Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. The psychologist was convicted of four counts of healthcare fraud.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Provider Trust

JUNE 1, 2022

Organizations across the healthcare continuum have experienced several workforce trends that are creating gaps in license monitoring and verifications. In this post, we’ll explore three current challenges impacting the healthcare license and credential verification process. See our Telehealth Credentialing Guide for more information.

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Licensing Nurses COVID-19 Compliance 52

HIPAA Journal

APRIL 23, 2024

A cybersecurity firm was engaged to investigate the disruption and confirmed that unauthorized individuals accessed its network and exfiltrated files containing the personal information of residents. It took more than 10 months (April 10, 2024) to determine the types of information involved and the number of individuals affected.

Ransomware 105

Ransomware Fraud Licensing HIPAA 105

HIT Consultant

DECEMBER 10, 2021

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. Licensed Clinical Social Worker. For more information, download the full report here.

Fraud 98

Fraud COVID-19 Nurses Licensing 98

Provider Trust

MARCH 13, 2023

State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment. In Delaware, 26 nursing licenses were revoked when the nurses’ credentials were tied to the scheme. ProviderTrust recommends conducting license verification monthly.

Fraud 52

Fraud US Department of Health and Human Services Licensing Compliance Officers 52

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

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Fraud Health Insurance Ransomware HIPAA 72

HIPAA Journal

APRIL 24, 2023

Utah has updated its data breach regulations and from May 3, 2023, will require a breached entity to send a notification to the Utah Attorney General in the event of a breach of the personal information of 500 or more Utah residents. The post Utah Updates Data Breach Notification Requirements appeared first on HIPAA Journal.

Fraud 91

Fraud Licensing HIPAA Governance 91

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors?

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

Provider Trust

APRIL 18, 2024

Since that time, the organization has uniquely led the way in providing innovative solutions that uphold data integrity for ongoing exclusion monitoring, timely license and credential verification, and healthcare vendor data collection. To learn more, visit providertrust.com.

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Compliance Licensing Fraud Medicaid 52

Verisys

FEBRUARY 8, 2024

Here’s how Verisys can support pharmaceutical manufacturers in this critical area: Comprehensive Background Screening and Credentialing: Verisys’ FACIS (Fraud and Abuse Control Information System) is a key tool for screening and continuous monitoring of healthcare providers.

Compliance 52

Compliance Licensing Fraud 52

Verisys

NOVEMBER 8, 2023

Providers must use their NPI when transmitting any electronic health information in connection with a transaction. The NPI does not replace other identification numbers such as a provider’s taxpayer identification number (TIN), Drug Enforcement Administration registration, license number, or Social Security number. Who Needs an NPI?

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Fraud HIPAA Medicare Medicare 97

HIPAA Journal

JUNE 28, 2023

Good Samaritan Hospital in San Jose, CA, has agreed to settle a class action lawsuit that was filed in response to a data breach that exposed the protected health information of up to 233,835 individuals. A lawsuit – Young, et al.

Hospitals 81

Hospitals Fraud Licensing HIPAA 81

HIPAA Journal

DECEMBER 19, 2022

A review of the files on the compromised servers confirmed that protected health information such as patient names, dates of birth, Social Security numbers, driver’s license numbers, health insurance information, and diagnosis and treatment information had been exposed. The DOL and the U.S.

Fraud 99

Fraud Licensing HIPAA Health Insurance 99

MedTrainer

FEBRUARY 5, 2024

This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses. Information about the employer’s Taxpayer Identification Number (TIN) , practice location, and protocol agreements are also needed.

Licensing 52

Licensing Governance Compliance Fraud 52

The Health Law Firm Blog

DECEMBER 6, 2023

Most insurers obtain a report from the Medical Information Bureau ("MIB") and use this in determining the risk you pose and, hence, your policy premium. [.] When you apply for insurance, an insurance company will look at various factors regarding your history to determine how much your insurance policy will cost.

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Licensing Fraud Nurses 52

HIPAA Journal

NOVEMBER 16, 2022

Unauthorized individuals have gained access to the email system of the Administrative Fund of the Detectives’ Endowment Association of the Police Department of the City of New York (NYCDEA) and potentially viewed or obtained the protected health information of 21,544 individuals.

HIPAA 91

HIPAA Licensing Health Insurance Fraud 91

HIPAA Journal

AUGUST 2, 2023

Notification letters will be sent to the affected individuals in the coming weeks and credit monitoring, fraud consultation, and identity theft restoration services will be offered. A third-party data review company was provided with the files on December 22, 2022, and provided the results of the analysis to SHS on May 16, 2023.

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Licensing Electronic Medical Records Ransomware Health Insurance 75

The Health Law Firm Blog

MARCH 26, 2024

It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D., Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released.

Licensing 52

Licensing Nurses Fraud Medicaid 52

HIPAA Journal

FEBRUARY 8, 2024

Azura Vascular Care, a Pennsylvania-based operator of 70 outpatient vascular centers and ambulatory surgery centers in 25 states and Puerto Rico, notified the HHS’ Office for Civil Rights last month about a cybersecurity incident involving the protected health information of 348,000 patients. The incident was detected on November 9, 2023.

