The Health Law Firm

JUNE 13, 2017

Board Certified by The Florida Bar in Health Law On May 1, 2017, a federal jury in Michigan found a Detroit-area doctor and owner of a medical billing company guilty of perpetrating a $28 million health care fraud scheme. Health Care Fraud Scheme. Indest III, J.D.,

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The Health Law Firm

DECEMBER 5, 2017

Board Certified by The Florida Bar in Health Law On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 US Supreme Court decision in her case holding that the government could not freeze untainted assets. By George F.

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Fraud Medicare Medicare Governance 40

Healthcare IT News - Telehealth

MAY 13, 2022

The owners of a national telehealth company pleaded guilty this week to charges of conspiracy to violate the federal Anti-Kickback Statute and to commit healthcare fraud. Law enforcement agencies have ramped up the pressure on telehealth fraud, particularly amid the COVID-19 pandemic. According to a statement released by the U.S.

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The Health Law Firm

MAY 12, 2017

Board Certified by The Florida Bar in Health Law On May 9, 2017, a federal jury found four New Orleans doctors and two others guilty for their participation in a Medicare fraud scheme. million in fraudulent Medicare reimbursements. Indest III, J.D., According to prosecutors the defendants netted more than $13.6

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HIPAA Journal

JUNE 9, 2023

In 2017, federal prosecutors indicted William and David Dubin on 20 counts related to the overbilling of Medicaid, which included 6 counts of aggravated identity theft and resulted in the practice receiving around $300,000 in fraudulent reimbursements. That fraudulent claim resulted in a payment of $338.

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Healthcare Compliance Blog

MAY 10, 2022

According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application. The provider is charged with one count of Medicaid fraud more than $50,000, a first-degree felony.

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Medicaid Medicaid US Department of Health and Human Services Fraud 59

Pharmacy Law Blog

MARCH 13, 2018

On December 4, 2017, a Florida federal judge refused to dismiss the federal government’s False Claims Act (FCA) suit against a compounding pharmacy. She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. December 4, 2017). fraud suit – judge.”

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Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”. He is awaiting sentencing on those charges.

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US Department of Health and Human Services Medicare Medicare Overpayments 59

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

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Healthcare IT Today

JUNE 29, 2023

Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid. ASCs must also meet Medicare’s Conditions for Coverage. Medicare Payment Resources CMS implemented an Ambulatory Payment Classification-based payment methodology in 2008.

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Provider Trust

JULY 17, 2023

Medicare and Medicaid’s growing presence in managed care was also heavily discussed, with OIG urging healthcare organizations to become increasingly aware of risk adjustment payment scams. To combat this fraud, waste, and abuse, the OIG introduced a three-part plan called the PRO framework to guide the oversight of nursing homes.

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CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2017 to 8.12 percent in 2017 to 6.55 Jeremy.Booth@c…. Seema Verma.

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AIHC

MARCH 2, 2023

I remember actually defining my objectives in 2017 with one of the classes through AIHC. My task was to educate providers and staff through seminars on rules and regulations with Medicare. I have also added the CFE, Certified Fraud Examiner through the Association of Certified Fraud Examiners.

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Health Law RX

NOVEMBER 10, 2022

The United States alleged that, between August 1, 2016 and June 30, 2017, Sutter Health fraudulently billed and received reimbursement from government health programs for lab tests that Sutter Health did not itself perform. Some patients treated were allegedly able to walk without assistance and were ineligible for homebound therapy.

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Med Law Blog

MAY 1, 2023

Additional Investigative and Enforcement Activity In 2017, a whistleblower suit was filed against Surgery Partners, Inc. Howell, Constantine Yannelis and Abhinav Gupta positing that their research shows that “PE ownership increases short term mortality of Medicare patients by 10%, in nursing homes”. Hahnemann Hospital and St.

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Pharmacy Law Blog

MARCH 8, 2018

On December 6, 2017, three nurse practitioners and a doctor were arrested following an Alabama federal grand jury indictment accusing them of operating a “pill mill.” They face maximum sentences of 10 years in prison on the health care fraud counts. December 5, 2017). December 5, 2017). By George F. Indest III, J.D.,

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Hall Render

MAY 10, 2024

Vincent reopens Westside Crossing Walk-In Care Indiana’s 2017 abortion law violates free speech, federal judge rules Ind. Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

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CMS.gov

OCTOBER 2, 2018

Administrator, Centers for Medicare & Medicaid Services. Last week, we released the latest Federal Fiscal Year 2017 quality measurement data from the Medicaid and CHIP Child and Adult Core Sets that states have voluntarily reported to CMS. It also enhances the ability to identify potential fraud and improve program efficiency.

