HIPAA Journal

MARCH 31, 2023

District Court Judge has denied class certification in a long-running legal battle against CareFirst BlueCross BlueShield over its 2014 data breach that affected 1.1 million plan members. million individuals who were registered to use CareFirst’s websites and online services.

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Fraud HIPAA 89

HIPAA Journal

JUNE 2, 2023

Rico Prunty, 41 years old, of Sierra Vista, Arizona, was previously employed at an Arizona medical facility where he unlawfully accessed the medical intake forms of patients between July 2014 and May 2017. His co-conspirators have already been sentenced for their roles in the identity theft scheme.

HIPAA 55

HIPAA Fraud Health Insurance Compliance 55

The Health Law Firm

SEPTEMBER 18, 2017

Board Certified by The Florida Bar in Health Law An administrator of a Louisiana pediatric clinic has recently pleaded guilty in a health care fraud case. The charges allege embezzling more than $500,000 of the clinic's money and diverting it to her personal account, from approximately August through September of 2014. Indest III, J.D.,

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Fraud Medicaid Medicaid 40

Health Law Advisor

FEBRUARY 3, 2022

billion, FY 2021 marks DOJ’s largest annual total FCA recovery since FY 2014, and more than twice the $2.3 With collections amounting to $5.6 billion received in FY 2020. WHISTLEBLOWER ACTIONS AND AWARDS REACH DECADE LOW. 1] DOJ’s FY 2021 is for the period of October 1, 2020 to September 30, 2021.

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Fraud COVID-19 Governance Medicare 52

Healthcare Compliance Blog

FEBRUARY 15, 2022

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. This is the second largest annual total in False Claims Act history, and the largest since 2014. More than $5.6

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Fraud Governance Compliance Medicare 59

Health Care Law Brief

OCTOBER 18, 2023

Consistent with and as has been elaborated in its 2014 Special Fraud Alert , OIG reasoned that such arrangements may implicate and potentially violate the AKS by “disguising” remuneration for FHCP business through the payment of amounts purportedly related to non-FHCP ( e.g. , commercial) business. .

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Regulatory Compliance Fraud Compliance Hospitals 52

The Health Law Firm

DECEMBER 11, 2015

Board Certified by The Florida Bar in Health Law A Virginia dermatologist, revered by several publications as one of the top doctors in the nation for several years running, was recently acquitted of more than 40 counts of health care fraud following an unusually lengthy 16-day trial. Indest III, J.D.,

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Fraud Doctors 40

The Health Law Firm

MARCH 10, 2014

The lawsuit alleged more than a decade of illegal compensation to doctors, violating the federal Stark Law, and Medicare fraud. According to the Orlando Sentinel, on March 3, 2014, Halifax and the US Department of Justice (DOJ) reached the tentative agreement just as jury selection was set to begin. Indest III, J.D.,

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Fraud Doctors Medicare Medicare 40

Hall Render

JANUARY 3, 2024

He represents clients in actions and investigations initiated under the False Claims Act and has experience working closely with state and federal authorities to resolve fraud and abuse-related matters. from the University of Dayton School of Law in 2014. Matt graduated with his J.D. Jennifer received her J.D. McKinney School of Law.

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Fraud Hospitals Compliance FDA 40

Provider Trust

JULY 26, 2022

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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Licensing Fraud Compliance Nurses 52

Healthcare Compliance Blog

MARCH 31, 2022

The DOJ, in coordination with the Medicaid Fraud Control Unit of the Office of the New York State Attorney General, began an investigation after whistleblowers alleged that certain LHCSAs had knowingly defrauded the federal government and New York State by underpaying home health aides in violation of New York’s Wage Parity Act.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

HIPAA Journal

MARCH 8, 2023

An investigation was launched when the unauthorized access was detected which revealed the unauthorized access had been occurring over a period of 9 years, starting in 2014. The doctor – Dr. Paul Hoffman – has had his access to the electronic medical record system terminated.

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Electronic Medical Records Doctors Fraud Licensing 68

Hall Render

JANUARY 4, 2023

James assists clients, which include hospitals, health systems, federally qualified health centers and safety net providers, as they navigate the complex 340B program, drug distribution laws, and fraud and abuse rules that regulate the health care industry. James earned his law degree from the University of Wisconsin in 2014.