Ransomware 86

Ransomware Electronic Medical Records Licensing Health Insurance 86

HIPAA Journal

SEPTEMBER 9, 2022

Birmingham, AL-based Henderson & Walton Women’s Center (HWWC) has recently notified 34,306 patients that some of their protected health information may have been compromised as a result of a hacker gaining access to the email account of one of its employees. The information exposed varied from patient to patient.

Licensing 105

Licensing Health Insurance Fraud HIPAA 105

HIPAA Journal

NOVEMBER 23, 2022

Third-party security experts were engaged to investigate the nature and scope of the attack, with the investigation concluding on or around May 2, 2022, that files containing the protected health information of patients and employees may have been accessed and exfiltrated from its network.

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Ransomware Fraud Licensing HIPAA 112

The Health Law Firm Blog

MARCH 11, 2024

It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D., Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released.

Licensing 52

Licensing Nurses Fraud Medicaid 52

HIPAA Journal

OCTOBER 17, 2022

Phoenix, AZ-based Valle del Sol Community Health has notified 70,268 patients that some of their protected health information has been exposed. Valle de Sol said the investigation indicated unauthorized individuals had access to files containing sensitive patient data and that patient information may have been acquired.

Health Insurance 119

Health Insurance Licensing Fraud HIPAA 119

Verisys

FEBRUARY 16, 2023

Transition Process Oregon: License Suspensions and Terminations of Orders by Operation of Law and Continuing Education Deficiencies: Oregon Administrative Rule 847-001-0035 has been amended to expand the reasons for which the Executive Director or Medical Director may issue final orders. The information is fluid and evolving.

Licensing 52

Licensing Nurses Fraud Compliance 52

Verisys

MAY 11, 2023

Publication of Notice – Operation Nightingale Oregon : The Oregon Medical Board has proposed a new rule to add “license denials” as a class of cases exempt from the 90-day timeline requirements. This new rule would allow a longer timeline due to board meeting schedules and the complexity of license denial cases.

Licensing 52

Licensing Nurses Medicaid Medicaid 52

Verisys

MARCH 1, 2024

As the healthcare industry is increasingly targeted for data theft and fraud, information security has emerged as a top priority for healthcare institutions. Continuously monitoring keeps you in compliance and prevents fraud and abuse within your organization. Healthcare data has never been more susceptible to fraud and abuse.

Governance 52

Governance Compliance Fraud HIPAA 52

HIPAA Journal

MARCH 22, 2023

Cardiovascular Associates in Alabama is facing a class action lawsuit over a recently reported hacking incident in which patients protected health information (PHI) was stolen. The plaintiff and class members now face an increased risk of identity theft and fraud as their private information is now in the hand of cybercriminals.

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HIPAA Fraud Licensing Health Insurance 100

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 113

Health Insurance Licensing Ransomware Fraud 113

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. According to the U.S.

Licensing 52

Licensing Fraud Compliance Nurses 52

HIPAA Journal

FEBRUARY 14, 2023

The compromised email accounts contained patient names, medical record numbers, driver’s license numbers, financial account information, Social Security numbers, health insurance information, and clinical or treatment information. Class members will also be provided with two years of credit monitoring services.

Fraud 96

Fraud Licensing Health Insurance HIPAA 96

HIPAA Journal

FEBRUARY 15, 2023

The medical device manufacturer Electromed has proposed a $850,000 settlement to resolve claims related to a June 2021 ransomware attack and data breach involving the protected health information of 47,200 individuals. A lawsuit – Lutz, et al.

Ransomware 89

Ransomware Fraud Licensing Health Insurance 89

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). The National Practitioner Data Bank (NPDB) is a confidential information clearinghouse operated by the U.S. For more information, view the webinar on demand.

Licensing 52

Licensing Malpractice Fraud Compliance 52

MedTrainer

APRIL 17, 2024

CAQH credentialing is designed to alleviate the work for providers because many major payers can access that information without the provider completing a separate application. Navigating the complex landscape of state licensing laws can be time-consuming and costly for organizations.

Licensing 52

Licensing Compliance Fraud Nurses 52

HIPAA Journal

JANUARY 10, 2024

Stripe is not HIPAA compliant and – other than its payment processing services – should not be used by covered entities and business associates to create, collect, store, or transmit Protected Health Information (PHI). As well as its payment processing activities, Stripe provides billing, identity verification, and fraud management services.

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HIPAA US Department of Health and Human Services Fraud Telemedicine 71

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 91

HIPAA Nurses Licensing Compliance 91

MedTrainer

APRIL 22, 2024

Creating and using a supplier compliance checklist ensures vendors meet regulatory requirements and are trusted partners in managing sensitive information. Compliance with federal compliance guidelines is often seen as ensuring ethical behavior, protecting sensitive information, and maintaining accountability.

Compliance 52

Compliance HIPAA Licensing Fraud 52

Provider Trust

AUGUST 16, 2023

Despite such mandates, OIG investigations over the past five years have found that vendors are accountable for much of the healthcare ecosystem’s fraud, waste, and abuse. Over the past several years, OIG has discovered that a significant amount of fraud, waste, and abuse occurs within the vendor domain.

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Fraud Compliance Licensing Compliance Officers 52