The Health Law Firm

MAY 31, 2016

Board Certified by The Florida Bar in Health Law On May 9, 2016,Michael John Veit, 64, the former chief procurement officer for Arizona's state Medicaid program, was sentenced to 10 years in prison for his role in the fraud scheme that resulted in the theft of 5.9 The Original Fraud and Theft Charges. Indest III, J.D., million dollars.

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Medicaid Medicaid Fraud 40

The Health Law Firm

JUNE 23, 2015

The Health Law Firm On June 9, 2015, the US Department of Health and Human Services, Office of the Inspector General issued a special fraud alert on physician compensation arrangements. By: Lance O. Leider, J.D.,

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US Department of Health and Human Services Fraud 52

The Health Law Firm

JUNE 22, 2015

Board Certified by the Florida Bar in Health Law and Shelby Root The largest criminal health care fraud takedown in the history of the US Justice Department, in terms of both loss amount and arrests, took place June 18, 2015. Indest III, J.D.,

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Fraud Medicare Medicare Licensing 40

The Health Law Firm

DECEMBER 15, 2015

Board Certified by The Florida Bar in Health Law On Thursday, December 10, 2015, 24-year-old, Daniel Suarez, was sentenced to nine years in prison and ordered to pay nearly $21 million in restitution by US District Judge Donald Middlebrooks, for his alleged leading role in a Medicare fraud scheme in Miami, Florida. Indest III, J.D.,

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Fraud Medicare Medicare 40

HIPAA Journal

MARCH 31, 2023

The lawsuit was initially filed in 2015 but was dismissed by a lower court in 2016 due to lack of injury, but was resurrected by a federal appeals court in 2017. million individuals who were registered to use CareFirst’s websites and online services. In 2018, the U.S.

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Fraud HIPAA 89

The Health Law Firm

NOVEMBER 17, 2015

The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its 2016 Annual Work Plan (Work Plan) on November 2, 2015, with an effective date of October 1, 2015.

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Fraud Medicaid Medicaid Medicare 40

HIPAA Journal

JULY 11, 2023

2015 Health Plan 78,800,000 Hacking/IT Incident American Medical Collection Agency 2019 Business Associate 26,059,725 Hacking/IT Incident HCA Healthcare 2023 Healthcare Provider 11,000,000+ Hacking/IT Incident Premera Blue Cross 2015 Health Plan 11,000,000 Hacking/IT Incident Excellus Health Plan, Inc.

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HIPAA Fraud Doctors Hospitals 62

The Health Law Firm

OCTOBER 8, 2015

Juan Carlos Delgado and his wife, Nereyda Infante, co-owners of the clinic, were charged with conspiracy to commit health care fraud. The pair pleaded guilty on June 24, 2015, before United States District Judge Paul G. Indest III, J.D., million scheme to defraud Medicare will spend the next five years behind bars.

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Fraud Medicare Medicare 40

HIPAA Journal

OCTOBER 26, 2022

The lawsuit alleges the plaintiffs and class members have been exposed to an ongoing risk of fraud and identity theft, which requires them to constantly monitor their financial accounts and credit reports as their personal information is in the hands of cybercriminals.

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HIPAA Fraud Health Insurance 103

Healthcare IT Today

JUNE 3, 2023

Read more… Know Your Patient and Prevent Insurance Fraud. For busy CISOs, fraud prevention can easily slip under the radar. Verifying patient identity and requiring authentication on an ongoing basis can help safeguard providers against fraud , said Bala Kumar at Jumio.

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Fraud 86

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.

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Fraud COVID-19 Governance Medicare 52

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. 2, 2015–July 31, 2016, and a range of $11,181–$22,363 for violations committed after Jan. Issue: All submitted claims must be accurate and truthful.

Medicaid 59

Medicaid Medicaid Compliance Governance 59

HIPAA Journal

JULY 27, 2023

Malone was employed by Norton Healthcare between 2015 and 2022 and claims her sensitive information was stolen and attempts have already been made to misuse that information. District Court on behalf of plaintiff Lanisha Malone and similarly situated individuals who had their sensitive data stolen in the attack.

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Ransomware Fraud Licensing Health Insurance 52

Healthcare Compliance Blog

FEBRUARY 8, 2022

From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta. The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

MedTrainer

JANUARY 12, 2024

Compliance in healthcare began to encompass billing, fraud, and abuse prevention. MACRA (2015): The Medicare Access and CHIP Reauthorization Act (MACRA) introduced the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Compliance efforts shifted toward protecting patient information.

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Compliance HIPAA Telemedicine ACA 52

Hall Render

JANUARY 4, 2023

Mayo graduated from the Saint Louis University School of Law in 2015. 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.

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Fraud Compliance Hospitals 40

The Health Law Firm

SEPTEMBER 12, 2016

The health care industry has found a similar success in recent years, as federal agents use data mining, predictive analytics, and other modeling approaches to catch Medicare fraud. Medicare Strike Force Enhanced to Reduce Billion-Dollar Losses.

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Medicare Medicare Fraud Medicaid 40

Med-Net Compliance

JULY 27, 2022

A California home healthcare and hospice agencies’ owner was sentenced to 18 months in prison for one count of conspiracy to commit healthcare fraud and one count of conspiracy to pay and receive healthcare kickbacks.

Medicare 59

Medicare Medicare Nurses Fraud 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.

