The Health Law Firm Blog

FEBRUARY 10, 2023

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] Indest III, J.D.,

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Fraud Health Insurance Overpayments Overpayment 52

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

The Health Law Firm Blog

MARCH 14, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

FEBRUARY 23, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

FEBRUARY 1, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

Fraud 59

Fraud COVID-19 Health Insurance Compliance 59

HIPAA Journal

APRIL 25, 2024

The exposed and stolen data included contact information, Social Security numbers, driver’s license numbers, financial information, health insurance information, medical records, medical histories, diagnoses/conditions, and health insurance information.

Fraud 106

Fraud Health Insurance Licensing HIPAA 106

HIPAA Journal

OCTOBER 21, 2022

A pharmaceutical sales rep has pleaded guilty to conspiring to commit healthcare fraud and wrongfully disclosing and obtaining patients’ protected health information in an elaborate healthcare fraud scheme involving criminal HIPAA violations. Ritson identified the patients through the medical practice of Dr. Frank Alario.

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Fraud HIPAA FDA Health Insurance 60

The Health Law Firm Blog

JANUARY 8, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 40

Fraud Medicaid Medicaid Overpayments 40

American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. The Department of Justice recently revealed charges against 78 individuals involved in healthcare fraud schemes. Compliance with physician self-referral law requires strict adherence to its provisions.

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Compliance Fraud HIPAA Health Insurance 105

The Health Law Firm Blog

NOVEMBER 29, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

DECEMBER 19, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

OCTOBER 14, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

NOVEMBER 7, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

HIT Consultant

JULY 26, 2023

What You Should Know: HealthLock , a leading medical fraud and overbilling protection solution, today unveiled insightful findings from a recent attitudinal study exploring how adults in the United States feel about healthcare, from claims and billing to medical fraud and privacy.

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Medical Billing Fraud Health Insurance Doctors 98

The Health Law Firm

NOVEMBER 4, 2021

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District of New York. Indest III, J.D.,

Fraud 40

Fraud Health Insurance 40

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. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

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Fraud Health Insurance Compliance Medicaid 52

Health Care Law Brief

JUNE 5, 2023

We previously wrote about the United States Department of Justice’s (“ DOJ ”) Civil Cyber-Fraud Initiative (“ CCFI ”), which “aims to hold accountable entities or individuals that put U.S. To resolve these allegations, Jelly Bean and Spinks agreed to pay $293,771.

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Fraud Due Diligence Medicaid Medicaid 52

HIPAA Journal

MAY 2, 2024

Hackers gained access to the BioPlus network for more than 2 weeks between October and November 2021, and potentially stole names, dates of birth, contact information, health insurance information, prescription information, and Social Security numbers.

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Fraud HIPAA Health Insurance Compliance 89

HIPAA Journal

APRIL 23, 2024

Kisco Senior Living said additional security features have been implemented to prevent similar breaches in the future and the affected individuals have been offered 12 months of complimentary credit monitoring services, which include a $1 million identity fraud loss reimbursement policy.

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Ransomware Fraud Licensing HIPAA 99

Kaiser Health News

APRIL 16, 2024

“Health insurance is important for people to have, but it’s also important to be sold properly,” said Doss, who said both consumers and legitimate agents can suffer when it’s not. Some consumers were switched multiple times or had duplicative policies.

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ACA Health Insurance Governance Medical Billing 138

HIPAA Journal

OCTOBER 7, 2022

Questions are often sent to HIPAA Journal about the Health Insurance Portability and Accountability Act, one of which is how HIPAA has improved healthcare. In this article, I explain some of the main ways that healthcare has been improved by HIPAA for healthcare providers, health plans, and patients.

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HIPAA Fraud Health Insurance Compliance 84

HIPAA Journal

APRIL 8, 2024

The stolen data included names, addresses, dates of birth, diagnoses, health insurance information, and medical information, including procedures and prescriptions. Planned Parenthood discovered the ransomware attack on October 17, 2021, and confirmed on November 4, 2021, that the stolen files contained patient data.

