Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

Med-Net Compliance

OCTOBER 27, 2022

The psychologist was convicted of four counts of healthcare fraud. The FBI and HHS-OIG investigated the case, which was brought as part of the Chicago Strike Force, supervised by the Criminal Division’s Fraud Section and the US Attorney’s Office for the Northern District of Illinois.

Nursing Homes 59

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

Health Law RX

JUNE 2, 2023

The Prior SafeCo Standard Until yesterday, defendants could seek dismissal of fraud claims based on the absence of scienter by relying on the two-part test codified by the Court in SafeCo Ins. A mistake is still a mistake, not fraud. of America v. 3] That test posed two questions. per 30-day supply). [9] per 30-day supply). [10]

Fraud 52

Fraud Governance Medicaid Medicaid 52

Hall Render

APRIL 6, 2022

Third and finally, the relator pointed out that around the same time that CMS issued its 2006 Manual and memorandum, many state-run Medicaid plans adopted CMS’s definition of “usual and customary” pricing. Regarding the PBM’s adoption of this definition, the Court stated that this may not serve as the basis of a fraud claim under the FCA.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Launched in 2007, star ratings enable the CMS as well as consumers to compare health plans on metrics other than cost. A&G automation with single-click compliance.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Hall Render

JUNE 7, 2023

This practice implicated the pharmacies’ contracts with Pharmacy Benefit Managers (“PBMs”) as well as Medicaid and other federal health care programs. 47 (2007), the U.S. Thus, it’s important to seek legal counsel to resolve concerns about statutory or regulatory non-compliance. 47, 70 (2007). [10] Burr , 551 U.S.

Fraud 40

Fraud Medicaid Medicaid Governance 40