The Health Law Firm Blog

MARCH 14, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

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Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

FEBRUARY 23, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Fierce Healthcare

DECEMBER 15, 2022

Genetic testing lab owner convicted in $463M Medicare fraud case. Thu, 12/15/2022 - 14:14.

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Fraud Medicare Medicare 122

Fierce Healthcare

DECEMBER 12, 2022

House and Senate Dems want CMS to drop ACO REACH members due to fraud concerns. Mon, 12/12/2022 - 16:08.

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Fraud 139

The Health Law Firm Blog

FEBRUARY 1, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

HIT Consultant

AUGUST 17, 2023

Erin Rutzler, VP of Fraud, Waste, and Abuse at Cotiviti As behavioral health claim volumes continue to increase, there’s a growing need for health plans to be vigilant in spotting fraud, waste and abuse. But not every plan has access to a large SIU to combat fraud, waste and abuse in behavioral health.

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Fraud COVID-19 Medicare Medicare 98

Fierce Healthcare

NOVEMBER 9, 2022

Customization vs. Configuration in Healthcare Fraud Detection. Wed, 11/09/2022 - 16:55.

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Fraud 98

The Health Law Firm Blog

JANUARY 13, 2024

Board Certified by The Florida Bar in Health Law On September 27, 2022, a Florida pharmacy owner pled guilty to conspiring to commit healthcare fraud in an $8.3 By George F. Indest III, J.D., million scheme.

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Fraud Medicare Medicare Medicaid 52

Fierce Healthcare

DECEMBER 8, 2022

to settle Medicaid fraud allegations in California. Thu, 12/08/2022 - 16:58. 3 providers to pay $22.5M

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Fraud Medicaid Medicaid 109

HIPAA Journal

AUGUST 30, 2022

An unauthorized individual had access to the network of Avamere Health Services between January 19, 2022, and March 17, 2022, and exfiltrated files containing protected health information. The breach was detected on or around March 17, 2022, yet Avamere waited until July 13, 2022, to issue notifications to affected individuals.

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Nursing Homes Fraud Ransomware HIPAA 117

American Medical Compliance

MARCH 13, 2023

The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. Healthcare organizations must take all possible steps to prevent instances of fraud. Employees should receive training that educates them on how to identify, report, and combat fraud, waste, and abuse in the workplace.

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Fraud Medicare Medicare Compliance 52

Fierce Healthcare

FEBRUARY 2, 2022

DOJ recovers over $5B in healthcare fraud settlements, judgments in 2021. Wed, 02/02/2022 - 12:13.

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The Health Law Firm Blog

JANUARY 8, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

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Fraud Medicaid Medicaid Overpayments 40

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

HIPAA Journal

FEBRUARY 22, 2023

A lawsuit has been filed against Freehold Township, NJ-based CentraState Healthcare System over its December 2022 ransomware attack, a few days after the health system started sending notification letters to around 617,000 affected patients.

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Ransomware Fraud Health Insurance HIPAA 91

Healthcare Law Blog

AUGUST 8, 2022

On August 5, President Biden signed two bills into law that extend to ten years the statute of limitations for civil and criminal enforcement actions for fraud on the Paycheck Protection Program (“PPP”) and Economic Injury Disaster Loans (“EIDL”).

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Fraud Due Diligence COVID-19 Governance 52

Med Law Blog

FEBRUARY 10, 2022

Highmark Health issued a Press Release on February 7, 2022 announcing that it’s Financial Investigations and Provider Review (FIPR) department generated more than $245 million in savings related to fraud waste and abuse in 2021, the majority of which was in Pennsylvania–$184 million.

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Fraud 52

Med Law Blog

JULY 21, 2022

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”.

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Telemedicine Fraud 52

The Health Law Firm

JUNE 26, 2023

Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,

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Fraud FDA 40

HIPAA Journal

JANUARY 24, 2023

Even with that reduction, 2022 still ranked as the second-worst-ever year in terms of the number of reported breaches. million records in 2022. The theft of protected health information places patients and health plan members at risk of identity theft and fraud, but by far the biggest concern is the threat to patient safety.

