HIT Consultant

DECEMBER 10, 2021

What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Report Background.

Fraud 98

Fraud COVID-19 Nurses Licensing 98

HIPAA Journal

MARCH 16, 2022

This is the first settlement to be reached under the DOJ Civil Cyber Fraud Initiative, which was launched in 2021. The post DOJ Settles Civil Cyber Fraud Initiative Case with CHS and Imposes a $930,000 Penalty appeared first on HIPAA Journal.

Fraud 95

Fraud Electronic Medical Records Governance HIPAA 95

Healthcare IT Today

SEPTEMBER 21, 2022

New types of fraud are continually emerging, and it’s also become harder to uncover with traditional approaches. The telehealth market is growing at a significant rate, and fraud is continuing to grow with it. between the beginning of 2019 and the end of 2020. Is Telehealth Fraud Getting Harder to Identify?

Fraud 69

Fraud COVID-19 Medicare Medicare 69

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors?

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Fraud US Department of Health and Human Services Medicaid Medicaid 52

Healthcare Compliance Blog

FEBRUARY 2, 2022

The optician fraudulently received approximately $74,000 in Medicaid payments between 2016 and 2019 by billing for the optician services that were not provided. The post New York Optician Convicted of Medicaid Fraud for Nursing Home Residents appeared first on.

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Nursing Homes Fraud Medicaid Medicaid 59

The Health Law Firm

OCTOBER 31, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019.

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Fraud Medicare Medicare Doctors 40

The Health Law Firm

OCTOBER 3, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019.

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Fraud Doctors Medicare Medicare 40

Provider Trust

MARCH 13, 2023

So, let’s say they were revoked in 2019; then they would issue the certificate and the diploma as if the student had attended between 2016 and 2017.” Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail.

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Fraud US Department of Health and Human Services Licensing Compliance Officers 52

The Health Law Firm

FEBRUARY 3, 2021

In December 2019, she pled guilty to wire fraud, healthcare fraud, identity theft, and practicing nursing without a license. Indest III, J.D., How a Fake Nurse Gained Employment for Six Years.

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Fraud Nurses Licensing 40

HIPAA Journal

SEPTEMBER 30, 2022

and Magellan RX Management, LLC on behalf of patients whose protected health information was exposed in a May 2019 phishing attack. The phishing attack occurred in May 2019, was not detected until July 2019, and notification letters were not sent to affected individuals until November 2019, 6 months after the attack.

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Fraud HIPAA Health Insurance 91

HIPAA Journal

MARCH 7, 2023

DoppelPaymer ransomware first appeared in 2019. Peak activity occurred in late 2019 and early 2020, then attack volume reduced to just a few attacks a month. The FBI said attacks in the United States resulted in ransom payments of at least $42 million between May 2019 and March 2021.

Ransomware 79

Ransomware Fraud HIPAA Hospitals 79

The Health Law Firm

NOVEMBER 25, 2019

Board Certified by The Florida Bar in Health Law On November 22, 2019, the United States Attorney for the Southern District of New York Announced the indictment and arrest of an ophthalmologist for healthcare fraud. By George F. Indest III, J.D.,

Fraud 40

Fraud Doctors Medicare Medicare 40

Healthcare IT News - Telehealth

MAY 13, 2022

The owners of a national telehealth company pleaded guilty this week to charges of conspiracy to violate the federal Anti-Kickback Statute and to commit healthcare fraud. Law enforcement agencies have ramped up the pressure on telehealth fraud, particularly amid the COVID-19 pandemic. According to a statement released by the U.S.

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Doctors Fraud COVID-19 Medicare 152

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. The DOJ’s Civil Division updated its guidelines in 2019.

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Compliance Due Diligence Fraud Governance 52

McBrayer Law Blog

SEPTEMBER 28, 2021

Posted In COVID-19 , Health Care Fraud , Healthcare Regulation , Telehealth The shift to telemedicine in the United States predates the pandemic, but COVID-19 has accelerated its widespread use.

Telemedicine 64

Telemedicine Compliance COVID-19 Fraud 64

HIPAA Journal

JUNE 9, 2023

In 2019, David Dubin was sentenced to one year in jail for submitting inflated bills and 2 years for aggravated identity theft, with the sentences to run consecutively. Under the letter of the law, small-scale fraud and large-scale fraud carry the same sentence for aggravated identity theft.

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Fraud Medicaid Medicaid Doctors 95

HIPAA Journal

JUNE 28, 2023

Individuals that have suffered identity theft, medical fraud, tax fraud, other forms of fraud, and other actual misuses of their personal information, can submit claims for documented, unreimbursed extraordinary losses that are reasonably traceable to the data breach of up to a maximum of $5,000.

Hospitals 76

Hospitals Fraud Licensing HIPAA 76

HIPAA Journal

MAY 27, 2022

In late 2019, security researchers identified the exposed data and notified the affected companies, which included Northeast Radiology and its vendor, Alliance HealthCare Services. The plaintiffs alleged that they face an ongoing and imminent risk of identity theft and fraud, as there is no way to cancel protected health information.

