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. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. By George F.

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4

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Medicaid Medicaid Medicare Medicare 75

Kaiser Health News

APRIL 16, 2024

Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov. “Unfortunately, there’s so much fraud that legitimate agents who are really trying to help people are also being pushed out.”

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HIPAA Journal

OCTOBER 17, 2022

Valle de Sol did not state in its notification letters when hackers gained access to its network, or for how long they had access, but did confirm that the unauthorized activity was detected on January 25, 2022. A comprehensive review was conducted of all files that may have been accessed, which was completed on July 18, 2022.

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Health Insurance Licensing Fraud HIPAA 113

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. With Medicaid, the challenges are equally formidable.

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Fraud Medicaid Medicaid Medicare 52

HIPAA Journal

MARCH 21, 2023

ILS Identified the breach in July 2022 and determined unauthorized individuals had access to its network between June 30, 2022, and July 5, 2022. Affected individuals were offered complimentary credit monitoring services and security measures have been enhanced to prevent further data breaches. The lawsuit was filed by Joseph G.

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Fraud Health Insurance Medicaid Medicaid 98

HIPAA Journal

SEPTEMBER 9, 2022

That process concluded on June 24, 2022. Those emails contained patient information such as names, dates of birth, Social Security numbers, medical information, health insurance information, driver’s license numbers, and state ID numbers. The information exposed varied from patient to patient.

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Licensing Health Insurance Fraud HIPAA 96

HIPAA Journal

JULY 4, 2023

As a precaution against identity theft and fraud, affected individuals have been offered 24 months of complimentary credit monitoring services. In March 2022, an unauthorized individual accessed the email account of an employee. Many of the individuals affected were minors.

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Medicaid Medicaid Health Insurance Licensing 72

HIPAA Journal

MAY 25, 2022

Social Action Community Health System (SAC Health) has recently notified 149,940 patients that documents containing their protected health information were stolen in a break-in at an off-site storage location where patient records were stored. Notification letters were sent to those individuals on May 3, 2022.

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Ransomware Fraud HIPAA Licensing 124

HIPAA Journal

MARCH 25, 2022

Ultimate Care said no reports have been received that indicate there has been any misuse of patient information; however, as a precaution against identity theft and fraud, individuals whose Social Security numbers were impacted have been offered complimentary one-year memberships with a credit monitoring service.

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Health Insurance Licensing Ransomware Fraud 104

HIPAA Journal

APRIL 25, 2023

On February 13, 2023, NationsBenefits confirmed that the data compromised in the attack included protected health information such as name, address, phone number, gender, date of birth, health insurance number, medical ID number, Social Security number, date(s) of service, medical device or product purchased, and provider/caregiver name.

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Health Insurance Public Health Ransomware Fraud 81

HIPAA Journal

NOVEMBER 15, 2022

Anesthesiology firms started reporting data breaches to the Department of Health and Human Services’ Office for Civil Rights in September 2022, with the notification letters to patients indicating there had been a data breach at their anesthesia management services organization. The notification letters failed to name that company.

HIPAA 81

HIPAA Fraud Licensing Health Insurance 81

Hall Render

SEPTEMBER 16, 2022

4 Health Systems Join Provider-Created Data Collective to Improve Care. Full 4th Circuit to tackle Medicaid fraud standard under False Claims Act. Census: 7% of people in Illinois lack health insurance. Steward Health Care names new flagship hospital president. Amazon wants to add payer strategy muscle.

US Department of Health and Human Services 40

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

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. Providers and facilities that are not contracted with a health plan or insurer are known as out-of-network providers (OON).

Medical Billing 40

Medical Billing Medicare Medicare Compliance 40

Hall Render

APRIL 22, 2022

21 top management risks in healthcare for 2022. $1B Patient generated data can be a key factor in reducing health inequity. Supreme Court tosses Medicaid work requirement cases. UArizona launching new programs to address health care workforce shortages. SuperCare Health sued after data breach of 318,000 patient files.

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

Hall Render

NOVEMBER 4, 2022

Feds approve program for rural Arkansas health care but it will cost local taxpayers more. Governor Hutchinson Announces Expansion To Rural Health Services With ARHOME Medicaid Program. Feds OK Arkansas’ Life360 model incentivizing health outcomes. New vice president named at Baptist Health Lexington. CALIFORNIA.

US Department of Health and Human Services 40

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

Hall Render

MAY 13, 2022

Arizona Hospital Safety Grades 2022: The Best And Worst. Banner invests in Atlas Health Partners, plans to double ASC footprint. Prism pays $650K to settle Medi-Cal fraud claims filed in San Diego. Synergy Health Partners Acquires SoCal Anesthesia Solutions, Inc. California Hospital Safety Grades 2022: The Best And Worst.

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COVID-19 Nurses Nursing Homes Hospitals 40

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 59

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

The Health Law Firm Blog

APRIL 19, 2024

Board Certified by The Florida Bar in Health Law On November 30, 2022, a group of former Walgreens workers filed a proposed class action in Florida federal court that accuses the pharmacy chain of sending confusing, incomplete COBRA notices. By George F. Indest III, J.D., The former employees sued, saying the company purposely [.]

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Fraud Medicaid Medicaid Health Insurance 52

HIPAA Journal

OCTOBER 21, 2022

The passage of HIPAA resulted in multiple benefits for the health insurance industry, the healthcare industry, and the people that they serve. For example, the Administrative Requirements (Part 162) helped reduce insurance fraud and accelerated eligibility inquiries, authorization requests, and claims processing.