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Fraud Compliance Hospitals 40

Healthcare IT Today

NOVEMBER 4, 2022

The whistleblower in the case is Amanda Long, who joined the company in 2014 and exited her role as vice president of product management in 2017. And in 2017, eClinicalWorks settled civil fraud and kickback charges with the government for $155 million.

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Governance Fraud 62

Healthcare Law Today

JANUARY 11, 2023

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.

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FDA Governance Medicare Medicare 59

Hall Render

FEBRUARY 27, 2023

This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. Health Care Fraud Actions Medicaid. million to resolve allegations that it paid kickbacks to physicians who attended its programs in connection with its multiple sclerosis drugs between 2009 and 2014.

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Nursing Homes Fraud Medicaid Medicaid 40

The Health Law Firm

MARCH 10, 2016

million penalty over an alleged healthcare-related fraud scheme, challenging the penalty in both administrative proceedings and the United States Supreme Court. On December 3, 2014, the Securities and Exchange Commission (SEC) instituted administrative proceedings against Assisted Living Concepts Inc.’s Indest III, J.D.,

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Fraud 40

The Health Law Firm

MAY 29, 2014

Board Certified by The Florida Bar in Health Law Talk about cracking down on Medicare fraud. On May 14, 2014, a Brevard County radiation oncologist received his final judgment in a whistleblower Medicare fraud case. Indest III, J.D., million.

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Fraud Medicare Medicare Doctors 40

The Health Law Firm

JULY 7, 2015

Board Certified by The Florida Bar in Health Law and Shelby Root On July 2, 2014, the Administrator of the Drug Enforcement Administration (DEA) denied a DEA research registration application of an Arkansas clinical research company. To read a past blog on the consequences of clinical research fraud and misconduct, click here.

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Fraud 40

The Health Law Firm

DECEMBER 17, 2015

and his wife, Karen Dingle, were convicted at a one-week long jury trial in December 2014 of conspiracy, mail fraud and money laundering. Indest III, J.D., Leon Dingle Jr. To read the full press release issued by the US Department of Justice (DOJ) regarding the convictions, click here.

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Fraud 40

The Health Law Firm

DECEMBER 11, 2014

On December 3, 2014, CMS released these new anti-fraud measures. Indest III, J.D., Board Certified by The Florida Bar in Health Law Stop me if you've heard this one before: the Centers for Medicare and Medicaid Services (CMS) recently increased Medicare's authority over physicians and other health care providers.

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Medicare Medicare Fraud Medicaid 40

Innovaare Compliance

AUGUST 24, 2023

The requirement for annual reporting of Medical Loss Ratio (MLR) beginning in contract year 2014 is another attempt to glean from the reported details how Medicare and beneficiary payments are spent to meet the program’s goal. CMS provides a four-prong test to determine if the risk-bearing entity meets the criteria for “risk-bearing”.

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Medicare Medicare Fraud Medicaid 52

The Health Law Firm

FEBRUARY 21, 2014

According to the Florida Attorney General (AG), the therapist was arrested on February 7, 2014, for allegedly using falsified records to collect payment for services never rendered. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid Fraud Licensing 40

The Health Law Firm

MARCH 6, 2014

In an effort to do so, the agency is temporarily blocking several home health agencies (HHAs) and ground ambulance suppliers in fraud hot spots around the country from enrolling in and receiving reimbursements from Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) programs.

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Medicaid Medicaid Fraud Medicare 40

Healthcare Law Blog

FEBRUARY 13, 2023

This topic always involves a legal angle, such as Stark Law or Anti-Kickback compliance, or state fraud and abuse law considerations. 2014), the D.C. For many healthcare attorneys, these types of dual-purpose communications are more common than communications involving only purely “legal” advice. Are bonuses involved? 3d 754 (D.C.

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Compliance Fraud Governance 52

Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). The FCA is a fraud statute, requiring intent. 3729(b)(1)(A).