Licensing 52

Licensing Fraud Compliance Nurses 52

Healthcare Law Blog

FEBRUARY 9, 2024

Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance. Million To Resolve Health Care Fraud Allegations | United States Department of Justice [3] See Defs.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Hall Render

JUNE 1, 2022

For more than 15 years, Ritu has been an active member of AHLA and has held leadership roles consistently since 2015. “AHLA has played an integral role in my growth as an attorney, and I look forward to the opportunity to help guide this organization and bring industry leaders together to advance how we are able to best serve our clients.”.

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Compliance Fraud Governance Hospitals 40

The Health Law Firm

DECEMBER 24, 2015

Rendon, said of a Westlake, Ohio cardiologist sentenced to 20 years in prison on Friday, December 18, 2015, "This defendant used his medical license as a license to steal."

Licensing 40

Licensing Fraud 40

Hall Render

AUGUST 22, 2023

the government alleged a clinical pharmacy manager for a Tennessee Walgreens falsified twelve different patients’ medical records between January 2015 and June 2016. Walgreens learned of the fraud as early as 2016. In United States v. Walgreen Co. ,

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Medicaid Medicaid Governance Fraud 40

The Health Law Firm

AUGUST 18, 2015

Board Certified by The Florida Bar in Health Law On July 14, 2015, Ann Maxwell, Assistant Inspector General for Evaluation and Inspections of the Office of Inspector General (OIG), US Department of Health and Human Services (HHS), gave testimony to Congress on the Medicare Part D Program. By George F. Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Fraud 40

C&M Health Law

APRIL 21, 2022

In 2016, Larry Bomar, a former hospital reimbursement manager in Florida filed a whistleblower suit alleging that, between October 2013 and September 2015, BayCare had allegedly made improper cash donations to the Juvenile Welfare Board (JWB) as part of a scheme to boost BayCare’s Medicaid funding.

Medicaid 52

Medicaid Medicaid Governance Fraud 52

The Health Law Firm

DECEMBER 17, 2015

Board Certified by The Florida Bar in Health Law A husband and wife from Chicago, Illinois, were sentenced to prison terms by US District Judge Richard Mills on Monday, December 14, 2015, for their roles in the misappropriation of $3 million in grant funds. Indest III, J.D., Leon Dingle Jr.

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Fraud 40

Healthcare Law Today

JANUARY 2, 2023

The FCA is a fraud statute, requiring intent. For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question. For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question. Potential Impact. ” United States ex rel. Healthfirst, Inc. ,

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Overpayments Overpayment ACA Medicare 52

Verisys

NOVEMBER 14, 2023

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

Licensing 52

Licensing Medicaid Medicaid Governance 52

HIPAA Journal

OCTOBER 21, 2022

For example, the Administrative Requirements (Part 162) helped reduce insurance fraud and accelerated eligibility inquiries, authorization requests, and claims processing. The passage of HIPAA resulted in multiple benefits for the health insurance industry, the healthcare industry, and the people that they serve. billion and $11.5

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HIPAA Compliance Medicare Medicare 96

Kaiser Health News

JANUARY 19, 2022

Many cited examples beginning with a 2015 case in which an agent allegedly signed up hundreds of people from North Carolina homeless shelters for plans in which the federal government paid the entire premium, often referred to as “zero-premium plans,” by using questionable estimates of their annual income.

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ACA Health Insurance Licensing Governance 72

HIPAA Journal

JANUARY 24, 2023

For the first time since 2015, there was a year-over-year decline in the number of data breaches reported to the Department of Health and Human Services’ Office for Civil Rights (OCR), albeit only by 1.13% with 707 data breaches of 500 or more records reported. million records in 2021 to 51.9 million records in 2022.

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Ransomware HIPAA Hospitals Fraud 114

HIPAA Journal

JANUARY 12, 2023

Before the introduction of HIPAA, healthcare fraud was rife and was costing the healthcare industry around $7 billion a year. The standardization of healthcare transactions has helped to reduce significantly reduce fraud.

HIPAA 83

HIPAA Compliance Fraud COVID-19 83

Verisys

JANUARY 18, 2022

Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. ISO 9001:2015 (quality management). Proven software and technology which continuously monitors these sources will ensure that your healthcare organization is in compliance at all times. ISO 27001:2013 (information security).

Licensing 52

Licensing Medicaid Medicaid Governance 52

Healthcare Law Blog

APRIL 19, 2023

Justice Kagan reasoned that the Court in Escobar noted the FCA is grounded in common law fraud principles under which a defendant’s subjective knowledge of the truth or falsity of its statement is relevant to the knowledge inquiry. Circuit, in a decision joined by then D.C. MWI Corp. , 3d 281, 290–91 (D.C.

Governance 52

Governance Fraud Compliance 52

Total HIPAA

OCTOBER 28, 2019

A federal grand jury indicted a former MedStar Ambulance paramedic on counts of identity theft and fraud. He altered patient records as part of a scheme to steal narcotics from a local hospital from January 2013 to May 2015. Keeping these logs is an important risk management measure.

HIPAA 52

HIPAA Compliance Fraud Hospitals 52

Health Care Performance

JULY 20, 2022

Mole billing fraud scheme totals $4.1 million in fraudulent payments between 2015 and 2021. Compliance lesson: Enforcement agencies are actively using data analytics to identify, investigate and prosecute providers with unusual billing activity – and so should you. million in false claims over 7 years.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

HIPAA Journal

DECEMBER 31, 2022

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was introduced to simplify the administration of healthcare, eliminate wastage, prevent healthcare fraud, and ensure employees could maintain healthcare coverage between jobs. What is HIPAA and Who Does It Apply To? What is considered a HIPAA violation?

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HIPAA Due Diligence Compliance Fraud 130