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. It also is used to ensure that the arrangement reflects fair market value for bona fide services actually provided. By: Lance O.

US Department of Health and Human Services 52

US Department of Health and Human Services Fraud 52

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.

HIPAA 60

HIPAA Fraud Doctors Hospitals 60

HIPAA Journal

MARCH 31, 2023

million individuals who were registered to use CareFirst’s websites and online services. 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. In 2018, the U.S.

Fraud 88

Fraud HIPAA 88

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.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

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

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.

HIPAA 103

HIPAA Fraud Health Insurance 103

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. The lawsuit also seeks 10 years of credit monitoring services for all victims of the breach.

Ransomware 52

Ransomware Fraud Licensing Health Insurance 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. The hearing is scheduled for May 2, 2022. US Attorney Peter D.

Medicaid 59

Medicaid Medicaid Compliance Governance 59

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. In total, the agencies submitted over 8,000 claims to Medicare for the cost of home healthcare and hospice services.

Medicare 59

Medicare Medicare Nurses Fraud 59

MedTrainer

JANUARY 12, 2024

With advances in medical technology, new treatment modalities, and an expanding array of healthcare services, the regulatory framework has had to adapt to ensure patient safety, quality of care, and ethical standards. Compliance in healthcare began to encompass billing, fraud, and abuse prevention.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Hall Render

JANUARY 4, 2023

He provides services to a broad array of health care providers, including hospitals, health systems and physician practices. Mayo graduated from the Saint Louis University School of Law in 2015. James Junger (Milwaukee office) focuses his practice on pharmacy and health care compliance issues.

Fraud 40

Fraud Compliance Hospitals 40

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.

Licensing 52

Licensing Fraud Compliance Nurses 52

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.

Medicare 40

Medicare Medicare Fraud Medicaid 40

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. Ritu is a shareholder in Hall Render’s health section and serves as a co-leader of the firm’s compliance service line.

Compliance 40

Compliance Fraud Governance Hospitals 40

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. Despite the increasing use of technology, there are still some healthcare providers who do not qualify as Covered Entities. The National Patient Identifier.

HIPAA 95

HIPAA Compliance Medicare Medicare 95

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

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. billion decrease in estimated improper payments from 2015 to 2018. percent in 2015 to 17.61 Jeremy.Booth@c…. Fri, 11/16/2018 - 18:46. Seema Verma. Leadership.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

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

Verisys

NOVEMBER 14, 2023

Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. Verisys designed and built the first data-powered Software as a Service (SaaS) credentialing platform, CheckMedic, 20 years ago. When it comes to credentialing, an experienced and trusted partner is critical.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Kaiser Health News

JANUARY 19, 2022

Although the practice does not appear widespread, it has prompted the Department of Health and Human Services to seek changes to some oversight rules affecting brokers. But agents, brokers and web-based services are. They would start in 2023. Nonetheless, experts in law, policy and enrollment say it has been a recurrent issue.

ACA 72

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. on behalf of Novant Health ACE & as contractor for NMG Services Inc.

Ransomware 113

Ransomware HIPAA Hospitals Fraud 113

Provider Trust

MAY 18, 2022

All companies rely on third parties, independent contractors, suppliers and other key partners in order to effectively perform their services. at a provider that furnishes items or services payable by Federal health care programs. In January 2015, the OIG settled for $96,259 with a Minnesota Pharmacist, Joseph C.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Verisys

JANUARY 18, 2022

Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. Verisys designed and built the first data-powered Software as a Service (SaaS) credentialing platform, CheckMedic, 20 years ago. ISO 9001:2015 (quality management). Our experience shows in our high standards.

Licensing 52

Licensing Medicaid Medicaid Governance 52

HIPAA Journal

DECEMBER 23, 2022

That’s more than any other year to date apart from 2015 when Anthem Inc reported its 78.8 Shields Healthcare Group is a Massachusetts-based vendor that provides MRI, PET/CT, radiation oncology, and surgical services. Professional Finance Company is a Colorado-based vendor that provides debt recovery services. million records.

HIPAA 79

HIPAA Ransomware Health Insurance Compliance 79

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

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. They were significantly increased in the HITECH Act of 2009; and, since 2015, they have been adjusted for inflation annually.

HIPAA 132

HIPAA Due Diligence Compliance Fraud 132

Health Law RX

AUGUST 10, 2021

The whistleblowers’ qui tam complaints alleged that Alliance violated the AKS by providing EEG interpretive reports to non-neurologist physicians who referred patients to Alliance to enable them to bill government healthcare programs for services they did not provide. Moreover, the U.S.

Due Diligence 40

Due Diligence Compliance Governance Fraud 40

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

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

Compliancy Group

JANUARY 25, 2022

With at least six weeks before final numbers are in, the Department of Health and Human Services HIPAA Breach Reporting Tool website is reporting 713 major healthcare data breaches in 2021, an increase of more than 7.5 This is the second-largest number of records reported breached on the government site since 2015. million individuals.

HIPAA 98

HIPAA Ransomware Governance Fraud 98

Hall Render

APRIL 22, 2022

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. Tenet hospital CEO resigns amid service cuts. Allina Health names new leader for acute care services. 2 variant becomes dominant. CONNECTICUT.

COVID-19 40

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

HIPAA Journal

JANUARY 23, 2024

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has added the founder and CEO of the health technology firm Theranos, Inc. 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.

Fraud 70

Fraud FDA Medicaid Medicaid 70

Health Law RX

JULY 18, 2023

On June 27, 2023, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its long-anticipated final rule amending the OIG’s civil monetary penalty (CMP) regulations as they relate to information blocking (CMP Final Rule or Rule). The CMP Final Rule was published in the Federal Register on July 3, 2023.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

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

HIPAA 94

HIPAA Compliance Ransomware Hospitals 94

Healthcare IT Today

MARCH 26, 2023

News In a Microsoft press release announcing the availability of GPT-4 in Azure OpenAI Service, Epic’s Seth Hain, Senior Vice President of Research and Development, said the EHR vendor sees “tremendous potential” for the latest version of the multimodal large language model.

Doctors 81

Doctors Fraud Medicaid Medicaid 81

Hall Render

DECEMBER 22, 2023

fraud scheme UConn Health is in financial trouble. approval for obstetrics services in Prince George’s County Maryland health system gets state OK for $300M labor, delivery unit Maryland hospitals must pay back millions to poor patients. health care spending hits $4.5 First, they have to find them.

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