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Ransomware HIPAA Health Insurance Fraud 76

HIPAA Journal

SEPTEMBER 7, 2023

The information accessed in the attack included names, addresses, dates of birth, Social Security numbers, financial account information, medical record numbers, health insurance plan member IDs, and claims data. The affected individuals were notified by mail on August 11, 2023.

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HIPAA Health Insurance Fraud 87

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Compliance audits aren’t a “one size fits all” process.

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Compliance US Department of Health and Human Services Fraud Medicare 52

Provider Trust

OCTOBER 10, 2023

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. See the Complete Report Reporting from a Survey of 150 Respondents from Health Insurance Companies

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Licensing Health Insurance Fraud Medicare 52

HIPAA Journal

MARCH 30, 2023

On November 14, 2022, a hacker gained access to Rise’s network and accessed files containing sensitive patient data, including names, email addresses, phone numbers, provider information, diagnoses, expected delivery dates, and health insurance information.

Health Insurance 93

Health Insurance Fraud HIPAA 93

Electronic Health Reporter

JUNE 26, 2019

health insurance companies have begun implementing prior authorization processes. These insurers do not possess the specialized knowledge needed to determine medical necessity, so they have to shift the responsibility to providers in order to minimize instances of fraud and abuse. Recently, major U.S.

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Fraud Health Insurance 117

American Medical Compliance

JANUARY 9, 2024

Provider Compliance and Responsibilities Additionally, the federal government’s False Claims Act (FCA) of 1986 explicitly targeted fraud and abuse in the healthcare industry in an effort to eliminate it. HCFAC received $248,459,000 from HHS and the Attorney General in 2007 to combat healthcare fraud and abuse.

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Fraud Compliance HIPAA Health Insurance 52

HIPAA Journal

JUNE 2, 2023

An Arizona man has been sentenced to 54 months in jail for aggravated identity theft and criminal violations of the Health Insurance Portability and Accountability Act (HIPAA). His co-conspirators have already been sentenced for their roles in the identity theft scheme.

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HIPAA Fraud Health Insurance Compliance 56

HIPAA Journal

FEBRUARY 22, 2023

The database included names, addresses, dates of birth, Social Security numbers, health insurance information, medical record numbers, and patient account numbers. CentraState confirmed that the hackers gained access to part of its systems that contained an archived database, and stole that database.

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Ransomware Fraud Health Insurance HIPAA 94

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.

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Hospitals Fraud Licensing HIPAA 77

HIPAA Journal

JUNE 13, 2023

The forensic investigation confirmed the affected systems contained PHI such as names, addresses, phone numbers, birthdates, health insurance account information, Social Security numbers, provider taxpayer ID numbers, and clinical information and that information was in the files exfiltrated from its systems. and Point32Health, Inc.

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Ransomware Fraud Health Insurance HIPAA 95

HIPAA Journal

FEBRUARY 23, 2022

HIPAA is an acronym for the Health Insurance Portability and Accountability Act. When the Health Insurance Portability and Accountability Act was passed by Congress in 1996, the establishment of federal standards for safeguarding PHI was not one of the primary objectives. What is HIPAA? What is HIPAA Title II?

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HIPAA Fraud Health Insurance Medicaid 89

Compliancy Group

MARCH 12, 2024

When unauthorized parties gain access to this information, identity theft, fraud, and diminished care often result. Prevent fraud: All parties must comply with laws that prevent fraud and misconduct, such as ordering necessary tests or treatments or billing for services not provided.

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Compliance Framework Compliance US Department of Health and Human Services Fraud 52

HIPAA Journal

JANUARY 1, 2023

Most state that HIPAA is an acronym of the Health Insurance Portability and Accountability Act of 1996 and that it led to the development of standards for the privacy of Protected Health Information. However, at the time, the healthcare insurance industry was governed by a hotchpotch of federal and state legislation.

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HIPAA Health Insurance Fraud Governance 73

HIPAA Journal

SEPTEMBER 30, 2022

The plaintiffs alleged the security failures were in violation of the Health Insurance Portability and Accountability Act, although the lawsuit was filed over the violation of state laws. The plaintiffs also took issue with how Magellan Health handled the data breach and the delay in issuing notifications.

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Fraud HIPAA Health Insurance 94