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HIPAA Compliance Medicare Medicare 95

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations.

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COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare Law Blog

MAY 31, 2022

The FTC’s increasing interest in health information that sits outside of HHS/OCR’s reach is likely to only expand in light of health-related metaverse use cases. In response to the growth of the metaverse and digital health generally, the FDA has been working to expand its guidance in the area. 1, 2021). [2] Code § 321(h). [4]

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FDA HIPAA Medicare Medicare 90

HIPAA Journal

DECEMBER 31, 2022

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was introduced to simplify the administration of healthcare, eliminate wastage, prevent healthcare fraud, and ensure employees could maintain healthcare coverage between jobs. What is HIPAA and Who Does It Apply To? Annual Penalty Limit .

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HIPAA Due Diligence Compliance Fraud 132

The Health Law Firm Blog

JANUARY 24, 2023

Board Certified by The Florida Bar in Health Law On November 30, 2022, a group of former Walgreens workers filed a proposed class action in Florida federal court that accuses the pharmacy chain of sending confusing, incomplete COBRA notices. By George F. Indest III, J.D., The former employees sued, saying the company purposely [.]

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Fraud Medicaid Medicaid Health Insurance 52

Hall Render

JULY 28, 2023

million for rural hospital expansion Hospices in Arizona & other states receive scrutiny over concerns of fraud, waste & abuse Phoenix Children’s Building New 44,000-Square Foot Level IV Neonatal Intensive Care Unit Firefighters oppose Banner’s planned $400M hospital There’s a growing nurse shortage in Arizona.

US Department of Health and Human Services 40

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

Hall Render

JANUARY 11, 2023

On December 7, 2022, the Federal Trade Commission (“FTC”) in conjunction with the U.S. Department of Health & Human Services (“HHS”) updated the Mobile Health App Interactive Tool (the “Tool”) to include new questions and new use cases.

Compliance 40

Compliance HIPAA FDA Due Diligence 40

Hall Render

AUGUST 19, 2022

Stockton Doctor and Medical Practice Agree to Pay Nearly $2 Million to Resolve Allegations of Health Care Fraud. UC San Diego Health names new CIO. United Health Centers says patient data was stolen. New Colorado Mountain Medical program helps employees grow into health care industry. Novant Health patients.

COVID-19 40

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

HIPAA Journal

JULY 24, 2023

The team’s roles are to investigate and audit the Department’s operations to prevent fraud, waste, and abuse within the Department, and also to audit and investigate potential crimes against the Department. In addition to HHS OIG enforcement actions, Medicare Fraud Control Units (MFCUs) operate in every state and territory.

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Fraud Medicare Medicare Medicaid 52

Hall Render

APRIL 15, 2022

Health information breach feared through surplus Alabama rehab equipment. Huntsville Doctor Charged with Health Care Fraud Conspiracy. Health care workers not immune to growing mental health crisis, but help is available. to settle fraud, kickback charges. UI Health Care names new chief quality officer.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

SEPTEMBER 23, 2022

Children’s Hospital takes over pediatric work at Main Line Health as Nemours affiliation ends. The Top Doctors Making a Difference in Delaware in 2022. Delaware extends public health emergency order 30 days. Workers’ comp insurers fight Florida’s hospital payment plan. million to resolve Medicare fraud claims.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

AUGUST 12, 2022

BayCare names Philadelphia health care executive as new CEO. Doctor loses at least four homes, sentenced to federal prison for healthcare fraud amounting to $38M. Jefferson Health COO Stephanie Conners leaving to become CEO of Florida health system. New UF Health Shands interim CEO named after CEO resigns.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Provider Trust

FEBRUARY 3, 2023

Government Oversight On December 29, 2022, President Biden signed the Consolidated Appropriations Act into law. This includes a number of provisions related to Medicaid and the Children’s Health Insurance Program (CHIP), but certain flexibilities were also extended to Telehealth until the end of 2024.

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Compliance Fraud Nurses Telemedicine 52

Hall Render

APRIL 1, 2022

Fraud plagues California’s hospice industry, audit finds. Lawmakers not giving up on bill to expand Medicaid to undocumented kids. Noble Health presents key findings of Hospital feasibility study. Co-Immunity takes WBJ 2022 Inno Madness crown. over MassHealth fraud. California nurses begin strike.

COVID-19 40

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

Hall Render

DECEMBER 1, 2023

1 Mass General Brigham to build AI products with Australian health tech company Mass General Brigham hospital workers to receive average 21% raises Mass General Brigham to integrate triage AI across system Mass General Brigham sued over infection control lapse Nurse practitioner pleads guilty to $7.8M

Nursing Homes 40

Nursing Homes Nurses Ransomware COVID-19 40

Compliancy Group

MAY 27, 2022

Partnership Health Plan in Northern California was the victim of a cyberattack by the Hive ransomware group. The cybercriminals stole more than 400GB of data before encrypting the organization’s files on March 19, 2022. Affected persons received notification letters in December 2021. Two of the cases have been filed in the U.S.

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HIPAA Ransomware Compliance Hospitals 98

Hall Render

MARCH 3, 2023

million for youth mental health care KENTUCKY Pike County nursing home officials release statement following loss of Medicare agreement Three Humana executives drop $11.2M

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Nursing Homes COVID-19 Nurses Hospitals 40