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Fraud HIPAA 79

Healthcare IT News - Telehealth

DECEMBER 20, 2019

With an eye on reducing waste and tackling fraud, the VA is also changing the way it buys medicine and equipment by tapping into the Defense Department’s centralized acquisition system.

Department of Veterans Affairs 61

Department of Veterans Affairs Fraud 61

HIPAA Journal

AUGUST 31, 2022

The leader of Evil Corp, Maksim Yakubets, was indicted by a Federal grand jury in 2019 and was charged with conspiracy, computer hacking, wire fraud, and bank fraud related to the distribution of Bugat malware, the predecessor of Dridex. Evil Corp has been the subject of multiple law enforcement operations.

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Ransomware Fraud Governance Public Health 117

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Situation One: Before the Pandemic   In April 2019, government officials announced Operation Brace Yourself: a fraud takedown related to telemedicine and durable medical equipment (DME).

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Fraud Medicare Medicare COVID-19 52

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

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Fraud Medicaid Medicaid Medicare 52

Med-Net Compliance

SEPTEMBER 23, 2022

From February 2019 to April 2021, certain individuals and entities — including marketing, physician recruiting, and telemedicine companies — developed a scheme that targeted the Medicare and Medicaid programs to obtain millions of dollars in reimbursements from those programs. million, and Medicare actually paid those companies almost $3.1

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Fraud Medicaid Medicaid Telemedicine 59

Healthcare IT Today

MAY 6, 2023

Read more… Preventing Genetic Testing Fraud: 5 Actions for Health Plans. Medicare payments for genetic testing quadrupled from 2016 to 2019, which has unfortunately led to a rise in a rise in fraud, waste, and abuse. On the heels of ViVE and HIMSS, they also discuss whether in-person conferences are back.

Fraud 88

Fraud Doctors Medicare Medicare 88

Med-Net Compliance

SEPTEMBER 9, 2022

From January 13, 2013, through April 12, 2019, the ophthalmologist routinely administered vascular endothelial growth factor inhibitor injections into the eyes of patients to treat purported wet age-related macular degeneration (Wet-AMD) or other ophthalmological conditions for which treatment with such injections is indicated.

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Medicare Medicare Medicaid Medicaid 59

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 82

The Health Law Firm

NOVEMBER 3, 2021

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. She was indicted in January 2019, along with the dentist who ran the practice. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid Fraud 40

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Operation Brace Yourself was one of the largest healthcare fraud schemes investigated and prosecuted by enforcement agencies. The $73 million fraud scheme was discovered and busted. 

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Fraud Compliance Medicare Medicare 52

Healthcare Law Today

DECEMBER 16, 2022

Sentencing in federal fraud cases is driven by loss amounts. In health care fraud cases, the government frequently asserts a high “intended loss” based on amounts billed to payers, even when amounts actually paid were far less. 2400 (2019) narrowing Auer deference applied to the Sentencing Commission’s commentary.

Fraud 52

Fraud Governance Medicaid Medicaid 52

Healthcare Compliance Blog

APRIL 12, 2022

On 18 different occasions from the first quarter of 2016 through the fourth quarter of 2019, she withheld payroll taxes from her employees’ paychecks. Violations of payroll management can be considered fraud and can result in fines and imprisonment. The withheld taxes totaled over $900,000.

Medical Billing 59

Medical Billing Fraud Governance Medicare 59

HIPAA Journal

FEBRUARY 1, 2023

To put that figure into perspective, in 2019, almost 100% of notices included attack details, and 72% of notices included both attack and victim details. In 2022, two-thirds of data breach notices lacked the necessary information to allow individuals and businesses affected by those data breaches to accurately assess potential risk.

Fraud 110

Fraud HIPAA Ransomware Compliance 110

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

HIT Consultant

DECEMBER 10, 2021

Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know. What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Report Background.

COVID-19 98

COVID-19 Fraud Nurses Licensing 98

Healthcare IT Today

AUGUST 29, 2023

“In a landscape inundated with payment accuracy solutions—primary, secondary, post-pay, fraud, waste, abuse, coordination of benefits, subrogation, among others—our customers have endless choices,” noted Carolyn Wukitch, Lyric’s COO.

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Fraud 77

HIPAA Journal

JANUARY 25, 2023

In addition to this breach, Logan Health had experienced others while operating as Kalispell Regional Medical Center, which had affected 2,081 state residents in 2021 and 126.805 individuals in 2019.

Medical Billing 82

Medical Billing Fraud HIPAA Health Insurance 82

HIPAA Journal

JANUARY 10, 2023

An external investigation into credit card fraud pointed to Captify Health as the source of a data breach. The forensic investigation revealed the initial breach of its website occurred on May 26, 2019, and lasted until April 20, 2021.

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HIPAA Doctors Fraud Compliance 97

Healthcare Compliance Blog

APRIL 13, 2022

The two men, both 51, were convicted of criminal healthcare fraud and conspiracy charges in 2019. The owner and administrator of Texas-based hospice and home health entities have been named in a multimillion-dollar whistleblower lawsuit. Providing and billing for unnecessary medical services can be considered a false claim.

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Fraud Medicare Medicare Compliance 59