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Planned Parenthood Pays $4.3 Million to Settle Allegations of Medicaid Fraud in Qui Tam/Whistleblower Case

The Health Law Firm

The nonprofit organization is accused of fraudulently billing Medicaid and other government programs for health services provided by some of its Texas clinics between 2003 and 2009, according to the DOJ. Indest III, J.D., Board Certified by The Florida Bar in Health Law Planned Parenthood Gulf Coast recently paid $4.3

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Sentencing Guidelines: Third Circuit Rejects Use of “Intended” Loss in Favor of “Actual” Loss

Healthcare Law Today

Sentencing in federal fraud cases is driven by loss amounts. In health care fraud cases, the government frequently asserts a high “intended loss” based on amounts billed to payers, even when amounts actually paid were far less. Health care fraud cases are a prime example. In United States v. Banks Decision.

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What is a HIPAA Violation?

HIPAA Journal

According to the most recent update, the HHS has received almost 300,000 complaints since the compliance date of the Privacy Rule (April 2003). Most administrative HIPAA violations are investigated by the Centers for Medicare and Medicaid Services (CMS), while civil HIPAA violations are investigated by HHS´ Office for Civil Rights (OCR).

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HHS-OIG Excludes Theranos Founder and CEO from Federal Health Programs for 90 Years

HIPAA Journal

The Theranos Scandal Theranos was a blood testing startup founded by Elizabeth Holmes in 2003. Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors.

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Part 2: Understanding How Payers Deny Claims

AIHC

trillion government-wide from fiscal years 2003 through 2019. o These types of denials can potentially trigger a larger audit, a probe, or an abuse or fraud investigation of your organization CMS estimates the Medicare FFS improper payment rate through the Comprehensive Error Rate Testing (CERT) program. According to the U.S.

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What Are THE 3 Major Things Addressed in the HIPAA Law?

HIPAA Journal

Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. It was not until 2002 that the Privacy Rule was published, and 2003 that the Security Rule was published. Abuse and Fraud in the Health Care Industry. $7

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April-July 2022 State Regulatory Developments

New Jersey Healthcare Blog

The chapter describes the policies and procedures of the New Jersey Medicaid/NJ FamilyCare program regarding transportation services. On April 4, 2022, at 54 N.J.R. 620(b), the Department of Human Services, Division of Medical Assistance and Health Services adopted amendments to Transportation Services Rules. See N.J.A.C. 191 (N.J.S.A.