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

Health Care Law Brief

JUNE 5, 2023

We previously wrote about the United States Department of Justice’s (“ DOJ ”) Civil Cyber-Fraud Initiative (“ CCFI ”), which “aims to hold accountable entities or individuals that put U.S. Jelly Bean’s failure left the website and such PHI vulnerable from attack.

Fraud 52

Fraud Due Diligence Medicaid Medicaid 52

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

HIPAA Journal

MARCH 15, 2023

FHKC receives Medicaid funds and state funds for providing health insurance programs for children in Florida. The contract was renewed by FHKC through 2020, with the federal government covering 86% of the payments to Jelly Bean Communications Design.

Health Insurance 72

Health Insurance HIPAA Due Diligence Fraud 72

MedTrainer

FEBRUARY 12, 2024

Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. The Physician Self-Referral Law (STARK) , commonly referred to as the Stark law, prohibits physicians from referring patients to receive designated health services payable by Medicare or Medicaid.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

Nurses 52

Nurses Licensing Fraud Medicaid 52

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This is due to the large amounts of COVID-19 tests that were administered in 2020.

US Department of Health and Human Services 52

US Department of Health and Human Services Nursing Homes COVID-19 Medicare 52

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. New York Social Services Law § 363-d.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This is due to the large amounts of COVID-19 tests that were administered in 2020.

US Department of Health and Human Services 52

US Department of Health and Human Services COVID-19 Nursing Homes Medicare 52

HIPAA Journal

AUGUST 25, 2022

Humana & Cotiviti have agreed to settle a class action lawsuit to resolve claims from individuals affected by a 2020 data breach that exposed the PHI of 64,654 individuals. Humana had contracted with Cotiviti to assist with medical record requests to verify the data it reports to the HHS’ Centers for Medicare and Medicaid Services.

Fraud 52

Fraud Medicaid Medicaid HIPAA 52

Healthcare Compliance Blog

MARCH 2, 2022

An indictment was filed on February 25, 2022, against ten persons in Florida for their alleged roles in a $67 million healthcare fraud, wire fraud kickback, and money laundering scheme. Healthcare fraud and anti-kickback violations are each punishable by a maximum penalty of 10 years in prison.

Medicare 45

Medicare Medicare Fraud Compliance 45

Healthcare Compliance Blog

FEBRUARY 7, 2022

The court documents reveal that the Michigan woman admitted to previously owning a home health care agency in Indiana, which she had closed in early 2020. Issue: Misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds.

COVID-19 59

COVID-19 Fraud Governance Compliance 59

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. Health care fraud cases are a prime example. In United States v. Banks Decision.

Fraud 52

Fraud Governance Medicaid Medicaid 52

HIPAA Journal

MAY 25, 2022

The break-in was discovered on March 4, 2022, with the subsequent investigation confirming on April 22, 2022, that six boxes of paper documents had been stolen from the facility, which included files relating to patients served by SAC Health in 1997 and between 2006 and 2020. Notification letters were sent to those individuals on May 3, 2022.

Ransomware 123

Ransomware Fraud HIPAA Licensing 123

Healthcare Compliance Blog

JUNE 9, 2022

In March of 2022, in a related matter, the man pleaded guilty to Healthcare Fraud, Money Laundering, and Theft of Public Money for defrauding Medicare, Medicaid, and the US Department of Health and Human Services between 2016 and 2020. He is awaiting sentencing on those charges.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

Hall Render

FEBRUARY 4, 2022

billion from False Claims Act (“FCA”) cases in the federal fiscal year 2021, “the second largest annual total in False Claims Act history” and more than doubling the FCA recoveries for the DOJ from fiscal year 2020. That figure does not include even more funds recovered for state Medicaid programs.

Fraud 40

Fraud Governance Medicare Medicare 40

The Health Law Firm Blog

MARCH 26, 2024

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. Indest III, J.D., It provides information and statistics on actions involving licensed health professionals through March 2021.

Licensing 52

Licensing Nurses Fraud Medicaid 52

The Health Law Firm Blog

MARCH 11, 2024

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. Indest III, J.D., It provides information and statistics on actions involving licensed health professionals through March 2021.

Licensing 52

Licensing Nurses Fraud Medicaid 52

Kaiser Health News

NOVEMBER 11, 2021

In response, the Centers for Medicare & Medicaid Services has threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers. She told the woman she had reported the calls to CMS, the AARP Fraud Watch Network Helpline and the FTC.