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Verisys

MARCH 24, 2022

Healthcare facilities receive billions of dollars in federal and state funding through the Affordable Care Act (ACA), Medicare, Medicaid, CHIP, and other programs. A 2017 report showed several of the largest penalties have been imposed on small- to medium-sized healthcare organizations, including United Medical Instruments Inc.

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AIHC

AUGUST 8, 2023

I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Both the American Society for Quality (ASQ) and Centers for Medicare and Medicaid Services (CMS) recognize this tool’s usefulness in root cause analysis (RCA). In an October 12, 2017 article over Dr. Deming I find the best characterization of him and his importance to Quality.

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Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. 7,872 2018 5,851 77.1% 7,589 2019 5,871 79.3% 7,215 2021 5,532 77.5%

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AIHC

FEBRUARY 16, 2024

To begin, the authors use Medicare patients who are diagnosed with aspiration pneumonia: “This study, one of the largest undertaken of aspiration pneumonia, confirms that patients with aspiration pneumonia are older, have more comorbidities, and are more likely to die than with other forms of pneumonia. Sound familiar ?

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Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

To begin, the authors use Medicare patients who are diagnosed with aspiration pneumonia: “This study, one of the largest undertaken of aspiration pneumonia, confirms that patients with aspiration pneumonia are older, have more comorbidities, and are more likely to die than with other forms of pneumonia. Sound familiar ?

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Compliance US Department of Health and Human Services COVID-19 Hospitals 52

New Jersey Healthcare Blog

JULY 22, 2022

1117(a), the Department of Human Services, Office of Program Integrity and Accountability proposed amendments, repeals, and new rules to comply with the Department’s Fee-for-Service initiative, the Centers for Medicare and Medicaid Services’ guidelines for funding, Danielle’s Law, P.L. On June 20, 2022, at 54 N.J.R.

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COVID-19 Vaccine Licensing COVID-19 Public Health 40

Hall Render

FEBRUARY 24, 2023

NATIONAL Addressing Staff Burnout In Healthcare Design Amazon completes $3.9B Can Hospitals Change in Time to Keep Them? Staff shortages could spur next public health crisis, Baystate Health CEO warns CommonSpirit, Mass General, Moffitt execs to judge telehealth challenge Brigham and Women’s, AI company get $2.5M

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CMS.gov

DECEMBER 21, 2018

Administrator, Centers for Medicare & Medicaid Services. Medicare Parts A & B. Pathways to Success,” an Overhaul of Medicare’s ACO Program. Today the Trump Administration announced our overhaul of the program for Accountable Care Organizations, or “ACOs,” in Medicare. Innovation models.

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Medicare Medicare Payment Systems Fraud 41

Hall Render

JANUARY 14, 2022

CMS proposed rule seeks to lower Medicare Part D prescription drug costs. HHS secretary orders Medicare to ‘reassess’ premium increase driven by Alzheimer’s drug. Medicaid, Medicare won’t pay Denver-area elder care provider for new clients after finding staffing issues, other problems. NEW MEXICO.

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COVID-19 Nursing Homes Nurses COVID-19 Vaccine 40

Hall Render

APRIL 21, 2023

health care fraud scheme SA cancer research company entering Dallas market as it eyes more U.S., health-tech startup MemoryWell pivots, eyes new funding to roll out software for insurers Department of Veterans Affairs health system kicks off multiyear Greater Washington expansion Georgetown to open Southeast D.C. Mississippi Dept.

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US Department of Health and Human Services COVID-19 Nurses Nursing Homes 40

Hall Render

JANUARY 28, 2022

Medicare posts key nursing home staffing info for consumers. Medicare scheme. Federal officials arrest nursing home owner charged with more than $3M in Arkansas Medicaid fraud. More Civil, Criminal Charges for Former Skyline CEO Accused of Tax and Medicaid Fraud. Massachusetts optometrist accused of $35K billing fraud.

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Nursing Homes COVID-19 US Department of Health and Human Services Nurses 40

CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? When listening to those advocating ‘Medicare for All’ it’s good to be skeptical about their promises. keya.joy-bush@…. Fri, 11/02/2018 - 21:32.

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Governance Medicare Medicare ACA 55

Drug & Device Law

DECEMBER 29, 2023

2023) (rejecting any express anti-preemption presumption in Medicare case) ( here ); Baker v. 2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. Hrymoc was tried in late 2017. Executive Health Resources, Inc. , UnitedHealthcare, Inc. , 3d 239 (Cal. Croda Inc. , 3d 191 (Del. 3d 949 (N.H. Monsanto Co. ,

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