Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. Over $5 billion of the total amount recovered in 2021 was related to the healthcare industry. government or a government contractor.

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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 By the Numbers: Major Healthcare Data Breaches Increase in 2021. million records in 2021.

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Med-Net Compliance

JUNE 22, 2022

A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Her theft of the cards began at least as early as May 2021 and continued through September 2021. Participating in the fraud can result in the person(s) being prosecuted.

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COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. During the fiscal year 2021, the report states that the federal government won or negotiated over $5 billion in healthcare fraud judgments and settlements. Monetary Penalties.

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Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

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Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.

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Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

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Med-Net Compliance

JUNE 15, 2022

In October 2021, the California Department of Justice’s?Division Division of Medi-Cal Fraud and Elder Abuse (DMFEA) and the US Attorney’s Office for the Eastern District of California intervened in the? The post California Doctor to Pay over $9.48M, Sentenced to Prison, to Settle Fraud Allegations appeared first on Med-Net.

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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.

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Verisys

JUNE 8, 2023

Data Compliance: How to Identify and Close Data Risk Gaps Using Technology A three-part compliance series that focuses on using technology to help you achieve your compliance goals. Hiring a provider with red flags, even if in the past, can put your organization at risk for non-compliance. Fraud Data Gap The U.S.

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Provider Trust

FEBRUARY 3, 2023

Hosted by Co-Founder of ProviderTrust Michael Rosen and Chief Compliance Officer Donna Thiel, our webinar outlined various factors affecting the healthcare space in the new year, from staffing strikes to increased scrutiny around private equity investment firms. What does this mean for compliance and oversight or management of these risks?

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Med-Net Compliance

AUGUST 16, 2022

Five individuals and two for-profit skilled nursing facilities (SNFs) in Pennsylvania were indicted on charges of conspiracy to defraud the United States and related healthcare fraud charges. The post Five Individuals and Two Nursing Facilities Indicted on Healthcare Fraud Charges appeared first on Med-Net.

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Health Law Advisor

FEBRUARY 3, 2022

Department of Justice (DOJ) released its annual False Claims Act (FCA) enforcement statistics for fiscal year (FY) 2021. [1]. billion, FY 2021 marks DOJ’s largest annual total FCA recovery since FY 2014, and more than twice the $2.3 Marking another record, DOJ’s health care recoveries in FY 2021 in non- qui tam actions ($3.6

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Fraud COVID-19 Governance Medicare 52

AIHC

MAY 24, 2022

Once your suspicions have been reported to the Compliance Officer, were you asked to partake in evidence gathering during the investigation? I also recommend reading When Healthcare White-Collar Crimes Turn Red , an AIHC blog article from 2021. Have you ever uncovered erroneous or potentially fraudulent evidence?

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Provider Trust

MARCH 13, 2023

Between 2016 and 2021, over 7,600 fake diplomas were sold to nursing students who used the fraudulent degrees to qualify for the National Council Licensure Exam (NCLEX). 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

Health Law Advisor

MAY 3, 2022

On April 20, 2022, the Department of Justice (DOJ) announced a nationwide coordinated enforcement action targeting COVID-19-related fraud involving charges against 21 individuals across nine federal districts, and over $149 million in alleged false claims submitted to federal programs. [1]. 2] See id. [3] 2] See id. [3]

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Provider Trust

SEPTEMBER 29, 2022

On July 20th, 2021, the Texas Medical Board allegedly ordered an immediate suspension of his license after an investigation revealed that Mendez had violated ethical boundaries by initiating a sexual relationship with a patient. Mendez faces seven counts of healthcare fraud and up to 10 years in federal prison.

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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.

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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. Whistleblowers themselves received $237 million in 2021. Health Care Fraud Actions.

