all U.S. healthcare spending goes unaudited today.

Fraud 106

Fraud Governance Hospitals Licensing 106

Provider Trust

JULY 8, 2022

A holistic approach to exclusion monitoring and license verifications must include monitoring of disciplinary databases such as the National Practitioner Data Bank (NPDB). Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S. Also, individuals may query their own records.

Licensing 52

Licensing Malpractice Fraud Compliance 52

Healthcare IT Today

DECEMBER 20, 2022

Former Hospital Employees Accused of Selling Patient Information. Five former employees of Methodist Hospital in Memphis, TN, including a recently-licensed Registered Nurse, were indicted by a federal grand jury for allegedly selling medical information about car accident victims to personal injury attorneys and chiropractors.

HIPAA 86

HIPAA Nurses Licensing Compliance 86

MedTrainer

MARCH 14, 2024

The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Courtesy: This is when a hospital occasionally allows a provider to admit and treat a patient. However, not all providers need hospital privileges.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

Verisys

JULY 20, 2023

An organization must verify all certifications and licenses for every provider who administers patient services. Hospitals or health systems may not allocate adequate resources or staff to complete the medical credentialing process. Properly credentialing every individual is an enormous amount of work for a team. Mistake No.

Due Diligence 52

Due Diligence Malpractice Licensing Hospitals 52

Verisys

MARCH 1, 2024

FACIS® for Compliance and Safety: Verisys, through its flagship product FACIS® (Fraud Abuse Control Information System) , provides a gold standard dataset for sanction and exclusion screening.

Compliance 52

Compliance Fraud Licensing Governance 52

HIPAA Journal

JULY 20, 2022

Louis-based hospital system reported a breach of its email system to the HHS’ Office for Civil Rights on May 5, 2020, that affected 287,876 individuals. BJC HealthCare has agreed to settle a class action lawsuit to resolve claims it failed to adequately protect patient data from phishing attacks. The nonprofit St.

Fraud 108

Fraud Licensing HIPAA Health Insurance 108

Verisys

JULY 27, 2023

This includes licensed and unlicensed staff members, as well as partners, investors, contingent workers, agents, and contractors you do business with. The safety of your patients depends on making sound hiring decisions and ensuring that the licenses of your staff are current.

Compliance 52

Compliance Due Diligence Licensing Fraud 52

Verisys

JULY 5, 2023

This includes licensed and unlicensed staff members, as well as partners, investors, contingent workers, agents, and contractors you do business with. Not only does thorough screening and rigorous continuous monitoring help ensure quality employees, but it also provides 360-degree transparency.

Compliance 52

Compliance Due Diligence Licensing Fraud 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

MedTrainer

JANUARY 12, 2024

Department of Health and Human Services focuses on preventing fraud, abuse, and waste in federal healthcare programs. Regulatory agencies have the authority to impose monetary sanctions, revoke licenses, or exclude providers from federal healthcare programs as punitive measures.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Verisys

NOVEMBER 14, 2023

The Importance of Thorough Credentialing The credentialing process for hospitals and health systems prioritizes in-depth research and meticulous accuracy, which means that it is not a speedy process, often taking from 90 to 120 days to complete. However, verifying a provider’s credentials is essential.

Licensing 52

Licensing Medicaid Medicaid Governance 52

MedTrainer

FEBRUARY 12, 2024

Non-compliance can lead to significant fines, legal battles, and the loss of license or accreditation. For example, healthcare fraud or intentional non-compliance with regulations can lead to criminal charges. These actions can include fines, sanctions, or even revocation of licenses or certifications.

Compliance 52

Compliance Licensing Governance Fraud 52

Healthcare IT News - Telehealth

JUNE 8, 2022

But even now, hospitals and health systems should be preparing proactively to meet the regulatory demands of a post-PHE future. Early in the pandemic, many states issued executive orders that allowed out-of-state practitioners to provide services to patients in the state without being licensed in the state. Cohen, a Washington, D.C.-based

US Department of Health and Human Services 179

US Department of Health and Human Services Compliance Overpayments Overpayment 179

HIPAA Journal

JULY 27, 2023

Norton Healthcare, a Kentucky-based operator of more than 140 clinics and hospitals in Kentucky and Southern Indiana, is facing a class action lawsuit over a May 2023 cyberattack and data breach.

Ransomware 52

Ransomware Fraud Licensing Health Insurance 52

Hall Render

APRIL 19, 2024

to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Healthcare IT News - Telehealth

JANUARY 26, 2022

Ain Shams University Virtual Hospital (ASUVH) in Cairo, Egypt, employs a model of care where they reach patients throughout the continent by connecting with local clinics. Further, telehealth providers can help reduce the chance for fraud, waste and abuse by implementing risk-management policies and mechanisms.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

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. Affected individuals had one or more of the following exposed: name, address, driver’s license number, health insurance information, medical information, date of birth, and Social Security number.

