Health Law Advisor

FEBRUARY 3, 2022

FY 2021 was also a record-shattering year for DOJ as it relates to health care fraud enforcement; over $5 billion (90% of the total) was obtained from cases pursued against individuals and entities in the health care and life sciences industries. With collections amounting to $5.6 billion received in FY 2020. KEY TAKEAWAYS.

Fraud 52

Fraud COVID-19 Governance Medicare 52

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. Donna Thiel. Linkedin.

Licensing 52

Licensing Fraud Compliance Nurses 52

HIPAA Journal

DECEMBER 31, 2022

To best answer the question what is a HIPAA violation, it is necessary to explain what HIPAA is, who it applies to, and what constitutes a violation; for although most people believe they know what a HIPAA compliance violation is, evidence suggests otherwise. What is HIPAA and Who Does It Apply To? Other Types of HIPAA Law Violation.

HIPAA 132

HIPAA Due Diligence Compliance Fraud 132

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 billion decrease in estimated improper payments from 2015 to 2018. Jeremy.Booth@c….

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Verisys

NOVEMBER 14, 2023

Proven software and technology which continuously monitors these sources will ensure that your healthcare organization is in compliance at all times. Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Health Care Performance

JULY 20, 2022

A New York ENT physician was convicted of filing false claims with Medicare and Medicaid. The physician submitted claims totaling about $585,000 to Medicare and Medicaid and was paid roughly $191,000. Mole billing fraud scheme totals $4.1 million in fraudulent payments between 2015 and 2021. That is how you collect $4.1

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Verisys

JANUARY 18, 2022

Proven software and technology which continuously monitors these sources will ensure that your healthcare organization is in compliance at all times. Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. ISO 9001:2015 (quality management).

Licensing 52

Licensing Medicaid Medicaid Governance 52

Health Law RX

JULY 18, 2023

Those subject to the CMP Final Rule should consider prioritizing their compliance efforts because the OIG will begin enforcing the Rule on September 1, 2023. As context, between 2015 and 2022, the DOJ reported FCA settlements with health IT vendors in an amount exceeding $500 million.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

HIPAA Journal

JANUARY 23, 2024

Carreyrou published the story in 2015 that revealed the company was using third-party technology rather than its own, as its own technology was inefficient. Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors.

Fraud 70

Fraud FDA Medicaid Medicaid 70

Hall Render

APRIL 6, 2022

However, some of the defendant’s customers typically paid less than the retail price for their medications through several discount programs that the defendant offered between 2006 and 2015. Subsequently, it was incorporated into the CMS’s Medicare Prescription Drug Benefit Manual (“Manual”) in December of 2006.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Hall Render

DECEMBER 29, 2023

NATIONAL 4 largest healthcare data breaches of 2023 Anesthesia practices sue CMS over reimbursement method Antitrust enforcements hit a high in 2022, with health deals impacted ASCs face leadership exodus CMS floats appeals process over observational stays CMS proposes additional Medicare appeals processes FTC eyes healthcare mergers, report shows (..)

Nursing Homes 40

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

Drug & Device Law

DECEMBER 29, 2023

2023) (rejecting any express anti-preemption presumption in Medicare case) ( here ); Baker v. 2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. Negligence requires an evaluation of a defendant’s reasonableness, and all relevant NC authority includes relevant regulatory compliance in that mix. 3d 239 (Cal.

FDA 105

FDA US Department of Health and Human Services COVID-19 Informed Consent 105

Drug & Device Law

JANUARY 30, 2023

470 (1996), was decided – removing express preemption as a defense for manufacturers of §510(k) products So defendants moved on fraud on the FDA under an implied preemption theory and won. Mensing , 564 U.S. Mensing , 564 U.S. Lohr , 518 U.S. Davidowitz , 312 U.S. Davidowitz , 312 U.S.

FDA 72

FDA Fraud Governance Medicare 72