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Fraud Governance Medicare Medicare 40

Florida Health Care Law Firm

DECEMBER 7, 2021

Telemedicine pharmacy arrangements continue to be of significant interest to fraud enforcement. The federal jury trial in the billion-dollar telehealth pharmacy fraud scheme resulted in conviction on 22 counts of mail fraud, conspiracy to commit health care fraud and introduction of misbranded drugs into interstate commerce.

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Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The post CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance appeared first on Inovaare.

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Health Care Law Brief

JULY 21, 2022

On July 20, 2022, the Office of Inspector General for the Department of Health and Human Services (“ OIG ”) issued a special fraud alert (“ Alert ”) advising “practitioners to exercise caution when entering into arrangements with purported telemedicine companies.” OIG Flags Seven Characteristics of Telehealth Fraud.

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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

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. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

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Fraud Health Insurance Compliance Medicaid 52

YouCompli

JANUARY 4, 2022

Ross addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance Forum in December 2021. . They provide great insight for Compliance practitioners. YouCompli sponsored MHA’s 2021 Healthcare Legal Compliance Forum in 2021. Her detailed slides are available from PYA here.

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Hall Render

SEPTEMBER 15, 2022

This study comes on the heels of a recent Press Release issued July 20, 2022 (“Press Release”), in which the Department of Justice (“DOJ”) announced criminal charges against 36 defendants in 13 federal districts across the United States largely alleging fraud in the telemedicine space. Inspector General Christi A.

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Telemedicine Fraud Medicare Medicare 40

HIPAA Journal

MAY 2, 2024

BioPlus Specialty Pharmacy Services has proposed a settlement to resolve a class action lawsuit that was filed in response to a 2021 data breach that exposed the data of up to 350,000 patients.

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HIPAA Journal

APRIL 8, 2024

Planned Parenthood Los Angeles, a provider of reproductive healthcare services in Los Angeles County, has proposed a $6 million settlement to resolve all claims related to a 2021 data breach that exposed the personal information of more than 409,437 patients.

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Ransomware HIPAA Health Insurance Fraud 77

Healthcare Compliance Blog

FEBRUARY 7, 2022

According to the Department of Justice, in May 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to “marshal the resources of the department in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud.

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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.

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Med-Net Compliance

JULY 13, 2022

In the plea agreement, both defendants admitted that between March 2021 and August 2021, they conspired to defraud the Centers for Disease Control by agreeing to sell stolen CDC COVID-19 Vaccination Record Cards to others for $50 each. Participating in the fraud can result in the person(s) being prosecuted.?.

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COVID-19 Vaccine US Department of Health and Human Services COVID-19 Fraud 59

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

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Innovaare Compliance

FEBRUARY 9, 2021

New CMS star ratings criteria 2021. With the CMS release of the Final Rule for Contract Year 2021 on May 22, 2020, Medicare Advantage (MA) plans now have some near-term clarity regarding the many star-rating proposals made earlier this year. Read More – Medicare Star Ratings Changes 2021 . Industry trends.

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Compliancy Group

MARCH 30, 2023

According to the report, there were 847,376 complaints of suspected internet crime in 2021, representing a 7% increase compared to the previous year. In 2022 there were a total of 800,944 complaints, which shows a 5% decrease from 2021, but the potential total loss has increased from $6.9 billion to more than $10.2

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Ransomware Fraud HIPAA Compliance 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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Health Law Advisor

FEBRUARY 10, 2023

billion recovered in FY 2021, marking the lowest annual reported recovery in 14 years. The total recoveries in fraud cases brought with respect to the health care and life sciences industries fell to the lowest level since 2009. 1] While total recoveries exceeded $2.2 billion, this is a drop of more than 50 percent from the $5.7

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HIPAA Journal

OCTOBER 6, 2022

Mon Health is facing a class action lawsuit over a hacking incident that allowed unauthorized individuals to gain access to its network for an 11-day period in December 2021. Mon Health said it detected the breach on December 30, 2021, with the forensic investigation determining hackers accessed its network between December 9 and December 19.

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