MedTrainer

JANUARY 12, 2024

The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation.

Compliance 52

Compliance HIPAA Telemedicine ACA 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

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. Michael Rosen, Esq.

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

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. A common misconception about HIPAA is that all healthcare data is subject to its protection. Health Care Data Collected by Personal Health Records. billion and $11.5

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HIPAA Compliance Medicare Medicare 95

Verisys

NOVEMBER 14, 2023

Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. With proven credentialing software, you never have to worry about scalability if you’re rapidly hiring and credentialing more healthcare providers. This could create a huge liability issue.

Licensing 52

Licensing Medicaid Medicaid Governance 52

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 is Only the First Step.

HIPAA 83

HIPAA Compliance Fraud COVID-19 83

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.

ACA 72

ACA Health Insurance Licensing Governance 72

HIPAA Journal

DECEMBER 31, 2022

The evidence that there may be a misunderstanding about what a HIPAA violation is comes from the Department of Health and Human Services (HHS) Enforcement Highlights web page. The web page is regularly updated with statistics relating to complaints about HIPAA violations, compliance reviews, and enforcement action.

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HIPAA Due Diligence Compliance Fraud 132

HIPAA Journal

DECEMBER 23, 2022

That’s more than any other year to date apart from 2015 when Anthem Inc reported its 78.8 On October 14, Wisconsin-based Advocate Aurora Health notified OCR about an impermissible disclosure of the protected health information of up to 3,000,000 patients. million records. million-record data breach. Million Records.

HIPAA 79

HIPAA Ransomware Health Insurance Compliance 79

Verisys

JANUARY 18, 2022

Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. With proven credentialing software, you never have to worry about scalability if you’re rapidly hiring and credentialing more healthcare providers. ISO 9001:2015 (quality management).

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

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. In January 2015, the OIG settled for $96,259 with a Minnesota Pharmacist, Joseph C. Our approach to monitoring and intelligence delivers always-accurate data insights on compliance and payment eligibility about the vendors in your networks. Get Daily Vendor Monitoring.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 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. These logs should also include information about when the files leave the file room.

HIPAA 52

HIPAA Compliance Fraud Hospitals 52

Health Law RX

AUGUST 10, 2021

It based its position on the grounds that Ancor, through its due diligence prior to the purchase of Alliance, learned about the alleged conduct and had the ability to remedy the conduct after the closing of the transaction. The DOJ also contended that Ancor caused Alliance to submit false claims to governmental programs. Moreover, the U.S.

Due Diligence 40

Due Diligence Compliance Governance Fraud 40

Health Care Performance

JULY 20, 2022

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. Outlier billing patterns will get you noticed! million in false claims over 7 years.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

CMS.gov

NOVEMBER 16, 2018

Fraud, waste, & abuse. Improper payments are not necessarily measures of fraud, but instead are payments that did not meet statutory, regulatory, administrative, or other legally applicable requirements. billion decrease in estimated improper payments from 2015 to 2018. percent in 2015 to 17.61 Jeremy.Booth@c….

Medicare 20

Medicare Medicare Overpayments Overpayment 20

HIPAA Journal

APRIL 5, 2024

CareFirst announced the data breach in May 2015 and explained that a single database was compromised that stored data that members and other individuals enter to access CareFirst’s websites and online services. In response to major data breaches at Anthem Inc.,

Fraud 65

Fraud HIPAA Health Insurance Compliance 65

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 22, 2022

HHS Issues Warning to HPH Sector about Hive Ransomware. Colorado Springs health clinic to pay settlement in fraud lawsuit. Maryland Doctor Among 18 Indicted In COVID-19 Healthcare Fraud Scheme, Allegedly Overbilled For COVID-19 Tests. Healthcare Orgs Struggle With Software Supply Chain Risk Management Policies. CONNECTICUT.

COVID-19 40

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

Health Law RX

JULY 18, 2023

The CMP Final Rule also addresses enforcement and CMPs for fraud, false claims, or similar conduct in HHS grants, contracts, and other agreements, which are not addressed in this article. 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

MAY 18, 2023

State attorneys general HIPAA cases were relatively rare occurrences, with only 11 settlements reached with HIPAA-covered entities and business associates to resolve HIPAA violations between 2010 and 2015. million 78.8 million Phishing attack and major data breach Multiple violations of HIPAA and state laws 2020 California Anthem Inc $8.7

HIPAA 94

HIPAA Compliance Ransomware Hospitals 94

Healthcare IT Today

MARCH 26, 2023

Meanwhile, the latest State of Locum Tenens Report from CHG Healthcare found an 88% increase since 2015 in the number of physicians taking on at least one short-term assignment each year. Those in patient-facing roles spend half their time seeing patients, with 34% of time devoted to administrative work.