Medicaid 72

Medicaid Medicaid Health Insurance Licensing 72

HIT Consultant

DECEMBER 10, 2021

Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know. What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Report Background.

COVID-19 98

COVID-19 Fraud Nurses Licensing 98

HIPAA Journal

MARCH 8, 2023

Asante, an Oregon-based health system with three hospitals and more than 30 primary care facilities, has started notifying certain patients that their medical records have been accessed by a local doctor who had no treatment relationship with the patients.

Electronic Medical Records 70

Electronic Medical Records Doctors Fraud Licensing 70

YouCompli

DECEMBER 7, 2022

These exclusions are generally related to criminal activity like fraud or healthcare-related misconduct. Felony convictions for other healthcare-related fraud, theft, or other financial misconduct. A Puerto Rican hospital settled for $105,000 for allegedly hiring an excluded individual as a medical utilization director.

Fraud 52

Fraud US Department of Health and Human Services Compliance Medicaid 52

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Situation One: Before the Pandemic   In April 2019, government officials announced Operation Brace Yourself: a fraud takedown related to telemedicine and durable medical equipment (DME).

Fraud 52

Fraud Compliance Medicare Medicare 52

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Verisys

DECEMBER 5, 2023

For the medical staff services team at a hospital to properly verify a healthcare practitioner’s credentials, dozens of primary sources must be contacted directly, and those primary source organizations must then verify the credentials of the practitioner in question. State licensing boards verify practitioner license type and status.

Governance 52

Governance Licensing Malpractice Medicaid 52

Verisys

JANUARY 6, 2022

The OIG through the Social Security Act has the power to bar individuals and entities from receiving federal payments as the result of intentional fraud or abuse. Hospitals, healthcare clinics, pharmacies, and other organizations should frequently check their entire population against the OIG LEIE to maintain compliance and mitigate risk.

US Department of Health and Human Services 52

US Department of Health and Human Services Fraud Medicaid Medicaid 52

Verisys

JANUARY 18, 2022

The credentialing process for hospitals and health systems prioritizes in-depth research and meticulous accuracy, which means that it is not a speedy process, often taking from 90 to 120 days to complete. Provider information should be continuously monitored for any changes to exclusion or license status.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Hall Render

JULY 28, 2023

million for rural hospital expansion Hospices in Arizona & other states receive scrutiny over concerns of fraud, waste & abuse Phoenix Children’s Building New 44,000-Square Foot Level IV Neonatal Intensive Care Unit Firefighters oppose Banner’s planned $400M hospital There’s a growing nurse shortage in Arizona.

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

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

APRIL 1, 2022

While Ciox’s investigation did not find any instances of fraud or identity theft as a result of this incident, out of an abundance of caution, beginning today, Ciox is notifying affected Catholic Health patients,” said Catholic Health, in a March 30, 2022 post on its website.

Fraud 128

Fraud HIPAA Licensing Health Insurance 128

The Health Law Firm

NOVEMBER 6, 2012

On October 16, 2012, the DOJ announced that the phony OT was charged with three counts of mail fraud, five counts of wire fraud, and one count of aggravated identity theft. How the Fake OT Received a License. Click here to see the press release from the DOJ.

Fraud 40

Fraud Licensing Hospitals 40

Verisys

JANUARY 25, 2023

Step 1: Screen all employees, providers, and entities: Verisys today works with pharmacies, health plans, hospitals, and background screeners to identify physician sanctions. By contrast, other credentials verification organizations (CVO) limit their searches by license type or to one or a few states. states and jurisdictions.

Compliance 52

Compliance Fraud Telemedicine Licensing 52

Verisys

FEBRUARY 14, 2024

For example, a hospital board might implement a robust governance framework that encompasses regular assessments of treatment outcomes, patient satisfaction surveys, and evaluations of financial performance. How does Verisys help with risk management in healthcare? Verisys significantly contributes to reinforcing healthcare compliance.

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

Compliancy Group

SEPTEMBER 27, 2023

Close Mount Desert Island Hospital (MDIH) Breach Incident In another concerning incident related to vulnerabilities in Progress Software’s MOVEit Transfer software, Mount Desert Island Hospital (MDIH) in Bar Harbor, Maine, reported a breach affecting 32,661 individuals. Please Wait. Something is wrong with your submission.

HIPAA 52

HIPAA Compliance Health Insurance Fraud 52