Protecting against Healthcare Fraud: Lessons Learned from the Financial Industry

by James Christiansen

We all have routines: get up, brush our teeth, eat breakfast, and exercise. As consumers, we also have fairly set spending patterns. Visa was among the first credit card issuers to develop a system for tracking those patterns—and noticing deviations in them—as a way to detect potential fraud.

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Information Security of Health Information Exchanges – Are Humans the Weakest Link?

by Winston Krone

Technology glitches have been a predominant source of news headlines for health information exchanges (HIEs).  These glitches have raised a breadth of concerns ranging from usability to the protection of patient privacy.  What has received less news coverage is the risk that human vulnerabilities pose to HIEs.

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Happy New Year & What’s in Store for 2014 in Healthcare Privacy, Security & Compliance

by Doug Pollack

So 2013 was a very busy year for anyone that knows what HIPAA stands for. This should include healthcare providers, insurance companies, and (at least soon) their thousands of business associates, among others. If you hold a privacy, security, compliance, or general counsel title within any such organization, hopefully you got some rest over the holidays, because 2014 promises to be a barnburner.

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Why Aren’t Health Insurance Exchanges (HIX) Bound By HIPAA Rules?

by Mahmood Sher-jan

Yes, it is understandable that a HIX would not meet HIPAA’s definition of a covered entity (CE) and therefore HIPAA Privacy Rule would not generally apply.  But I wonder why these exchanges did not get designated as Business Associates (BA) under HIPAA since they all provide a clear service (data analysis and eligibility) to participating Health Plans and these plans are all covered entities under HIPAA?

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Medical Identity Theft Prevention – Finally! A Tool for Consumers

by Robin Slade

Medical identity theft and related healthcare fraud in the U.S. are undermining healthcare and increasing costs for its provision. Individuals are being physically harmed because of fraudsters and the dangerous changes they make to individuals’ medical identities through their healthcare records. And, shockingly, the FBI reports that medical professionals are more willing to risk patient harm in healthcare fraud schemes than ever before.

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Fraud and Medical Identity Theft: Scary Tales from the Darker Side of Healthcare

by Christine Arevalo

Fraudsters. Scammers. Medical identity thieves. The news is full of bad people making patients sicker and healthcare costlier. A quick scan of the headlines pulls up some stories that you have to read to believe.

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ID Experts Launches MIDAS

by Bob Gregg

Criminals stealing children’s Medicaid numbers. Billing Medicare for “phantom clinics” that exist only on paper. A fraudster posing as a doctor. These horror stories are real and far too frequent. According to the FBI, healthcare fraud costs the United States at least $80 billion a year, and the Ponemon Institute’s 2013 Survey on Medical Identity Theft found that 1.84 million people are victims of medical identity theft.

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Sitting down with the OCR; Advice for Business Associates & What it Means to be Investigated

by Heather Noonan

We hosted a pretty impressive webinar focusing on what is important to the Office for Civil Rights (OCR), what it means to be a business associate or a covered entity, and what it means to be investigated after a data breach. I can say it was impressive, because it really was.

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Prepare Now! Six Tips for a Successful Breach Response in the HIXs

by James Christiansen

If you have a yard, chances are you’ve spent hours this fall raking up thousands of fallen leaves. Have you ever wondered which leaf on the tree fell first?

It’s impossible to say, but it gives you an idea of the challenge organizations in a health insurance exchange (HIX) face when trying to pinpoint the source of a breach—in this analogy, a breach is like a leaf. Consider all that data flowing everywhere among all those entities. And we thought data breaches were complicated before!

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Security in the Health Insurance Exchange—Easier Said than Done

by James Christiansen

You’ve felt it for years—the weight of securing private health information as part of a typical compliance program, now add the complexity of information flowing through a health insurance exchange and you may feel your knees start to buckle. Especially as Health Insurance Exchanges (HIXs) face new security and privacy issues—read this article for more on that. How do you ensure that your information is secure when traversing the exchanges?

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