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Ransomware HIPAA Hospitals Fraud 113

Health Law RX

AUGUST 1, 2022

While this new flexibility increased access to care, it also increased opportunities for fraud. On July 20, 2022, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a Special Fraud Alert cautioning Practitioners about potential fraudulent telemedicine contracts ( Fraud Alert ).

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Fraud Telemedicine Nurses Governance 59

The Health Law Firm Blog

NOVEMBER 29, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

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Fraud Medicaid Medicaid Overpayments 52

Health Law Checkup

AUGUST 9, 2022

On July 20, 2022, the OIG released a Fraud Alert encouraging practitioners to exercise caution when entering into arrangements with telemedicine companies, given the various fraud and abuse risks associated with such arrangements, including an increased risk of fraudulent claims to Medicare, Medicaid, and other federal healthcare programs.

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Fraud Telemedicine Medicaid Medicaid 52

The Health Law Firm

DECEMBER 4, 2023

At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. Indest III, J.D., He was ordered to pay $187 million in restitution.

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Fraud Medicare Medicare Governance 52

The Health Law Firm

DECEMBER 4, 2023

At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. Indest III, J.D., He was ordered to pay $187 million in restitution.

Fraud 52

Fraud Medicare Medicare Governance 52

The Health Law Firm Blog

DECEMBER 19, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

OCTOBER 14, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Compliancy Group

AUGUST 31, 2022

Department of Justice’s (DOJ) Civil Cyber Fraud Initiative (CCFI). Details of DOJ Cyber Fraud Initiative Settlements. DOJ Cyber Fraud Initiative and the HIPAA Connection. Whistleblower Incentives Within the DOJ Cyber Fraud Initiative. million from the total settlement.

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Fraud HIPAA Governance Electronic Medical Records 52

Becker's Health IT

APRIL 22, 2024

Federal judge recommends dismissing class-action lawsuit against CommonSpirit Health over 2022 cyberattack due to lack of evidence linking breach to bank fraud.

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Fraud 88

The Health Law Firm Blog

NOVEMBER 7, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

OCTOBER 19, 2022

Board Certified by The Florida Bar in Health Law On September 27, 2022, a Florida pharmacy owner pled guilty to conspiring to commit healthcare fraud in an $8.3 By George F. Indest III, J.D., million scheme.

Fraud 52

Fraud Medicare Medicare 52

HIT Consultant

DECEMBER 6, 2022

What You Should Know: – Epstein Becker Green (EBG) recently released its 2022 updates to the Telemental Health Laws survey. – The 2022 updates report a significant evolution of the telemental health and telehealth industries, including increased regulatory flexibilities that promote increased use of telehealth.

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Compliance Medicaid Medicaid COVID-19 98

Healthcare Law Blog

MAY 8, 2023

Department of Health and Human Services (“HHS”) is responsible for detecting and preventing fraud, waste, and abuse in federal health care programs. Upon request from health care providers and others, the OIG periodically issues advisory opinions concerning the application of fraud and abuse laws to existing or proposed business arrangements.

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Fraud COVID-19 Public Health Compliance 52

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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Fraud Medicaid Medicaid Nursing Homes 59

HIPAA Journal

JANUARY 3, 2023

Attacks in the education sector have remained fairly consistent over the past 4 years with between 84 and 89 attacks conducted each year, as has the number of attacks on state and local governments – 105 in 2022 with an average of 102 attacks a year.

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Ransomware Hospitals HIPAA Governance 106

Compliancy Group

MARCH 30, 2023

The 2022 Internet Crime Report has revealed alarming statistics about the rampant rise in cybercrime, making it more critical than ever to be aware of the dangers and take necessary precautions. 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

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Ransomware Fraud HIPAA Compliance 52

HIPAA Journal

OCTOBER 21, 2022

A pharmaceutical sales rep has pleaded guilty to conspiring to commit healthcare fraud and wrongfully disclosing and obtaining patients’ protected health information in an elaborate healthcare fraud scheme involving criminal HIPAA violations. Alario pleaded guilty to his role in the healthcare fraud scheme earlier this month.

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Fraud HIPAA FDA Health Insurance 59