2015 Fraud Licensing Medicare 
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.,
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.
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MedTrainer
JANUARY 12, 2024
Licensing and credentialing were introduced to regulate healthcare professionals and ensure minimum standards of care. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance evolved to include performance reporting and quality metrics.
Verisys
NOVEMBER 14, 2023
Primary source verification must be done to confirm a provider’s education, professional license and certifications, medical training, work history, references, and more. Provider information should be continuously monitored for any changes to exclusion or license status. However, verifying a provider’s credentials is essential.
Kaiser Health News
JANUARY 19, 2022
A spokesperson for the Centers for Medicare & Medicaid Services said in an email that the agency is not seeing a pervasive problem, but he declined to provide data on how often such cases occur or how the agents or brokers get the personal information needed to enroll unsuspecting people. States also can revoke agents’ licenses.
Verisys
JANUARY 18, 2022
Primary source verification must be done to confirm a provider’s education, professional license and certifications, medical training, work history, references, and more. Provider information should be continuously monitored for any changes to exclusion or license status. ISO 9001:2015 (quality management).
Provider Trust
MAY 18, 2022
Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. In January 2015, the OIG settled for $96,259 with a Minnesota Pharmacist, Joseph C.
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