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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Healthcare Law Blog

FEBRUARY 3, 2023

New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. For a second violation, OMIG may increase the penalty to $10,000 per month.

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Medicaid Medicaid Compliance Overpayments 52

Med-Net Compliance

OCTOBER 21, 2022

The Office of Inspector General (OIG) has recently posted the False Claims Act (FCA) settlements for FY 2022 Q1–Q4 on the risk spectrum. The government’s primary civil tool for addressing healthcare fraud is the FCA. Issue: Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate.

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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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Hall Render

FEBRUARY 27, 2023

billion in False Claims Act (“FCA”) related settlements and judgments in the federal fiscal year 2022. Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, as whistleblowers filed 652 qui tam suits in 2022 with recovery totaling $1.9 Health Care Fraud Actions Medicaid.

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Healthcare IT News - Telehealth

JUNE 8, 2022

based attorney in the health law practice of Baker, Donelson, Bearman, Caldwell & Berkowitz about what providers should be doing to ensure compliance when the PHE finally sunsets. State government executive orders. What do you see as the primary compliance issues providers will have to contend with? Cohen, a Washington, D.C.-based

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US Department of Health and Human Services Compliance Overpayments Overpayment 179

HIT Consultant

JANUARY 3, 2023

Department of Health and Human Services Office of Information Security noted in a 2022 report on health sector cybersecurity, that threat actors continue to evolve and become more sophisticated and effective in their attacks. The Challenges to Meeting Compliance Regulations. Compliance with regulations is nothing new for the industry.

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Health Law Checkup

JANUARY 27, 2022

Medicare Advantage plans and providers need to be aware of the recent increase in government enforcement of risk adjustment coding issues. See below for an overview of risk adjustment coding, recent enforcement examples, and five tips for providers to help ensure accurate coding.

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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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Health Care Law Brief

JUNE 2, 2022

For the reasons discussed below, DTC telehealth platforms should re-visit their compliance plans and be prepared for increased state and federal regulatory scrutiny. For example, the Department of Justice has aggressively pursued health care fraud claims against individuals and entities involved in non-compliant telehealth models.

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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. HHS estimated that over 15% of payments in FY 2022 were improper.

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Healthcare Compliance Blog

APRIL 27, 2022

The hearing is scheduled for May 2, 2022. Under the False Claims Act, the government is entitled to three times damages and civil penalties ranging from $5,500 and $11,000 for each identifiable claim submitted between Nov. Train all staff on your compliance and ethics policies and procedures upon hire and at least annually.

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Healthcare IT Today

APRIL 25, 2024

For a healthcare entity, the data and information are viewed as extremely valuable as it includes PII as well as other health information that can be used for insurance fraud and identity theft. Troy is a frequent speaker and highly published thought leader on IT compliance and cybersecurity topics.

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Ransomware Compliance Fraud Governance 99

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Priorities for Massachusetts’s Medicaid Fraud Division.

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AIHC

APRIL 5, 2022

Read Part 1 entitled “ Managing Denials Is Important to Good A/R Hygiene ” posted March 22, 2022, and Part 2 entitled “ Understanding How Payers Deny Claims. Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time.

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Healthcare Compliance Blog

APRIL 13, 2022

The two men, both 51, were convicted of criminal healthcare fraud and conspiracy charges in 2019. On April 7, 2022, a civil complaint was filed against the two men, which alleges that they conspired to violate the False Claims Act by submitting false and fraudulent claims to Medicare for medically unnecessary hospice and home health services.

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Hall Render

OCTOBER 18, 2022

Grifols USA, LLC , 2022 WL 7785044, at *1 (2nd Cir. The Second Circuit first considered and rejected Plaintiff’s two similar arguments that Defendants’ alleged cGMP failures were material: (1) That the government payors cannot purchase adulterated drugs and therefore the manufacture of Gamunex must comply with all cGMPs; and. (2)

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Healthcare Law Blog

DECEMBER 12, 2022

Now, almost three years later, governmental entities have focused their attention on telehealth services and the potential for fraud and abuse. On October 13, 2022 , Health and Human Services (“HHS”) Secretary Xavier Becerra renewed the COVID-19 PHE and the PHE is now set to expire on January 11, 2023. Notable Updates. Looking Forward.

