Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas. The psychologist was convicted of four counts of healthcare fraud.

Nursing Homes 59

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

Med-Net Compliance

JULY 20, 2022

According to court documents and evidence presented at trial, the doctor billed Medicare and Medicaid for an incision procedure of the external ear for hundreds of patients, when in fact all he actually performed was an ear exam or ear wax removal. He was convicted of one count of healthcare fraud and one count of making a false claim.

Fraud 59

Fraud Doctors Medicare Medicare 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. Trust is core to the provider-patient relationship.

Fraud 52

Fraud Medicare Medicare Compliance 52

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. Alario pleaded guilty to his role in the healthcare fraud scheme earlier this month.

Fraud 60

Fraud HIPAA FDA Health Insurance 60

Fierce Healthcare

APRIL 16, 2024

The National Association of ACOs (NAACOS) hosted a spring conference last week, with sessions on post-acute care, fraud, implementation best practices, health equity and legislative priorities. |

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Fraud Nurses 67

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.

Fraud 52

Fraud Medicare Medicare Compliance 52

Med-Net Compliance

JULY 26, 2022

In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds. Discussion Points: Review policies and procedures regarding the use of telemedicine within the facility and related requirements for preventing fraud, waste, and abuse of government funds.

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Fraud Telemedicine Medicare Medicare 59

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. However, they encounter numerous challenges in achieving this goal.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors?

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

Med Law Blog

DECEMBER 10, 2021

Mike Cassidy will be one of the panelists discussing “The Myths About Telehealth: Telefraud vs. Telemedicine Fraud” at the virtual CTeL Digital Health Summit on Thursday, December 16, 2021.

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Fraud Telemedicine 40

Hall Render

SEPTEMBER 12, 2022

Healthsouth of Sarasota Limited Partnership, et al , the Eleventh Circuit held that for a plaintiff to qualify as engaging in “protected activity,” the plaintiff must demonstrate that they had both a subjectively reasonable belief of fraud and an objectively reasonable belief of fraud. Background. Practical Takeaways.

Fraud 40

Fraud Governance Compliance 40

The Health Law Firm

AUGUST 20, 2021

Agents with the Federal Bureau of Investigation (FBI) said a Harvard nanotechnology researcher fighting federal charges of grant fraud never asked to have an attorney present during his interview. Indest III, J.D.,

Fraud 45

Fraud Governance 45

Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. The Operation Nightingale enforcement action has resulted in the execution of search warrants in five states: Delaware, New York, New Jersey, Texas, and Florida.

Fraud 52

Fraud US Department of Health and Human Services Licensing Compliance Officers 52

C&M Health Law

NOVEMBER 25, 2020

Earlier this month, OIG issued a Special Fraud Alert on Speaker Programs warning drug and device companies and health care providers that it has significant concerns about payments for “speaker programs.” HCPs are paid an honorarium and attendees are paid generally through free meals and drinks, for example.

Fraud 40

Fraud COVID-19 Health Care Reform ACA 40

The Health Law Firm

MAY 9, 2019

Unfortunately, many also find themselves defending their reputation after being accused of clinical research fraud or research misconduct. Although accusations of research fraud and misconduct have been present for decades, the number of complaints is on the rise, according to the Food and Drug Administration (FDA).

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Fraud FDA 40

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. But what exactly is considered fraud, waste, and abuse? These complaints can trigger an audit. Data Analysis and Trends.

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Fraud Compliance Medicaid Medicaid 98

Healthcare IT News - Telehealth

JUNE 28, 2021

" VanLandingham, who is senior counselor, Medicaid Policy/Acting Health IT at the agency, will be presenting at HIMSS21 this summer, HHS-OIG colleague, Assistant Inspector General for Legal Affairs Lisa Re. " VanLandingham explained that the healthcare fraud space gets "tens of thousands of complaints."

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US Department of Health and Human Services Fraud Compliance Medicaid 185

Healthicity

SEPTEMBER 30, 2022

The explosion of telehealth since 2020 means auditors, compliance managers, and regulators are scrambling.

Compliance 52

Compliance Fraud Telemedicine 52

Healthcare Law Blog

MAY 8, 2023

Department of Health and Human Services (“HHS”) is responsible for detecting and preventing fraud, waste, and abuse in federal health care programs. Upon request from health care providers and others, the OIG periodically issues advisory opinions concerning the application of fraud and abuse laws to existing or proposed business arrangements.

