Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Healthcare IT Today

JANUARY 3, 2023

As we head into 2023, we wanted to kick off the new year with a series of 2023 Health IT predictions. So, within my Medicare Advantage population for example, I split out patients with diabetes, find out who is due for an annual eye exam and then send them a message to match their communication preferences.

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Healthcare IT Today

MAY 6, 2023

Read more… Preventing Genetic Testing Fraud: 5 Actions for Health Plans. Medicare payments for genetic testing quadrupled from 2016 to 2019, which has unfortunately led to a rise in a rise in fraud, waste, and abuse. On the heels of ViVE and HIMSS, they also discuss whether in-person conferences are back.

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Med-Net Compliance

SEPTEMBER 20, 2022

million scheme to defraud Medicare by billing for services under another doctor’s name after Medicare revoked his privileges to participate in the program. According to court documents and evidence presented at trial, the podiatrist was revoked from participating in the Medicare program in January 2015.

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Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). MFCUs reported 1,143 total convictions in FY 2023—a marked decrease from 1,327 convictions in FY 2022.

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Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. The psychologist was convicted of four counts of healthcare fraud.

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Healthcare Law Today

DECEMBER 22, 2022

Department of Health and Human Services Office of Inspector General (HHS-OIG) Special Fraud Alert on telefraud, and the rise of asynchronous telehealth, among other topics. In July 2022, HHS-OIG published a Special Fraud Alert about arrangements with telemedicine companies to serve as an extra level of guidance to the industry at large.

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The Health Law Firm

DECEMBER 4, 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 hundred million dollars. Indest III, J.D.,

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The Health Law Firm

DECEMBER 4, 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 hundred million dollars. Indest III, J.D.,

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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. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

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Verisys

JANUARY 2, 2024

The post December 2023 Bad Actors Roundup appeared first on Verisys. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Civil Settlement with Total Access Urgent Care Over False Claims Allegations Full story Former Co-Owners of New Jersey Marketing Company Sentenced to Prison in $8.8

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HIPAA Journal

JUNE 28, 2023

Individuals that have suffered identity theft, medical fraud, tax fraud, other forms of fraud, and other actual misuses of their personal information, can submit claims for documented, unreimbursed extraordinary losses that are reasonably traceable to the data breach of up to a maximum of $5,000. A lawsuit – Young, et al.

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The Health Law Firm Blog

FEBRUARY 8, 2024

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 [.] Indest III, J.D.,

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The Health Law Firm Blog

JANUARY 18, 2024

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 [.] Indest III, J.D.,

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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 [.] Indest III, J.D.,

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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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Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How the OIG Exclusion Database Came to Be HHS oversees the CMS (Center for Medicare Services), which administers the Medicare program.

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Hall Render

JANUARY 29, 2025

The United States Department of Justice (DOJ) recently settled part of a qui tam lawsuit under the False Claims Act for alleged violations of the Medicare 14-Day Rule for $388,667. The DOJ, therefore, claimed the laboratory and health system knowingly caused the submission of false claims for reimbursement to Medicare.

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HIPAA Journal

MAY 10, 2023

Suspicious activity was detected within its computer systems on February 1, 2023, and third-party cybersecurity experts were engaged to conduct a forensic analysis of the incident to determine the nature and scope of the attack. The investigation concluded on March 3, 2023, that files within its network were accessed.

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HIPAA Journal

MAY 25, 2023

In April 2023, Point32Health, the second-largest health insurer in Massachusetts and the parent company of Tufts Health Plan and Harvard Pilgrim Health Care, announced it suffered a ransomware attack that resulted in system outages, including the systems that serviced members, accounts, brokers, and providers.

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YouCompli

AUGUST 22, 2023

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs.

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Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

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Compliancy Group

DECEMBER 20, 2024

The contractor used the ePHI to generate medical claims for services that were not actually rendered, resulting in approximately 6,500 false Medicare claims. Gumbs also alleged the complainant was not entitled to the records because the complainant would use the records to commit Maryland Medicaid insurance fraud (dont ask).

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HIPAA Journal

JUNE 13, 2023

million individuals in an April 2023 ransomware attack. According to Point32Health, hackers gained access to Harvard Pilgrim’s systems on March 28, 2023, and maintained access to those systems until April 17, 2023, when the intrusion was detected and blocked. million customers. At least 4 lawsuits have now been filed in the U.S.

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HIPAA Journal

MARCH 21, 2023

During that time they exfiltrated files that contained sensitive patient data, including names, contact information, Social Security number, Medicare/Medicaid IDs, health information, and health insurance information.

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Hall Render

MARCH 4, 2025

Nursing Facility ICPG, together with OIGs General Compliance Program Guidance (GCPG) issued in November 2023, serve as OIGs updated and centralized source of voluntary compliance program guidance for nursing facilities. Nationally, violations under this regulation were cited 36 times in 2024 and 27 times in 2023.

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Healthcare Law Blog

NOVEMBER 9, 2023

Thereafter, OIG said it planned to update existing industry-specific compliance program guidance (ICPG), which would include tailoring each to address fraud and abuse risk areas specific to a particular industry and describing the compliance measures that industry could take to reduce these risks [2].

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HIPAA Journal

APRIL 25, 2023

Santa Clara Family Health Plan Confirmed as Victim of Clop GoAnywhere Hack Santa Clara Family Health Plan has confirmed the 276,993-record data breach reported to the HHS’ Office for Civil Rights on March 30, 2023, was due to the hacking of Fortra’s GoAnywhere MFT solution by the Clop ransomware group.

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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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The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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The Health Law Firm Blog

MARCH 4, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. 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.

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Compliancy Group

DECEMBER 13, 2024

Maintaining healthcare compliance includes being vigilant for warning signs of potential waste, abuse, and fraud due to identity theft. For example, some medical identity thieves take insurance information and make fraudulent claims to Medicare or Medicaid for services or goods. For example, in December 2023, the U.S.

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Medisys Compliance

JANUARY 30, 2023

Medicare and Medicaid: Medicare and Medicaid are government-funded healthcare programs that provide coverage to millions of Americans. These can include additional privacy and security requirements, as well as laws related to medical billing and coding , fraud and abuse, and other issues.

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HIPAA Journal

JANUARY 23, 2024

Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors. Balwani was convicted of conspiracy to commit wire fraud against Theranos’s patients and investors and was sentenced to 12 years and 11 months in prison.

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Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

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