New OCR Rules for SUD Records
The Office for Civil Rights recently announced a new civil enforcement program. This program focuses on the confidentiality of substance use disorder patient records.
Stopping Medicare Advantage Fraud Now
Medicare Advantage is a private way to get Medicare benefits. This program works by giving private companies a fixed monthly fee for each member. Medicare calls this payment system "capitation".
Protecting Patient Data: Release for Treatment
Is It a Violation? Patient Records Release for Treatment You and your team work hard every day. Your top priority is, of course, patient care.
Ozempic Lawsuit: Protecting Your Practice
Understanding a Growing Legal Challenge The Ozempic lawsuit is a major concern. It involves claims against Novo Nordisk. Plaintiffs allege the company failed to warn about severe side effects.
Humana Lawsuit Loss: A Warning Sign?
When Humana lost its lawsuit against the Centers for Medicare & Medicaid Services (CMS) , it wasn’t just a legal defeat—it was a loud warning to insurers, providers, and healthcare organizations across the country.
Ongoing Federal Audit & Enforcement Trends
What Every MA Partner, Provider, and MSO Needs to Know in 2025 If you're in healthcare—especially if you're working with Medicare Advantage (MA) plans or supporting them through billing, coding, or administrative service
5.4 Million Patient Records Exposed
In early 2025, a major healthcare data breach shook the industry. The Episource data breach exposed the personal and medical information of 5.4 million people across the United States.
Tracking Technology and the Kaiser Data Breach
Tracking technology has become increasingly prevalent in various industries, including healthcare. It allows organizations to collect and analyze data about user interactions with their websites and applications.
Radiology Scandal
Introduction: In a recent revelation that sends ripples through the healthcare industry, a radiology company and its CEO have settled a civil fraud lawsuit totaling $3.1 million.
Laboratory Kickback Schemes and the Impact on Healthcare Integrity
In a recent announcement by the Office of Public Affairs, a staggering revelation shook the healthcare industry as two laboratory marketers and five physicians from various states agreed to settle allegations of involvem
COVID 19 and Fraud
The reality of today is that our lives will never go back to what they were before COVID.
COVID 19 Fraud Schemes
Fear and changes create opportunities and, sad to say, COVID 19 is no exception. As a matter of fact, the Federal Bureau of Investigation (FBI) has released several articles covering some of the COVID 19 fraud schemes th
The Dangers of Email
Based on Verizon’s latest Data Breach Investigations Report , email continues to be the most common attack vector (96%).
Policies and Procedures
Over the course of the last few years the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has investigated thousand of cases which have resulted in millions of dollars in fines and settle
Healthcare Businesses Compliance and Liabilities
If you are in the healthcare arena; can you afford a $50,000 a day per violation fine? I remember reading many years ago that farmers were the biggest gamblers as every year as they chance that their crops will be health
Business Associate and Healthcare
Over 8 million dollars were paid in just two settlements due to the lack of a business associate agreement.
eClinical $155M Settlement
eClinical, a Massachusetts company agreed to pay $155M to settle claims that they falsely obtained their Electronic Health Record (EHR) certification.
It is all about systems
Increases efficiency, standardizes processes, reduces mistakes, minimizes liability, offers protection from breaches, simplifies training.
EHR and Documentation
“Copy-pasting and over documentation are two easy ways for fraud to occur in EHRs; sometimes, it's the fault of pre-population by EHRs and sometimes, it's a lack of oversight from doctors and nurses who enter information
PHI Breaches
In the latest settlements regarding a breach in protected health information BCBS of Tennessee agreed to pay the Health and Human Services (HHS) Office for Civil Rights (OCR) 1.5 million in fines and implement a correct
Criminal and Enforcement Actions - November 2011
Over 33 cases have been closed during the month of November 2011. Some of these cases reminded me of the “not me” effect as we all try to do our best to follow Government regulations, however, I’m the first one to admit
Exploiting Privacy Breaches
I've described information security as a Cold War, requiring constant investment and vigilance to innovate faster than the hackers and criminals who are stealing data to commit identity theft.
Identity Theft - Red Flag
The Federal Trade Commission passed this law in November 1, 2008. Enforcement of the law has been postponed several times and the latest delay may come in the form of lawsuits.
Latest Kickback Settlement
Most people considered a kickback a bribe paid by an entity in exchange for a referral that resulted in a transaction or a contract. The interesting part is that a bribe doesn’t necessarily have to be in cash.