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.

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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.

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Fraud Medicaid Medicaid Overpayments 52

American Medical Compliance

MARCH 13, 2023

The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. The Centers for Medicare & Medicaid Services investigates these cases and prioritizes protecting patients. Healthcare organizations must take all possible steps to prevent instances of fraud. course today.

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Fraud Medicare Medicare Compliance 52

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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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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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”. Genetic testing. Wound care items.

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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

Health Law RX

AUGUST 1, 2022

To facilitate the provision of care during the pandemic, the federal government and many state governments enacted changes that encouraged physicians and other nonphysician practitioners (collectively, Practitioners) to use telehealth services. While this new flexibility increased access to care, it also increased opportunities for fraud.

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Fraud Telemedicine Nurses Governance 59

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

HIPAA Journal

JANUARY 24, 2023

For the first time since 2015, there was a year-over-year decline in the number of data breaches reported to the Department of Health and Human Services’ Office for Civil Rights (OCR), albeit only by 1.13% with 707 data breaches of 500 or more records reported. million records in 2022. million records in 2021 to 51.9

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Ransomware HIPAA Hospitals Fraud 113

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

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. In 2022, the OIG issued 21 new advisory opinions regarding arrangements and modified two of its existing opinions. The Office of Inspector General (“OIG”) within the U.S.

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Fraud COVID-19 Public Health Compliance 52

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. The money judgment represents the proceeds that she obtained as part of her scheme.

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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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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

HIPAA Journal

DECEMBER 8, 2022

The New York ambulance service, Empress EMS, is facing multiple class action lawsuits over a ransomware attack that was detected on July 14, 2022. Those files were stolen on July 13, 2022. The breach investigation revealed the ransomware gang first gained access to the network on or around May 26, 2022.

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Ransomware HIPAA Fraud 95

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.

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Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm

DECEMBER 6, 2022

Board Certified by The Florida Bar in Health Law On November 10, 2022, the US Supreme Court announced that it would weigh in on what it means to commit identity theft. In the case the Supreme Court accepted for review, the petitioner, a managing partner at a psychological services company, was convicted of Medicaid fraud in Texas in 2013.

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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.

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Fraud Medicaid Medicaid Overpayments 52

Health Care Law Brief

JULY 21, 2022

On July 20, 2022, the Office of Inspector General for the Department of Health and Human Services (“ OIG ”) issued a special fraud alert (“ Alert ”) advising “practitioners to exercise caution when entering into arrangements with purported telemedicine companies.” OIG Flags Seven Characteristics of Telehealth Fraud.

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Fraud Telemedicine COVID-19 Governance 52

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.

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Fraud Medicaid Medicaid Overpayments 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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HIPAA Journal

MARCH 25, 2022

Horizon Actuarial Services, Clinic of North Texas, and Parkland Community Health Plan have recently announced breaches of the protected health information of patients and plan members. Horizon Actuarial Services Reports Data Theft and Extortion Incident. Letters started to be mailed to affected individuals on March 9, 2022.

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HIPAA Journal

MARCH 2, 2023

Evergreen Treatment Services, a Washington-based provider of addiction treatment services, announced on February 13, 2023, that unauthorized individuals gained access to its IT systems and potentially accessed patient information, including names, addresses, birth dates, Social Security numbers, and treatment information.

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Medicare Medicare Fraud HIPAA 68

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

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

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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HIPAA Journal

JUNE 8, 2023

Alvaria explained that the ransomware attack occurred on November 28, 2022, and steps were immediately taken to contain the attack and prevent further unauthorized access to its network. The post Alvaria Confirms November 2022 Hive Ransomware Attack appeared first on HIPAA Journal.

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Ransomware Fraud HIPAA Health Insurance 52

HIPAA Journal

JANUARY 27, 2023

Des Plaines, IL-based Lutheran Social Services of Illinois, one of the largest providers of social services in the state, has announced that its systems were compromised and ransomware was used to encrypt files. The cyberattack was detected on January 27, 2022, and systems were taken offline to contain the attack.

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HIPAA Journal

NOVEMBER 15, 2022

A New York-based physician-owned provider of administrative services to anesthesiology firms is facing several class action lawsuits over a cyberattack and data breach that has affected at least 24 entities and involved the exposure and potential theft of the protected health information of more than 450,000 patients.

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HIPAA Fraud Licensing Health Insurance 81

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

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Fraud Medicare Medicare Medicaid 52

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]

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COVID-19 Fraud COVID-19 Vaccine Medicaid 52

Hall Render

SEPTEMBER 15, 2022

On September 2, 2022, the Office of the Inspector General (“OIG”) published a study assessing potential Medicare program integrity risks related to the proliferation of telehealth services during the first year of the COVID-19 pandemic. million in Medicare fee-for-service payments. million in Medicare fee-for-service payments.

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Telemedicine Fraud Medicare Medicare 40

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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Fraud Telemedicine Governance Compliance 40

Healthcare IT Today

SEPTEMBER 24, 2022

Read more… How AI Can Help Spot Telehealth Fraud. As telehealth use has increased, so have instances of telehealth fraud. Funding and M&A Activity: Latino-focused virtual primary care service Zócalo Health raised $5 million in seed funding. Read more… The Role of Information Exchange in Health Equity.

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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. Unnecessary Services.

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Nursing Homes Fraud Medicaid Medicaid 40

HIPAA Journal

DECEMBER 23, 2022

It has been another bad year for healthcare data breaches, with some of the biggest HIPAA breaches of 2022 resulting in the impermissible disclosure of well over a million records. In addition to the high number of data breaches, 2022 stands out for the sheer number of healthcare records breached, which currently stands at 49.8

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HIPAA Ransomware Health Insurance Compliance 79