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Overpayments Overpayment ACA Medicare 52

Compliancy Group

AUGUST 23, 2023

September of 2020 marked the month when Cronin, burdened by guilt, reluctantly admitted to a single count of conspiring to orchestrate health care fraud and another count of brazenly committing such deceitful acts. Prosecutors Evan Panich and Chris Looney from the Health Care Fraud Unit, alongside Special Assistant U.S.

Fraud 52

Fraud Medicaid Medicaid Governance 52

HIPAA Journal

APRIL 5, 2024

A lawsuit against CareFirst BlueCross BlueShield that was filed in response to a 2014 data breach has had a contract class certified by a federal judge, 9 years after legal action was initiated. In June 2014, hackers gained access to CareFirst systems, which contained the data of around 1.1

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Fraud HIPAA Health Insurance Compliance 65

Healthcare Law Blog

MAY 16, 2022

The detailed reporting requires MAOs to submit narratives explaining their reported quality improvement activity methodologies—including a line item specifically dedicated to fraud reduction. Greater Transparency in Medical Loss Ratio (“MLR”) Reporting (§§ 422.2460 and 423.2460, 422.2490 and 423.2490).

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Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

MAY 18, 2023

million Hacked by Chinese APT group Failure to implement and maintain reasonable security practices 2020 Multistate (43 states) Anthem Inc $39.5 million 78.8 million Phishing attack and major data breach Multiple violations of HIPAA and state laws 2020 California Anthem Inc $8.7 million 78.8

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HIPAA Compliance Ransomware Hospitals 95

Hall Render

APRIL 1, 2022

Fraud plagues California’s hospice industry, audit finds. over MassHealth fraud. UPMC begins payments to 66,000 employees affected by 2014 data breach. San Francisco’s Laguna Honda Hospital faces potential closure after patient overdoses trigger state review. California nurses begin strike. seed funding round.

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COVID-19 US Department of Health and Human Services Nursing Homes Nurses 40

Health Populi

JANUARY 5, 2021

Shkreli was ultimately convicted on securities fraud (not related to the Draprim pricing strategy). When he led Turing Pharmaceuticals in 2015, he acquired a license for the drug Daraprim (an anti-malarial therapy also used for HIV/AIDS), raising the drug price from $13.50 a pill to $750 a pill. health care system.

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COVID-19 Public Health COVID-19 Vaccine Doctors 62

Drug & Device Law

DECEMBER 4, 2023

Basically, CPAP II purported to do precisely what Buckman itself prohibited: using express preemption to limit the “ordinary working” of implied preemption of fraud on the FDA claims. We saw more of the same with the discussion of consumer fraud claims in CPAP II. 2023 WL 7019287, at *7 (twice), *8 (four times), *9 (twice).

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Fraud FDA Hospitals Doctors 52

Drug & Device Law

JULY 24, 2023

What’s worse, the fraud on the FDA claim, if brought under state law, would be preempted by Buckman Co. 2014) (both complete with diagrams). Fourth, similar factual problems were shoved under the rug with respect to the purported “pattern of racketeering activity” – allegations of “mail fraud and wire fraud.” 341 (2001).

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Fraud FDA Doctors 52

Drug & Device Law

NOVEMBER 10, 2023

Not a single state, including Pennsylvania, allows recover of medical monitoring for “breach of warranty or fraud or violation of consumer protection statutes,” and Valsartan doesn’t cite any precedent for its contrary conclusion. 2023 WL 1818922, at *36. In re National Football League Players Concussion Injury Litigation , 775 F.3d

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FDA Governance Fraud 59

Drug & Device Law

MARCH 3, 2022

Indian Ocean, on March 8, 2014 , 352 F. Judge Jackson had not been on the bench very long when she was assigned this MDL, which related to “one of the greatest aviation mysteries of modern times: the disappearance of Malaysia Airlines Flight MH370 somewhere in the southern Indian ocean in the early morning hours of March 4, 2014.”

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FDA Fraud Governance 59

Drug & Device Law

MARCH 31, 2023

Opposing attempts to use False Claims Act litigation to adjudicate scientific debate, here , in 2014. Scientific literature about the risks and benefits of prescription medical products does not – at least in the absence of academic fraud such as the actual falsification of data (see, here ) – subject the speaker to tort liability.

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Medical Personnel COVID-19 Fraud Doctors 59