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.

Fraud 52

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

Fraud 59

Fraud Governance Compliance Medicare 59

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.

Licensing 52

Licensing Fraud Compliance Nurses 52

Healthcare Compliance Blog

MARCH 31, 2022

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.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

Hall Render

JANUARY 4, 2023

He provides services to a broad array of health care providers, including hospitals, health systems and physician practices. James earned his law degree from the University of Wisconsin in 2014. Mayo graduated from the Saint Louis University School of Law in 2015.

Fraud 40

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. million to resolve allegations that it violated the Anti-Kickback Status and Stark Law by giving referring physicians subsidies on EHR systems along with free or discounted technology services.

Governance 62

Governance Fraud 62

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.

Electronic Medical Records 70

Electronic Medical Records Doctors Fraud Licensing 70

Innovaare Compliance

AUGUST 24, 2023

At the heart of the debate is whether Medicare is obtaining good value for the program’s expenditures, i.e., maintaining beneficiaries’ access to high-quality services while encouraging efficient use of resources. CMS provides a four-prong test to determine if the risk-bearing entity meets the criteria for “risk-bearing”.

Medicare 52

Medicare Medicare Fraud Medicaid 52

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. Unnecessary Services. DOJ also exercised enforcement action against providers who billed for services that were not medically necessary.

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

The Health Law Firm

DECEMBER 11, 2014

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. On December 3, 2014, CMS released these new anti-fraud measures. Indest III, J.D.,

Medicare 40

Medicare Medicare Fraud Medicaid 40

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

Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) continues to stop fraudulent repayment claims before they happen. The six-month moratorium began January 31, 2014. Indest III, J.D., Click here to read the press release from CMS.

Medicaid 40

Medicaid Medicaid Fraud Medicare 40

Healthcare Law Today

JANUARY 2, 2023

If this proposed rule is finalized, the Department of Justice (DOJ) and Health and Human Services (HHS) Office of Inspector General’s (OIG) should be applying the same intent standard to their evaluation of potential reverse false claims and Civil Monetary Penalty liability. The FCA is a fraud statute, requiring intent.

Overpayments 52

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. Using Cale’s provider identification credentials, he billed MassHealth for services that he personally delivered.

Fraud 52

Fraud Medicaid Medicaid Governance 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2 and 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 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

Fraud 65

Fraud HIPAA Health Insurance Compliance 65

HIPAA Journal

MAY 18, 2023

The Department of Health and Human Services’ Office for Civil Rights is the main enforcer of HIPAA compliance; however, state Attorneys General also play a role in enforcing compliance with the Rules of the Health Insurance Portability and Accountability Act (HIPAA). million 78.8 million 78.8 million 78.8 million 78.8 million 78.8 million 78.8

HIPAA 94

HIPAA Compliance Ransomware Hospitals 94

Hall Render

APRIL 1, 2022

Fraud plagues California’s hospice industry, audit finds. House advances bill to strengthen Colorado mental health services. over MassHealth fraud. Missouri hospitals suspend services to restructure amid IT, cash flow problems. Noble Health suspends all services at Audrain and Callaway hospitals.

COVID-19 40

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

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. is typical of such relationships in the United States, and it includes usual and customary services. Apparently, massive loss of evidence was merely a “usual and customary service” of pharmacy benefit mangers nationwide.

Fraud 52

Fraud FDA Doctors 52

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.”

FDA 59

FDA Fraud Governance 59

Drug & Device Law

MARCH 7, 2022

Here, Plaintiffs fail to supply factual support showing Defendant acted with “oppression, fraud, or malice,” relying instead upon conclusory allegations. Gloucester County , 2014 WL 1599499, at *3 (D.N.J. April 21, 2014). the actions or omissions of the defendant demonstrate malice or aggravated or egregious fraud.

Fraud 59

Fraud FDA Licensing Pharmaceutical Industry 59