Verisys

JANUARY 2, 2024

The post December 2023 Bad Actors Roundup appeared first on Verisys. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Civil Settlement with Total Access Urgent Care Over False Claims Allegations Full story Former Co-Owners of New Jersey Marketing Company Sentenced to Prison in $8.8

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Fraud Licensing Doctors Medicare 52

The Health Law Firm Blog

JANUARY 18, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

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Medicare Medicare Fraud Governance 52

The Health Law Firm Blog

DECEMBER 28, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

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Medicare Medicare Fraud Governance 52

HIPAA Journal

MARCH 6, 2023

The Department of Justice has announced one of its first prosecutions under the Medicare Access and CHIP Reauthorization Act of 2015 in a case involving the theft and sale of Medicare Beneficiary Identifiers. MACRA also made it illegal to buy, sell, or distribute Medicare Beneficiary Identifiers without proper authority.

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Med-Net Compliance

SEPTEMBER 20, 2022

million scheme to defraud Medicare by billing for services under another doctor’s name after Medicare revoked his privileges to participate in the program. According to court documents and evidence presented at trial, the podiatrist was revoked from participating in the Medicare program in January 2015.

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Fraud US Department of Health and Human Services Medicare Medicare 59

HIPAA Journal

APRIL 27, 2023

The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.

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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.

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

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

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Fraud Medicare Medicare Compliance 52

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

OCTOBER 6, 2022

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. In 2022, 48% of all eligible Medicare beneficiaries are enrolled in MAPD.

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Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

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Nursing Homes COVID-19 Fraud Medicaid 52

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

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Fraud Medicare Medicare Compliance 52

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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YouCompli

AUGUST 22, 2023

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs.

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Medicare Medicare US Department of Health and Human Services Compliance 52

The Health Law Firm Blog

MARCH 4, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How the OIG Exclusion Database Came to Be HHS oversees the CMS (Center for Medicare Services), which administers the Medicare program.

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Medicare Medicare Fraud HIPAA 52

Healthcare Law Blog

NOVEMBER 9, 2023

Thereafter, OIG said it planned to update existing industry-specific compliance program guidance (ICPG), which would include tailoring each to address fraud and abuse risk areas specific to a particular industry and describing the compliance measures that industry could take to reduce these risks [2].

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Healthcare IT Today

MAY 6, 2023

Read more… Preventing Genetic Testing Fraud: 5 Actions for Health Plans. Medicare payments for genetic testing quadrupled from 2016 to 2019, which has unfortunately led to a rise in a rise in fraud, waste, and abuse. On the heels of ViVE and HIMSS, they also discuss whether in-person conferences are back.

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Fraud Doctors Medicare Medicare 88

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

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Medicare Medicare Fraud Medicaid 52

Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes, which went into effect on January 1, 2023, are designed to ensure health plans are accurately reporting their costs and that they are not overcharging the government.

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Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. 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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Compliance Nursing Homes Nurses Fraud 52

HIPAA Journal

APRIL 23, 2024

The HHS Office of Inspector General (HHS-OIG) has issued a warning to the public about a fraud scheme that targets Medicare enrollees and involves them setting up monthly payments for medically unnecessary remote patient monitoring (RPN). Scammers are targeting Medicare enrollees and convincing them to sign up for RPN.

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Medicare Medicare Fraud HIPAA 52

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”).

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Medisys Compliance

JANUARY 30, 2023

Medicare and Medicaid: Medicare and Medicaid are government-funded healthcare programs that provide coverage to millions of Americans. These can include additional privacy and security requirements, as well as laws related to medical billing and coding , fraud and abuse, and other issues.

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Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

MedTrainer

JANUARY 10, 2024

It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. The OIG is making major investments to systematically detect and prosecute fraud. It may seem a little early to do some spring cleaning, but not when it comes to compliance!

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McGuire Wood

SEPTEMBER 8, 2023

In its continued effort to curb fraud and abuse in the hospice industry, on Aug. 22, 2023, the Centers for Medicare & Medicaid Services (CMS) announced it was making unannounced site visits to every Medicare-enrolled hospice nationwide.

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Medicare Medicare Fraud Medicaid 52

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

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Fraud Health Insurance Compliance Medicaid 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The Final Rule is effective June 5, 2023. Parts 417, 422, 423, 455, and 460. 79452 (2022)). 405.902). .

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Medicare Medicare Overpayments Overpayment 52

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. The audit also identified 1,714 providers whose billing for telehealth services for about a half million beneficiaries during the first year of the pandemic posed a high risk to Medicare.

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Fraud Medicare Medicare COVID-19 52

HIPAA Journal

JUNE 28, 2023

Individuals that have suffered identity theft, medical fraud, tax fraud, other forms of fraud, and other actual misuses of their personal information, can submit claims for documented, unreimbursed extraordinary losses that are reasonably traceable to the data breach of up to a maximum of $5,000. A lawsuit – Young, et al.

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Hospitals Fraud Licensing HIPAA 76

Healthcare Law Blog

FEBRUARY 1, 2023

As we approach the middle of the first quarter of 2023, private equity firms have continued to demonstrate their interest in investing in digital health. The following serves as a broad overview of recent policy updates and areas of opportunity in 2023. from 2023 to 2030.

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Electronic Medical Records Medicare Medicare Health Outcomes 52

The Health Law Firm Blog

JANUARY 4, 2024

On November 6, 2023, the U.S. By Michelle E. Missigman, J.D. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), released 91 pages of "General Compliance Program Guidance" (GCPG) on its website. This is the first compliance program guidance the OIG has released since 2008.

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Compliance Fraud Medicaid Medicaid 52

Healthcare Law Blog

MAY 11, 2023

When to Expect New CPG The OIG expects to issue updated GCPG by the end of calendar year 2023. When to Expect New CPG The OIG expects to issue updated GCPG by the end of calendar year 2023. Healthcare industry stakeholders are encouraged to incorporate the OIG’s CPG into the implementation and operation of their compliance programs.

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Compliance Fraud Nurses Medicare 52

HIPAA Journal

JUNE 13, 2023

million individuals in an April 2023 ransomware attack. According to Point32Health, hackers gained access to Harvard Pilgrim’s systems on March 28, 2023, and maintained access to those systems until April 17, 2023, when the intrusion was detected and blocked. million customers. At least 4 lawsuits have now been filed in the U.S.

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Provider Trust

OCTOBER 19, 2023

8, 2023 | 12pm CST Reserve Your Spot With new regulations and a changing payer demographic—marked by health plans entering new contracts such as Medicare Advantage—the demands for credentialing support can quickly outpace an organization’s available resources. Wednesday, Nov.

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Fraud Medicare Medicare Licensing 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. The audit also identified 1,714 providers whose billing for telehealth services during the first year of the pandemic posed a high risk to Medicare. million in Medicare fee-for-service payments.

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Fraud Compliance Medicare Medicare 52

HIPAA Journal

AUGUST 31, 2023

As well as supplying private customers, the company works with more than five hundred health plans, managed care organizations, and other agencies to provide access to meals for people covered by Medicare and Medicare. However, according to the Data Breach Notification, the date the breach was “discovered” is recorded as July 10, 2023.

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