Healthcare Law Today

DECEMBER 16, 2022

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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Fraud Governance Medicaid Medicaid 52

HIPAA Journal

DECEMBER 31, 2022

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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HIPAA Due Diligence Compliance Fraud 133

HIPAA Journal

JANUARY 23, 2024

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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Fraud FDA Medicaid Medicaid 72

AIHC

MARCH 28, 2022

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?

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Medicare Medicare Compliance Governance 52

HIPAA Journal

MARCH 30, 2022

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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HIPAA Fraud Health Insurance Health Care Reform 121

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.

COVID-19 Vaccine 40

COVID-19 Vaccine Licensing COVID-19 Public Health 40

Drug & Device Law

JANUARY 30, 2023

470 (1996), was decided – removing express preemption as a defense for manufacturers of §510(k) products So defendants moved on fraud on the FDA under an implied preemption theory and won. Mensing , 564 U.S. Mensing , 564 U.S. Lohr , 518 U.S. Davidowitz , 312 U.S. Davidowitz , 312 U.S.

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FDA Fraud Governance Medicare 72