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

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. Telehealth Spend.

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Fraud COVID-19 Nurses Licensing 98

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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Fraud Medicare Medicare Overpayments 62

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

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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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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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

APRIL 18, 2022

Fraud in these cases is generally easy to prove. Simply verifying inventory, orders and dispensing records yields incredible data that when combined with comparative data from peer pharmacies can be used by law enforcement to establish that fraud has been committed. Latest Enforcement Activity. On April 13, 2022, the U.S.

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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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The Health Law Firm

AUGUST 20, 2021

is Board Certified by The Florida Bar in Health Law On August 6, 2021, federal prosecutors pushed back on claims that government agents tricked a Harvard University professor into making incriminating statements during his interrogation by federal agents. Indest III, J.D.,

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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

Healthcare IT News - Telehealth

JANUARY 30, 2023

FINDINGS Based on the state audit , the department fell short in governance, risk management, and evaluation of the telehealth expansion. It also did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, before implementing the temporary and permanent MBS telehealth items.

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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. billion was recovered in qui tam cases in which the government declined to intervene. Last year, $1.2

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Fraud COVID-19 Governance Medicaid 52

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

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Fraud Health Insurance Ransomware HIPAA 103

HIPAA Journal

OCTOBER 6, 2022

Sebastien Vachon-Desjardins, 34, from Quebec, a former IT consultant who worked for the Public Works and Government Services in Canada, was arrested in Canada in January 2021 on suspicious of conducting ransomware attacks as part of a law enforcement crackdown on the Netwalker ransomware gang. A ransom of $1.14

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Ransomware Fraud COVID-19 HIPAA 107

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

Healthcare Compliance Blog

FEBRUARY 7, 2022

A Michigan woman has pled guilty to stealing government funds that were designated to aid medical providers in the treatment of patients suffering from COVID-19 and acknowledged using the money for her own personal use. Issue: Misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds.

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COVID-19 Fraud Governance Compliance 59

Med-Net Compliance

JULY 13, 2022

Two California brothers were both sentenced to 36 months of probation and ordered to pay $500 dollars in restitution after pleading guilty to misdemeanor conspiracy to steal or convert government property charges stemming from the theft of Centers for Disease Control (CDC) COVID-19 Vaccination Record Cards.

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

Healthcare Law Blog

APRIL 3, 2023

While government enforcement has traditionally been an indirect concern for private equity (“PE”) investors, such as looking at whether a target entity has been sanctioned or could be sanctioned in the future, the current trend in government enforcement has been to target PE firms directly. On March 25, 2021, the U.S.

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Due Diligence Governance Fraud Compliance 52

The Health Law Firm

MARCH 10, 2021

Board Certified by The Florida Bar in Health Law On February 3, 2021, a former University of Florida professor was indicted on allegations of fraudulently obtaining a federal grant from the US by concealing his ties with the Chinese government. Indest III, J.D., He is accused of fraudulently obtaining $1.75

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Fraud Governance 40

HIPAA Journal

MARCH 15, 2023

The contract was renewed by FHKC through 2020, with the federal government covering 86% of the payments to Jelly Bean Communications Design. Attorney’s Office for the Middle District of Florida, with assistance provided by HHS-OIG.

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Health Insurance HIPAA Due Diligence Fraud 77

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

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Fraud Health Insurance Ransomware HIPAA 72

Health Law RX

JUNE 17, 2022

The FCA imposes civil liability on any person requesting government funds or property who “knowingly presents. A pleading, “alleging fraud or mistake. must state with particularity the circumstances constituting fraud or mistake.” government. 2021) (noting a case does not have to be proven in the complaint).

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Health Law Attorney

NOVEMBER 12, 2021

On November 8, 2021, the Office of Inspector General (“ OIG ”) issued multiple updates to the Health Care Fraud Self-Disclosure Protocol (“ SDP ”), incorporating legal changes made since the previous SDP revision in 2013. The OIG’s updated SDP may be accessed here. Below is an overview of the updates.

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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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Healthcare Law Today

DECEMBER 16, 2022

Sentencing in federal fraud cases is driven by loss amounts. To seek a higher sentencing guidelines range, the government often relies on a defendant’s “intended” loss,” rather than the “actual” loss. Health care fraud cases are a prime example. In United States v. Banks Decision.

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Health Law RX

JUNE 27, 2023

the Court held that, despite declining to intervene at the outset of a case, the Government retains the authority to intervene later, including for the purposes of seeking dismissal pursuant to and consistent with Federal Rule 41(a) ( U.S. Circuit found the Government’s dismissal authority to be “unfettered” ( Swift v. SuperValu Inc.,

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Governance Fraud Compliance 52

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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AIHC

MAY 17, 2023

This article addresses various forms of fraud and how criminals’ prey on compromised citizens. There are many factors which can influence our health, and in turn, there are just as many schemes which are actually considered health care fraud. SNAP Fraud Food assistance is generally referred to as SNAP or food stamps.

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Health Outcomes Fraud Compliance Governance 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.

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COVID-19 Fraud Nurses Licensing 98

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

McGuire Wood

OCTOBER 2, 2023

times the amount the government believed was due to improper billing, after a voluntary disclosure to the Department of Justice (DOJ). If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure.

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Fraud Governance Compliance Medicare 52

Verisys

FEBRUARY 24, 2023

Intentionally causing patient harm is less of a motivation than fraud that results in personal gain, but patients are often the collateral damage of fraud schemes. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse. What Are the Risks of Data Fragmentation?

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Fraud Doctors Governance Licensing 52

Verisys

FEBRUARY 24, 2023

Intentionally causing patient harm is less of a motivation than fraud that results in personal gain, but patients are often the collateral damage of fraud schemes. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse. What Are the Risks of Data Fragmentation?

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Fraud Doctors Governance Licensing 52

HIPAA Journal

NOVEMBER 21, 2022

According to the FBI, more than $43 billion was lost to these scams between June 2016 and December 2021, and in 2021 alone, the FBI Internet Crime Complaint Center received reports of losses of $2,395,953,296 to BEC scams. million in losses were caused to federal government agencies, private companies, and individuals.

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Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

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Nursing Homes COVID-19 Fraud Medicaid 52

Healthcare IT Today

NOVEMBER 4, 2022

EHR vendor Modernizing Medicine has agreed to pay $45 million to the federal government to settle a whistleblower suit alleging that the vendor engaged in varied kickback schemes as well as causing its provider customers to submit false claims. For example, in 2021 CareCloud Health agreed to pay $3.8

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Governance Fraud 62