Medicare 141

Medicare Medicare Doctors Fraud 141

Healthcare IT Today

DECEMBER 11, 2020

As 2020 comes to a close, healthcare industry leaders are looking ahead to 2021 with excitement and anticipation. The following is a guest article by Mike Noshay, MSE, Founder and Chief Strategy & Marketing Officer at Verinovum.

COVID-19 Vaccine 145

COVID-19 Vaccine COVID-19 Fraud Medicaid 145

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

Healthcare Law Blog

MAY 31, 2022

As the metaverse market continues to grow, with some estimates potentially approaching $800 billion in 2024 (or a $300 billion increase from 2020 estimates), technology leaders in various industries, including healthcare, have begun to expand their presence in this new platform. [1] Code § 321(h). [4]

FDA 90

FDA HIPAA Medicare Medicare 90

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Pass-through Payments. Network Adequacy Standards.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Compliancy Group

AUGUST 23, 2023

In a shocking turn of events, a dental office manager from Worcester has been sentenced for participating in a scheme to defraud the Massachusetts Medicaid program, MassHealth. Prosecutors Evan Panich and Chris Looney from the Health Care Fraud Unit, alongside Special Assistant U.S. Senior District Court Judge Timothy S.

Fraud 52

Fraud Medicaid Medicaid Governance 52

Med-Net Compliance

SEPTEMBER 6, 2022

Following an investigation, the Vermont Attorney General’s Medicaid Fraud and Residential Abuse Unit (MFRAU) announced a settlement with an assisted living facility company. Additionally, if the company fails to meet certain standards at any point in the next three years, it will be required to pay $40,000 in damages and penalties.

Compliance 59

Compliance Nurses Fraud Licensing 59

AIHC

SEPTEMBER 5, 2023

Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. Telehealth has been used to bring healthcare services to consumers in distant locations, but became a necessity since the 2020 COVID-19 pandemic.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Hall Render

APRIL 19, 2024

to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

The Health Law Firm Blog

DECEMBER 31, 2022

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. Indest III, J.D., It provides information and statistics on actions involving licensed health professionals through March 2021.

Licensing 52

Licensing Nurses Fraud Medicaid 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.

HIPAA 96

HIPAA Compliance Medicare Medicare 96

The Health Law Firm Blog

DECEMBER 16, 2022

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. Indest III, J.D., It provides information and statistics on actions involving licensed health professionals through March 2021.

Licensing 52

Licensing Nurses Fraud Medicaid 52

Florida Health Care Law Firm

FEBRUARY 22, 2022

He has also had assets forfeited since these assets were acquired with money from his ill-gotten fraud scheme. Even more shocking, although Truglia and his group were swept up in “Operation Brace Yourself” in April 2019, they started a new scheme of greed that ran from April 2019 until July 2020. genetic testing).

Medicare 52

Medicare Medicare Telemedicine Fraud 52

Kaiser Health News

NOVEMBER 11, 2021

En respuesta, los Centros de Servicios de Medicare y Medicaid (CMS) han amenazado con penalizar a las compañías de seguros privadas que venden planes de medicamentos y Medicare Advantage (MA), si ellas o los agentes que trabajan en su nombre engañan a los consumidores.

Medicare 59

Medicare Medicare Fraud ADA 59

Hall Render

DECEMBER 6, 2022

As part of the final regulations released by the Centers for Medicare & Medicaid Services (“CMS”) effective January 19, 2021, CMS finalized a new exception for arrangements where an entity pays a physician less than $5,000 over the course of a calendar year in exchange for items or services. New Exception for Limited Remuneration.

COVID-19 40

COVID-19 Hospitals Overpayments Overpayment 40

Health Law Advisor

APRIL 13, 2023

These FAQs address subjects including “ General Questions Regarding Certain Fraud and Abuse Authorities ,” the “ Application of Certain Fraud and Abuse Authorities to Certain Types of Arrangements ,” and “ Compliance Considerations.” The vast majority of the principles articulated in the updated FAQs will undoubtedly be familiar to many.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

Healthcare IT Today

FEBRUARY 17, 2023

government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. They expect to recoup 4.7

Overpayments 106

Overpayments Overpayment COVID-19 Medicare 106

Florida Health Care Law Firm

DECEMBER 2, 2021

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The OIG recognized that there are benefits to disclose potential fraud.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40

Healthcare IT News - Telehealth

SEPTEMBER 28, 2022

In January 2020, then-Secretary of the U.S. Between March 2020 and February 2021, over 28 million Medicare beneficiaries, or more than 40%, used telehealth services. of Medicare providers engaged in telehealth billing practices that pose a high risk to Medicare that may indicate fraud, waste, or abuse.

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COVID-19 Public Health US Department of Health and Human Services Medicare 135