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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.

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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

Allow CMS to Calculate Star Ratings for Certain Measures for 2023 Given Impacts of the COVID-19 Public Health Emergency (§ 422.166). The detailed reporting requires MAOs to submit narratives explaining their reported quality improvement activity methodologies—including a line item specifically dedicated to fraud reduction.

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Health Provider News – April 1, 2022

Hall Render

Coalition of hospitals, health plans and others urge for stronger guidance around third-party apps. Hospital, long-term care groups again petition Becerra to extend COVID-19 public health emergency. Rural Alabama wastewater infrastructure ‘public health issue’ gets much-needed attention.

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The 2021 Shkreli Awards: Lown Institute Counts Down the Top 10 Healthcare Industry Abuses in the Coronavirus Pandemic

Health Populi

Shkreli was ultimately convicted on securities fraud (not related to the Draprim pricing strategy). health care system. Among the ten awards, I’ve selected three to highlight to synthesize one systemic issue that has plagued America’s response to the public health crisis.