Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. As part of the settlement, the doctor will pay a total of more than $9.48

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Fraud Doctors Elder Abuse Medicare 59

Healthcare Compliance Blog

APRIL 29, 2022

On April 25, 2022, a former owner of multiple Texas adult day care centers was sentenced to 60 months in prison and ordered to pay $1,784,817.96 in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. Provide periodic retraining to members of the compliance and ethics committee as well.

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Fraud Compliance Governance Medicaid 59

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

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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Fraud Compliance Medicare Medicare 59

Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

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Fraud Nurses Medicare Medicare 98

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. What do you see as the primary compliance issues providers will have to contend with? We spoke recently with Allison M. Cohen, a Washington, D.C.-based

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US Department of Health and Human Services Compliance Overpayments Overpayment 179

Health Law Advisor

FEBRUARY 10, 2023

Department of Justice (DOJ) released its annual False Claims Act (FCA) enforcement statistics for fiscal year (FY) 2022, which ended on September 30, 2022. [1] The total recoveries in fraud cases brought with respect to the health care and life sciences industries fell to the lowest level since 2009. Last year, $1.2

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Fraud COVID-19 Governance Medicaid 52

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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Fraud Medicaid Medicaid Medicare 52

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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Nursing Homes Fraud Medicaid Medicaid 40

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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Fraud Compliance Medicare Medicare 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 includes recommending compliance programs or trainings for staff. Get Certified.

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US Department of Health and Human Services Nursing Homes COVID-19 Medicare 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 includes recommending compliance programs or trainings for staff. Get Certified.

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

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. 79452 (2022)). 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. 405.902). .

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Medicare Medicare Overpayments Overpayment 52

YouCompli

MAY 11, 2022

It reflects remarks CJ made at HCCA’s 2022 Compliance Institute. For more insights from the Compliance Institute, download our white paper on how compliance professionals can help healthcare institutions mitigate risk.). The doctor will be sentenced in July for multiple counts of healthcare fraud.

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Compliance Officers Fraud Compliance Medicare 52

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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Nursing Homes COVID-19 Fraud Medicaid 52

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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Fraud Medicare Medicare Compliance 59

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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Public Health Compliance COVID-19 Licensing 52

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. 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.

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Fraud Compliance Medicare Medicare 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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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

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. Consequently, when data breaches occurred due to a lack of compliance by Business Associates, there was no accountability.

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HIPAA Compliance Medicare Medicare 95

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. Increased DOJ Activity.

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COVID-19 Fraud Telemedicine Public Health 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”).

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Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

OCTOBER 6, 2022

Mon Health announced the security breach on February 28, 2022, and confirmed that the hackers had access to the personal and protected health information of 492,861 individuals , including information about patients, employees, providers, and contractors.

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HIPAA Fraud Hospitals Health Insurance 89

Florida Health Care Law Firm

DECEMBER 9, 2021

On January 1, 2022, a new federal law, “ Requirements Related to Surprise Billing, Part I ” (“The Rule”), goes into effect for health care providers and facilities and for providers of air ambulance services. The post No Surprise Billing Requirements to be Implemented Jan 1, 2022 first appeared on Florida Healthcare Law Firm.

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Medical Billing Medicare Medicare Compliance 40

HIT Consultant

OCTOBER 18, 2023

Hilton Hudson, MD, FACS, and CEO of HPC International In May 2022, a California doctor was sentenced to nearly eight years in prison for his involvement in a $12 million Medicare fraud scheme. million in reimbursements from Medicare over a three-year period. He received $4.5

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Medicare Medicare Fraud Hospitals 105

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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Fraud COVID-19 Governance Medicare 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. Donna Thiel.

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Licensing Fraud Compliance Nurses 52

Healthcare IT Today

FEBRUARY 2, 2023

It has given every indication that it intends to investigate fraud, waste, and abuse more robustly in the foreseeable future. To that end, the agency doubled its budget for audits in 2022. The Justice Department has joined the fraud case against one large national insurer. These actions are more than just saber-rattling.

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Medicare Medicare Medicaid Medicaid 59

Provider Trust

JULY 25, 2022

To eliminate fraud in your health ecosystem, you must stay compliant with federal and state requirements for referring and ordering physicians. Continuous compliance begins with automated monitoring, cross-departmental communication, and population-specific workflow. billion in Medicare charges. Recent OIG Enforcement Actions.

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Electronic Medical Records Licensing Medicare Medicare 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. Medicare covers many telebehavioral and telemental health services including audio-only services.

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COVID-19 Telemedicine Compliance Informed Consent 59

HIPAA Journal

DECEMBER 31, 2022

To best answer the question what is a HIPAA violation, it is necessary to explain what HIPAA is, who it applies to, and what constitutes a violation; for although most people believe they know what a HIPAA compliance violation is, evidence suggests otherwise. What is HIPAA and Who Does It Apply To? Other Types of HIPAA Law Violation.

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HIPAA Due Diligence Compliance Fraud 132

Healthicity

JANUARY 10, 2023

Reporting of Monetary Donations in Research. Over the last several years, the medical research community has seen many high-profile announcements about researchers resigning or being fired over not properly disclosing financial interests, especially those related to foreign influence (see [link] ).

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Fraud Medicare Medicare Compliance 52

Hall Render

JANUARY 11, 2023

On December 7, 2022, the Federal Trade Commission (“FTC”) in conjunction with the U.S. For example, reimbursement under Medicare and Medicaid for certain telemedicine services was significantly increased due to the COVID-19 pandemic. Hall Render blog posts and articles are intended for informational purposes only.

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Compliance HIPAA FDA Due Diligence 40

Hall Render

SEPTEMBER 16, 2022

Full 4th Circuit to tackle Medicaid fraud standard under False Claims Act. House passes reform to Medicare Advantage prior authorizations. Massachusetts nurse pleads guilty in $100M fraud scheme. NewYork-Presbyterian/Queens Hospital settles federal healthcare fraud allegations for $2.5M.

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

Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”. He is awaiting sentencing on those charges.

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US Department of Health and Human Services Medicare Medicare Overpayments 59

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. This standard was interpreted and applied differently by various Medicare contractors and was difficult to review/audit.

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Medicare Medicare Medicaid Medicaid 40