The Health Law Firm Blog

DECEMBER 28, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] By George F. Indest III, J.D.,

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Medicare Medicare Fraud Governance 52

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. As Medicare Advantage continues to grow, the risk of provider-level fraud will also increase.

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Fraud Medicare Medicare US Department of Health and Human Services 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. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

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Nursing Homes COVID-19 Fraud Medicaid 52

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Trust is core to the provider-patient relationship.

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Fraud Medicare Medicare Compliance 52

Healthcare IT Today

JANUARY 2, 2023

As we head into 2023, we wanted to kick off the new year with a series of 2023 Health IT predictions. We are going to see an increased demand for privacy-preserving technology in 2023, and therefore more investment in the space. during 2023. Check out our community’s healthcare Security and Risk predictions.

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Ransomware Fraud Compliance Telemedicine 126

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

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Fraud Medicare Medicare Compliance 52

Medisys Compliance

JANUARY 30, 2023

The medical billing industry is a complex and ever-changing field, and it is crucial for healthcare providers and billing companies to stay compliant with government regulations. Violations of the False Claims Act can result in significant financial penalties, including fines and exclusion from government healthcare programs.

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Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

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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Fraud COVID-19 Compliance Medicaid 52

Healthcare IT Today

JANUARY 19, 2024

According to the 2023 ForgeRock Breach Report , healthcare has consistently ranked as the most targeted industry by cybercriminals for the past five years. The 2023 Verizon Breach Report further highlights vulnerabilities with the healthcare sector, identifying web applications as the number one attack vector.

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Fraud Governance Ransomware Compliance 87

Innovaare Compliance

JUNE 8, 2023

These changes, which went into effect on January 1, 2023, are designed to ensure health plans are accurately reporting their costs and that they are not overcharging the government. The post 2023 CMS Audit Protocols: What You Need to Know appeared first on Inovaare.

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Provider Trust

MARCH 13, 2023

On January 25, 2023, the US Department of Justice joined with the Federal Bureau of Investigation (FBI) and the US Department of Health and Human Services Office of Inspector General (HHS-OIG) to launch a multi-state law enforcement action to apprehend individuals involved in this fraudulent nursing degree scheme.

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Fraud US Department of Health and Human Services Licensing Compliance Officers 52

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. The DOJ Announcement stresses the importance of investing in strong compliance programs for both the buyers and sellers in business transactions.

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MedTrainer

JANUARY 31, 2024

federal government enacted the Federal False Claims Act (FCA) in 1863 during the American Civil War. It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. The need to combat fraud, waste, and abuse is what brought about the modern compliance program.

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Compliance Fraud Governance ACA 52

Health Law Advisor

FEBRUARY 10, 2023

Lowest Total Recoveries Since 2008 Record-Shattering Number of New Cases Filed Health Care and Life Sciences Cases Continue to Dominate On February 7, 2023, the U.S. 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

Healthcare IT News - Telehealth

SEPTEMBER 25, 2023

By Bill Siwicki | September 27, 2023 News AI-enabled efficiencies can improve patient outcomes and reduce clinician burnout "By prioritizing healthy data management practices through the deployment of AI, IT leaders. By Mike Miliard | August 10, 2023 News Senator wants Google to answer for accuracy, ethics of generative AI tool Sen.

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Nurses Governance Fraud Health Outcomes 101

Healthcare IT Today

FEBRUARY 9, 2024

In 2023, healthcare costs are projected to surge by almost 6%. government and leading medical associations call upon stakeholders to do their part. Even worse, up to 10% of this spending is rife with waste, abuse, and fraud. A vast majority of healthcare workers are reporting job burnout. In fact, studies by the U.S.

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Fraud Governance Hospitals Licensing 109

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. 21-1052, 2023 WL 4034314, at *2 (U.S. June 16, 2023)). SuperValu Inc., 1391, 1401 (U.S.

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Governance Fraud Compliance 52

HIPAA Journal

APRIL 24, 2023

Utah has updated its data breach regulations and from May 3, 2023, will require a breached entity to send a notification to the Utah Attorney General in the event of a breach of the personal information of 500 or more Utah residents.

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Fraud Licensing HIPAA Governance 85

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

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Fraud Health Insurance Compliance Medicaid 52

HIPAA Journal

MARCH 30, 2023

Ransomware and phishing continue to be the biggest cybersecurity concerns for healthcare organizations according to the February 2023 Current and Emerging Healthcare Cyber Threat Landscape report from Health-ISAC. Ransomware was the biggest concern for 2022 and 2023 with phishing and spear phishing in second.

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HIPAA Journal

FEBRUARY 8, 2024

The incident was detected on November 9, 2023. Cybersecurity experts were engaged to assist with the investigation, which confirmed that unauthorized individuals accessed certain systems on or before September 27, 2023, and encrypted certain files. It is not clear from the notification letters when the intrusion occurred.

