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Preventing Unlicensed Individuals and Subsequent Fraudulent Claims Submission

Provider Trust

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. According to the U.S.

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Two NY Home Healthcare Agencies Settle False Claims Act Allegations for $5.4 Million 

Healthcare Compliance Blog

The New York Wage Parity Act, Public Health Law sets minimum wage and benefit requirements for licensed home care services agencies (LHCSAs) that employ home care aides who render services to Medicaid recipients in New York City and three counties in New York. million to New York State for conduct between 2014–2017.

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Migraine Company Fails to Avoid Own Headache: Jet Medical and Others to Pay $745,000 to Resolve Allegations that Medical Device was not Approved or Cleared before Commercialization

Healthcare Law Today

The government alleged that, between April 2014 and April 2019, Jet Medical introduced devices into interstate commerce that were misbranded under the Federal Food, Drug and Cosmetic Act (FDCA) because Jet Medical did not obtain approval or clearance from the U.S. and Martech Medical Products Inc., Pre-submission Meetings.

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DOJ Recouped $2.2 Billion Under FCA in 2022

Hall Render

This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. Over 77% of the funds recovered were related to the health care industry, which shows the federal government’s commitment to enforcing the FCA. Health Care Fraud Actions Medicaid.

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CMS Issues Contract Year 2023 Final Rule for Medicare Advantage Organizations and Prescription Drug Sponsors

Healthcare Law Blog

At the beginning of the applicable contract year, the credit and the use of LOIs will no longer apply and, if the application is approved, the MAO must be in full compliance with network adequacy, including having signed provider and facility contracts. A warning letter = 3 points. A notice of noncompliance = 1 point.