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Protected Activity Under the FCA Requires Both a Subjectively and an Objectively Reasonable Belief of Fraud

Hall Render

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. Retaliation Under the FCA. 3730(h)(1).

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Hall Render Announces New Shareholders

Hall Render

Mayo Alao (Denver/Indianapolis offices) practices in the area of health care law with a focus on hospital and health system matters, regulatory and compliance issues, corporate transactions and hospital/physician alignment. James Junger (Milwaukee office) focuses his practice on pharmacy and health care compliance issues.

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Former Tennessee Medical Group Director Sentenced to Federal Prison

Med-Net Compliance

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.

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Settlement Agreed with Florida Children’s Health Insurance Website Contractor to Resolve False Claims Act Allegations

HIPAA Journal

While Jelly Bean Communications Design acted as a business associate under HIPAA, the action was taken over violations of the False Claims Act under the Department of Justice’s 2021 Civil Cyber-Fraud Initiative. FHKC is a state-created entity that offers health and dental insurance to children in Florida between the ages of 5 and 18.

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Former Payroll Manager Pleads Guilty to Several Tax Offenses

Healthcare Compliance Blog

In September 2012, the partnership ended, and, by court order, the sister was obligated to make payments to her partner for the purchase of the partner’s interest in the home healthcare company. Between 2012 and 2016, the payroll manager helped his sister by processing payroll that caused checks to be issued to “ghost employees.”

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Editorial: 5 Gaps in HIPAA and How They Are Being Filled

HIPAA Journal

For example, the Administrative Requirements (Part 162) helped reduce insurance fraud and accelerated eligibility inquiries, authorization requests, and claims processing. Consequently, when data breaches occurred due to a lack of compliance by Business Associates, there was no accountability.

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OIG-LEIE, GSA-SAM, and State Medicaid Exclusion Lists: What’s the Difference?

Provider Trust

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Guarantee Compliance with Automated Exclusion Monitoring. What is an exclusion and how does it affect your organization?