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

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

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

Fraud 52

Fraud COVID-19 Governance Medicaid 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

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

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?

Nursing Homes 52

Nursing Homes COVID-19 Fraud 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.

COVID-19 59

COVID-19 Fraud Governance Compliance 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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Fraud Compliance Officers Compliance Medicare 52

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.

Fraud 52

Fraud Governance Medicaid Medicaid 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

HIPAA Journal

OCTOBER 10, 2022

According to the breach notice, a presentation was emailed to the DHS Children’s Long-Term Support Council in April 2021 that contained protected health information. DHS said the breach affected 12,358 Wisconsin Medicaid members, who have now been notified and offered complimentary 12-month memberships to a credit monitoring service.

Medicaid 55

Medicaid Medicaid Governance Fraud 55

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.

Fraud 52

Fraud Governance Compliance Medicare 52

AIHC

NOVEMBER 29, 2023

Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar. Why this Trend of Value-Based Care?

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

NOVEMBER 29, 2023

Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar. Why this Trend of Value-Based Care?

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Med Law Blog

MAY 1, 2023

In the article entitled “The Death of Hahnemann Hospital” published in the New Yorker magazine in May 2021. In February of 2021, the National Bureau of Economic Research published a paper by Atul Gupta, Sabrina T. Similar issues were raised with respect to the private equity acquisition of Hahnemann Hospital. Surgery Partners, Inc.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

YouCompli

APRIL 13, 2022

But tactics common in other industries might be considered illegal beneficiary inducements in healthcare, especially for beneficiaries of federal programs like Medicare or Medicaid. The government contended the inducements were in the form of free blood glucose testing supplies and waiver of co-payments and deductibles for insulin.

Medicare 40

Medicare Medicare Governance Compliance 40

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. Of this $1.9

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare Law Blog

MAY 31, 2022

The healthcare system in the United States is governed by an expansive network of state and federal laws, including the aforementioned HIPAA regulations. For example, services that are billed to Medicaid or Medicare must comply with regulations that may not apply to services that are paid for in cash. 1, 2021). [2]

FDA 90

FDA HIPAA Medicare Medicare 90

Verisys

MARCH 24, 2022

Healthcare facilities receive billions of dollars in federal and state funding through the Affordable Care Act (ACA), Medicare, Medicaid, CHIP, and other programs. In 2021, OFAC shared publicly 20 enforcement actions, spanning 13 different sanctions totaling $20.8 Risks for Organizations Who Don’t Check the OFAC Sanctions List.

ACA 52

ACA Compliance Governance Medicaid 52

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. d)(6)), which are effective July 1, 2021.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

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]

COVID-19 52

COVID-19 Fraud COVID-19 Vaccine Medicaid 52

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. The higher the ratings, the larger the bonus payments health plans receive from the government. New CMS star ratings criteria 2021. Centers for Medicare & Medicaid.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Provider Trust

FEBRUARY 3, 2023

The National Council for the State Boards of Nursing has indicated that in 2021, there were 4.4 Another 100,000 nurses left the industry between 2020 and 2021, according to an industry trade-journal estimate , either to retire early, leave the field, or switch jobs. Do you have any risk based on poor standards of practice?

Compliance 52

Compliance Fraud Nurses Telemedicine 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.

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Overpayments Overpayment COVID-19 Medicare 91

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

Hall Render

MAY 13, 2022

Prism pays $650K to settle Medi-Cal fraud claims filed in San Diego. UChicago Medicine invests $607 million in community benefits for South Side and Southland regions in fiscal 2021. Troubled NC nursing home set to lose nearly all its government funding — and patients. Covid-19 continues climbing in state. CALIFORNIA.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

APRIL 6, 2022

In 2021, the Seventh Circuit Court, in United States ex. 2021); 551 U.S. Turning to the present case, in Safeway , the relator alleged that the defendant engaged in the submission of false claims to the government when it “reported its ‘retail’ price for certain drugs as its ‘usual and customary’ price.” Background.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

Fraud 52

Fraud Overpayments Overpayment Governance 52

Med-Net Compliance

NOVEMBER 1, 2022

South Carolina Attorney General Alan Wilson announced that his office’s Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old woman for allegedly practicing medicine as a registered nurse without a license at seven nursing and assisted living facilities in Anderson, Greenville, and Pickens counties.

Nursing Homes 59

Nursing Homes Licensing Nurses Fraud 59

Healthcare IT News - Telehealth

SEPTEMBER 28, 2022

Accountable Care Compliance & Legal Government & Policy Telehealth Workforce Healthcare organizations must urge the Senate to pass critical telehealth legislation, and enact at least a two-year extension of the important PHE-era policies while working toward a permanent solution. 4040), with a strong bipartisan vote of 416-12.

COVID-19 124

COVID-19 Public Health US Department of Health and Human Services Medicare 124

Healthcare IT News - Telehealth

SEPTEMBER 27, 2022

Accountable Care Compliance & Legal Government & Policy Telehealth Workforce Healthcare organizations must urge the Senate to pass critical telehealth legislation, and enact at least a two-year extension of the important PHE-era policies while working toward a permanent solution. 4040), with a strong bipartisan vote of 416-12.

COVID-19 112

COVID-19 Public Health US Department of Health and Human Services Medicare 112

Hall Render

MARCH 31, 2023

County-owned buildings facing potential earthquake risk Gilead drops option to buy cancer therapeutics company Health and Life Organization Inc. buys industrial property in Rancho Cordova for $5.12

US Department of Health and Human Services 40

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

Hall Render

FEBRUARY 25, 2022

CMS overhauls Direct Contracting model to include new requirements on governance, health equity in 2023. Why some Medicaid providers in Colorado aren’t getting paid. Missouri Takes Months to Process Medicaid Applications — Longer Than Law Allows. Cerner’s 2021: Revenue up 4%, net earnings down 29%.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

OCTOBER 27, 2023

Million Health Care Fraud Conspiracy in Idaho Orthopedic activity in the 5 most underserved states St. Million Health Care Fraud Conspiracy in Idaho Orthopedic activity in the 5 most underserved states St. Here’s why Grady Health System recognized as health care I.T. Here’s why Grady Health System recognized as health care I.T.

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

Hall Render

AUGUST 19, 2022

Stockton Doctor and Medical Practice Agree to Pay Nearly $2 Million to Resolve Allegations of Health Care Fraud. PruittHealth CEO: Nursing Home Operators Can’t Break Into Small Markets Without Government Support. ‘The unwinding’: Idaho Medicaid must recheck eligibility for 131K people when U.S. emergency ends.

COVID-19 40

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

Hall Render

MARCH 25, 2022

Health data breaches swell in 2021 amid hacking surge, POLITICO analysis finds. Alabama lawmaker’s push to extend postpartum Medicaid coverage. $12 Florida Medicaid hits Sunshine Health with $9M sanction for not paying providers’ claims. increase for 2023 Medicaid budget. State overcounts vaccinations by 600,000 people.

COVID-19 40

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

Hall Render

APRIL 26, 2024

New California rule aims to limit health care cost increases to 3% annually UC San Diego Health operations deal with California hospital slows to crawl Kaiser reports data breach affecting 13.4M in 256-Slice CT scanner Lifepoint reports $200M+ economic impact in Cen Ky St.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40