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YouCompli

AUGUST 2, 2022

Healthcare compliance history has shown that when the government disperses significant funds, audits and enforcement associated with the disbursement of those funds will shortly follow. The Federal government spent unprecedented trillions of dollars throughout the COVID public health emergency (PHE). MorseLife agreed to pay $1.75

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Health Law Advisor

FEBRUARY 3, 2022

On February 1, 2022, the U.S. FY 2021 was also a record-shattering year for DOJ as it relates to health care fraud enforcement; over $5 billion (90% of the total) was obtained from cases pursued against individuals and entities in the health care and life sciences industries. With collections amounting to $5.6

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Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders.

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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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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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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

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.

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Hall Render

JUNE 1, 2022

Hall Render attorney Ritu Kaur Cooper has been elected to serve a one-year term on the American Health Law Association (“AHLA”) Board of Directors beginning July 1, 2022. “I Ritu is a shareholder in Hall Render’s health section and serves as a co-leader of the firm’s compliance service line.

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HIT Consultant

MAY 4, 2023

But with so many competing training programs — everything from HIPAA and regulatory compliance to handwashing and job-specific training — it’s difficult to break through the noise and gain traction. Some healthcare organizations are minimally training their staff for compliance, hoping it will be sufficient.

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Healthcare Law Today

DECEMBER 12, 2022

In this episode of Health Care Law Today, Nate Lacktman and Maureen Stewart are joined by Mark Josephs, Deputy General Counsel of LifeMD to discuss the current regulatory and legal environment for telemedicine companies regarding online subscription services, and the recent investigations by the federal government of these services.

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Telemedicine Fraud Governance Compliance 49

AIHC

NOVEMBER 29, 2023

A 2022 report from the Commonwealth Fund U.S. 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.

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Health Law RX

NOVEMBER 10, 2022

Sutter Health (third-party billing) : On October 17, 2022, the U.S. The United States alleged that, between August 1, 2016 and June 30, 2017, Sutter Health fraudulently billed and received reimbursement from government health programs for lab tests that Sutter Health did not itself perform.

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Governance Medicare Medicare Medicaid 52

AIHC

NOVEMBER 29, 2023

A 2022 report from the Commonwealth Fund U.S. 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.

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Medicare Medicare Medicaid Medicaid 52

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. This requirement can sometimes apply to specific types of professionals when located in law or regulations governing their profession.

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HIT Consultant

DECEMBER 12, 2022

Once focused intensely on preventing fraud, waste, and abuse and ensuring high-quality patient care, the compliance department is tasked with maintaining programs that meet the regulations and laws of numerous government bodies pertaining to various areas, especially electronic protected health information (ePHI).

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Health Care Law Brief

FEBRUARY 7, 2022

On January 11, 2022, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) issued, without an opportunity for public notice and comment, [1] a Final Rule, amending its internal process for accepting and issuing advisory opinions. 11, 2022). at § 1008.39. at 1368 (emphasis added).

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HIPAA Journal

SEPTEMBER 5, 2023

Among its objectives, the Act aims to address illegal and misleading online content, better protect Internet users from fraud, and provide more control over what personal data is collected and how it is used. The Digital Services Act is a new EU law that updates the existing EU Electronic Commerce Directive. My Body, My Data Act”).

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Healthcare IT Today

JANUARY 2, 2023

Healthcare is the number one type of data hackers set their sites on, and healthcare identity fraud is prevalent. Compliance with the new framework should be another evaluation factor for an organization’s third-party vendors. Chandra Kalle, VP of Security & Compliance at LeanTaaS. to version 2.0 during 2023.

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Healthcare Law Blog

MAY 31, 2022

However, traditional healthcare players, subject to the Health Insurance Portability and Accountability Act (“HIPAA”), may also find themselves innovating in this space (and grappling with how to stand up a HIPAA compliance program in the metaverse). 4] CDRH Proposed Guidances for Fiscal Year 2022 (FY2022) | FDA. [5] Healthcare Laws.

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