Doctors 81

Doctors Fraud Medicaid Medicaid 81

Hall Render

DECEMBER 22, 2023

fraud scheme UConn Health is in financial trouble. governor pushes new Medicaid expansion proposal with work requirement Missouri state senator wants voters to have say in KU Health System, Liberty Hospital merger Kansas ACLU request to halt excessive wait times at Larned turned down by judge ‘Who cares about us?’:

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

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

Hall Render

APRIL 21, 2023

That may be about to change. health-tech startup MemoryWell pivots, eyes new funding to roll out software for insurers Department of Veterans Affairs health system kicks off multiyear Greater Washington expansion Georgetown to open Southeast D.C. Mississippi Dept.

US Department of Health and Human Services 40

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

Health Populi

JANUARY 5, 2021

“These are not just about individual instances or bad apples,” Dr. Vikas Saini, President of The Lown Institute, explained, referring to them as “cautionary tales” of the current state of U.S. Shkreli was ultimately convicted on securities fraud (not related to the Draprim pricing strategy). health care.

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COVID-19 Public Health COVID-19 Vaccine Doctors 62

Drug & Device Law

DECEMBER 4, 2023

On a host of issues, CPAP II makes a recommendations about state law – but without any basis in existing state law. Undisputedly, the complaint at issue “allege[d] no specific facts about any specific plaintiffs or specific injuries.” 28, 2023) (“ CPAP II ”), is entirely Mr. Hyde. 2023 WL 7019287, at *3. 2023 WL 7019287, at *3.

Fraud 52

Fraud FDA Hospitals Doctors 52

Drug & Device Law

DECEMBER 29, 2023

2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. Since the FDA requires pre-approval of any warnings about off-label uses, preemption at some point should have been pre-ordained under the Mensing ( 2011+1 ) independence principle, but off-label use did not really figure in Zofran ’s analysis. Monsanto Co. ,

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

Drug & Device Law

AUGUST 8, 2022

Recently, we have become concerned about personal injury plaintiffs deciding to sue these kinds of organizations because they don’t like some standard that stands between them and the pot of gold at the end of the litigation rainbow. The unfortunate truth is that ECFMG was also a victim of this fake doctor’s fraud. May 19, 2022).

Doctors 52

Doctors Fraud Licensing Compliance 52

Drug & Device Law

FEBRUARY 2, 2023

What’s really interesting about Atkinson is its holding that the other prerequisite to case-by-case application of comment k – that the product have “proper directions and warning” – was also satisfied as a matter of law. 2015 WL 11120857, at *2 (N.D. 23, 2015) (same); Lewis v. manufacturer, . . & Rem. 448 F.Supp.3d

FDA 59

FDA Licensing Fraud 59

Drug & Device Law

MAY 4, 2023

25, 2023), is one we have been talking about for a long time. 2015), finally gave appellate recognition to the preemption of design defect claims for FDA-approved branded prescription drugs. Pacira Pharms., 1:21-cv-700, 2023 WL 3075403 (S.D. As detailed here , the decision in Yates v. Ortho-McNeil-Janssen Pharms., 3d 281 (6th Cir.

FDA 64

FDA Fraud Compliance 64

Drug & Device Law

FEBRUARY 11, 2024

We’ve blogged several times already about the Alliance for Hippocratic Medicine v. et al. , “A Longitudinal Cohort Study of Emergency Room Utilization Following Mifepristone Chemical & Surgical Abortions, 1999–2015,” 8 H. But the scientific fraud that has evidently been perpetrated in the AHM litigation is far worse.

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FDA Fraud Pharmaceutical Industry Doctors 59

Drug & Device Law

MAY 13, 2022

2015), leading the charge in the “yes” column. Breaches of Express and Implied Warranties, Fraud-Based Claims. Finally, the court held that the fraud claims were not pled with the particularity Rule 9(b) requires. Ortho-McNeil-Janssen Pharms, Inc. , 3d 281 (6th Cir. The implied warranty claim did not meet the same fate.

Fraud 59

Fraud FDA Nurses Hospitals 59

Drug & Device Law

OCTOBER 13, 2023

The plaintiffs in Holley claim that the defendants should have offered a different drug instead, one based on tenofovir alafenamide (“TAF”), which the defendant had under development and brought to market about 10 years later. 2015), and the Supreme Court’s opinion in Mutual Pharmaceutical Co. 3d 281 (6th Cir. Bartlett , 133 S.

FDA 59

FDA Fraud 59

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.

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FDA Fraud Governance Medicare 72

Drug & Device Law

FEBRUARY 15, 2024

The two of us recently wrote about the issue of retroactivity of Michigan S.B. Nothing about retroactivity. Nothing about it applying to claims accruing on a certain date in the past. 15-cv-10133, 2015 WL 8175256, at *3 (E.D. 20, 2022) (dismissing 197 cases)) and discouraged countless others from being filed. Flex Techs.,

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FDA Compliance Fraud Hospitals 52