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Ransomware Electronic Medical Records Licensing Health Insurance 79

HIT Consultant

JANUARY 3, 2023

But they have also expanded the attack surface at these organizations and increased the level of risk and vulnerabilities that could result in direct loss of proprietary information, direct financial damage including theft and fraud, and potential loss of life (in addition to regulatory fines and brand damage) the healthcare sector faces.

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Compliance Ransomware Fraud Regulatory Compliance 52

Health Law RX

JUNE 2, 2023

2] Companies that regularly submit claims to the federal government are familiar with the complex maze of rules and regulations that often govern them. 6] These government payor programs limit the amount pharmacies can charge for generic medications to the “usual and customary” price. [7] A mistake is still a mistake, not fraud.

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Fraud Governance Medicaid Medicaid 52

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Situation One: Before the Pandemic   In April 2019, government officials announced Operation Brace Yourself: a fraud takedown related to telemedicine and durable medical equipment (DME).

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Fraud Medicare Medicare COVID-19 52

HIPAA Journal

AUGUST 2, 2023

The Chattanooga Heart Institute (CHI) in Tennessee has recently announced that it identified a cyberattack on its network on April 17, 2023. Notification letters will be sent to the affected individuals in the coming weeks and credit monitoring, fraud consultation, and identity theft restoration services will be offered.

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Licensing Electronic Medical Records Ransomware Health Insurance 71

MedTrainer

FEBRUARY 12, 2024

government collected $2.2B Here are some recent adjustments that may impact your risk exposure related to false claims: The Consolidated Appropriations Act of 2023 introduced new exceptions that allow certain health care entities to offer mental health and behavioral health support programs without fear of violating the Stark Law or AKS.

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Compliance Fraud Medicaid Medicaid 52

AIHC

MAY 17, 2023

This article addresses various forms of fraud and how criminals’ prey on compromised citizens. There are many factors which can influence our health, and in turn, there are just as many schemes which are actually considered health care fraud. SNAP Fraud Food assistance is generally referred to as SNAP or food stamps.

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Health Outcomes Fraud Compliance Governance 52

Health Law RX

MARCH 30, 2023

13-3003, the government alleged that an ophthalmology distributor and its founder violated the FCA by providing kickbacks to physicians in the form of travel and entertainment activities, encouraging the use of the company’s ophthalmic supplies and equipment. As for the final judgment award, on March 17, 2023, the U.S. per claim.

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Overpayments Overpayment Fraud Governance 52

Healthcare Law Today

JANUARY 11, 2023

Does violating requirements amount to fraud under the False Claims Act (FCA) when the requirements allegedly violated are unclear? 12-cv-299S, 2023 WL 24055 (W.D.N.Y. ” In particular, the government alleged Defendants violated the ICD guidelines which govern diagnosis coding for managed care plans. Health Corp.,

Governance 52

Governance Medicare Medicare Fraud 52

HIPAA Journal

JULY 27, 2023

Norton Healthcare, a Kentucky-based operator of more than 140 clinics and hospitals in Kentucky and Southern Indiana, is facing a class action lawsuit over a May 2023 cyberattack and data breach. On July 21, 2023, a class action lawsuit was filed in U.S.

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Ransomware Fraud Licensing Health Insurance 52

Healthcare Law Today

FEBRUARY 3, 2023

Director of Policy & Regulatory Affairs, Homeward Cecily Harris, Deputy General Counsel, Wheel Telemedicine Fraud & Abuse Enforcement Foley Partner Lisa Noller, Chair of the firm’s Government Enforcement & Investigations Practice will join a fireside chat on telemedicine fraud & abuse enforcement trends.

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Telemedicine Fraud Compliance Officers Compliance 83

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Operation Brace Yourself was one of the largest healthcare fraud schemes investigated and prosecuted by enforcement agencies. The $73 million fraud scheme was discovered and busted. 

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Fraud Compliance Medicare Medicare 52

HIPAA Journal

JANUARY 30, 2023

The event provides a tremendous opportunity for learning through HIPAA workforce training sessions and keynote speeches from top government officials and leading industry professionals. This will be followed by the preconference basic training day on March 2, 2023.

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US Department of Health and Human Services HIPAA Compliance Medicaid 81

McGuire Wood

OCTOBER 2, 2023

13, 2023, the U.S. times the amount the government believed was due to improper billing, after a voluntary disclosure to the Department of Justice (DOJ). If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure.

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Fraud Governance Compliance Medicare 52

Healthcare Law Blog

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

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Medicaid Medicaid Compliance Overpayments 52

Healthcare Law Today

JANUARY 11, 2023

On January 4, 2023, the Department of Justice issued a press release stating that Jet Medical Inc. The government also alleged that Jet Medical did not conduct an investigational study regarding the device’s safety and effectiveness when used as intended. Food and Drug Administration (FDA) prior to distribution.

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YouCompli

AUGUST 22, 2023

Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs. OIG’s audits, evaluations, and investigations have demonstrated that risks of fraud, waste, and abuse in managed care are real and significant.”

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