Fraud 52

Fraud COVID-19 Public Health Compliance 52

Med-Net Compliance

JULY 13, 2022

Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud. Participating in the fraud can result in the person(s) being prosecuted.?. Update your policies as needed.

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COVID-19 Vaccine US Department of Health and Human Services COVID-19 Fraud 59

Compliancy Group

FEBRUARY 28, 2024

CMS Compliance Requirements CMS compliance requirements are extensive, covering a wide range of topics: Billing and coding – healthcare providers must accurately code and bill for services rendered to ensure proper reimbursement and prevent fraud and abuse. 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

Natalia Mazina

MARCH 19, 2023

But in a nutshell, a group of California pharmacies brought a case against Optum alleging misrepresentation, fraud, and breach of contract. The California Court of Appeal, First Appellate District has just affirmed the holding of a trial court that Optum’s arbitration clause in its manual is unconscionable and unenforceable.

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Fraud 132

The Health Law Firm

SEPTEMBER 24, 2013

Leider with The Health Law Firm will be giving a presentation on Thursday, September 26, 2013, to the members of the Medical Office Resources of Florida (MOROF) and attending health care providers. This presentation is called, “Medicare and Medicaid Audits: Ready or Not, Here They Come.” Brown and Lance O. until 9:00 a.m.

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Medicaid Medicaid Medicare Medicare 40

Healthcare Law Blog

MAY 11, 2023

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

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Compliance Fraud Nurses Medicare 52

Healthcare IT News - Telehealth

JANUARY 26, 2022

Healthcare IT News interviewed Griffin to take a closer look at what he will be presenting at the HIMSS22 conference. The evergreen concern about virtual care is that of fraud, waste and abuse and how to balance it with the demonstrated value of extended medical services to patients who are either geographically or economically underserved.

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Fraud Telemedicine COVID-19 Licensing 148

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].

Compliance 52

Compliance Compliance Officers Fraud Medicare 52

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Med-Net Compliance

JUNE 24, 2022

A former Tennessee medical group director, 62, was sentenced to 18 months in federal prison for wire fraud. According to the information presented in court, from 2012 until 2020, she served as the director of risk management at a large medical group and worked at one of its hospitals.

Fraud 59

Fraud Hospitals 59

Healthcare It News

DECEMBER 5, 2022

" Community also said that the investigation has not found evidence that misuse or fraud has occurred as a result of the breach, and it "cannot say with certainty what information was involved."

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Fraud HIPAA Compliance Hospitals 257

Healthcare Law Blog

MARCH 24, 2022

OIG noted its longstanding concerns relating to the offer of incentives intended to induce beneficiaries to obtain federally reimbursable items and services, as such incentives could present significant risks of fraud and abuse.

Fraud 96

Fraud Licensing 96

Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

HIPAA Journal

FEBRUARY 22, 2022

The lawsuit alleges the plaintiff and class members are exposed to a present and imminent risk of fraud and identity theft because their sensitive data is in the hands of data thieves and has been made available to other cybercriminals through the leaking of the data on the dark web.

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Fraud HIPAA 110

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

Nurses 52

Nurses Licensing Fraud Medicaid 52

AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. They are also a large contributing factor for potential fraud and abuse when documentation does not support the diagnoses reported. They can, sometimes!

Fraud 52

Fraud Compliance Medicare Medicare 52

HIPAA Journal

AUGUST 30, 2023

The lawsuit alleges the plaintiff and class members now face a present and continuing risk of identity theft and fraud and are required to pay out-of-pocket expenses to prevent, detect, and recover from the misuse of their information, which is now in the hands of criminals.

HIPAA 77

HIPAA Fraud Health Insurance 77

Healthcare Law Blog

JULY 5, 2022

The conference presenters grappled in real-time with the transitory nature of the healthcare landscape today, including the significant role that technology has played in driving shifts in care delivery. Here, we provide an overview of what our healthcare law experts learned at the conference across relevant topic areas: Technology.

Fraud 52

Fraud Governance Ransomware Licensing 52

HIPAA Journal

AUGUST 29, 2023

The lawsuit alleged violations of the federal Wiretap Act as amended by the Electronic Communications Privacy Act of 1986, breach of an implied duty of confidentiality, violations of the Illinois Consumer Fraud and Deceptive Business Practices Act, violations of the Illinois Uniform Deceptive Trade Practices Act, intrusion upon seclusion, publication (..)

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HIPAA Fraud Health Insurance Compliance 73