The Health Law Firm Blog

JANUARY 18, 2024

By George F. Indest III, J.D., 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 [.]

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The Health Law Firm Blog

DECEMBER 28, 2023

By George F. Indest III, J.D., 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 [.]

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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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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. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

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Healthcare Compliance Blog

FEBRUARY 22, 2022

Two women, one from Colorado and the other from Houston, have been sentenced in federal court for their roles a multi-million dollar Medicare Fraud Scheme. Each woman pled guilty to one count of conspiracy to commit healthcare fraud. The post Two Women Sentenced for Conspiracy to Commit Healthcare Fraud appeared first on.

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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. Gandle, for her contribution to this blog post. 1] The authors would like to thank their former colleague, Lauren F.

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Hall Render

SEPTEMBER 12, 2022

Healthsouth of Sarasota Limited Partnership, et al , the Eleventh Circuit held that for a plaintiff to qualify as engaging in “protected activity,” the plaintiff must demonstrate that they had both a subjectively reasonable belief of fraud and an objectively reasonable belief of fraud. Background. 3730(h)(1). Practical Takeaways.

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Hall Render

APRIL 29, 2024

The disclosure must be made to the Criminal Division of the DOJ and must occur before any other corresponding government investigation or civil enforcement in order to be truly voluntary. Practical Takeaways Health care fraud is specifically listed as a key enforcement area for the DOJ.

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MedTrainer

MARCH 8, 2024

It educates employees on the laws, regulations, and policies governing their work and ensures they understand their responsibilities and obligations as healthcare professionals. Successful training is when team members understand and comply with various laws, regulations, and policies that govern the healthcare industry.

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Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

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Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. These status changes will help organizations identify which individuals may be at risk of their license becoming invalid due to the government investigation.

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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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MedTrainer

FEBRUARY 5, 2024

In this blog, we’ll discuss the two processes and key differences between provider enrollment and credentialing. Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. So, what is the difference between provider enrollment and credentialing?

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MedTrainer

FEBRUARY 1, 2024

These programs help to promote lawful and ethical conduct within healthcare organizations and minimize the risk of legal violations, such as fraud, abuse, and other unethical behaviors. We’ll answer that question in this blog along with assessments of a good corporate compliance process. What is Corporate Compliance in Healthcare?

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Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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The Health Law Firm

MARCH 14, 2013

In many cases the activity may amount to fraud on the government. This is the second blog in a two-part series on whistleblower/qui tam lawsuits. In the first blog I explained types of false claims, the reward programs for coming forward with a false claim, and who can file a whistleblower/qui tam lawsuit.

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The Health Law Firm

MARCH 13, 2013

In many cases the activity may amount to fraud on the government. This is the first blog of a two-part series. Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities.

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MedTrainer

FEBRUARY 12, 2024

government collected $2.2B In this blog, we’ll share how healthcare organizations are managing compliance around false claims and safeguarding both the integrity of healthcare services and the welfare of patients. in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022.

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MedTrainer

JANUARY 12, 2024

In this blog post, we’ll outline who regulates healthcare compliance, how rules are enforced, and why organizations need a robust compliance platform to stay in the good graces of regulators. Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

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Health Law Attorney

NOVEMBER 12, 2021

On November 8, 2021, the Office of Inspector General (“ OIG ”) issued multiple updates to the Health Care Fraud Self-Disclosure Protocol (“ SDP ”), incorporating legal changes made since the previous SDP revision in 2013. The post OIG Updates the Self-Disclosure Protocol: Key Changes appeared first on Health Law Attorney Blog.

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MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. But what exactly is considered fraud, waste, and abuse? Risk Assessment. Legislation and Congressional Requests.

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Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

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Healthcare Compliance Blog

FEBRUARY 15, 2022

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. Congress strengthened the False Claims Act by increasing incentives for whistleblowers to file lawsuits alleging false claims on behalf of the government.

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MedTrainer

OCTOBER 23, 2023

In this blog post, we will explain healthcare compliance, shine light on its significance, and share best practices within the industry. Who Governs Healthcare Compliance? Office of Inspector General (OIG): Prevents fraud, waste, and abuse within the department’s vast array of Department of Health and Human Services (HHS) initiatives.

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Hall Render

FEBRUARY 25, 2022

Although only a small minority of Children’s Hospital patients would be subject to cost-sharing under government health care programs, the OIG noted that the arrangement could implicate the AKS and Civil Monetary Penalties Law Beneficiary Inducement prohibition because the removal of cost? Your primary Hall Render contact.

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Health Law RX

JUNE 27, 2023

Earlier, in the SuperValu decision (discussed in a recent Health Law Rx Blog ), the Court clarified that subjective intent is relevant in determining whether an objectively reasonable (but incorrect) interpretation of a rule or regulation could negate the FCA’s scienter element ( U.S. SuperValu Inc., 1391, 1401 (U.S. Last week, in U.S.

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MedTrainer

JANUARY 31, 2024

In this blog, we’ll discuss the structured framework for managing risks and maintaining the highest standards of care and integrity in the healthcare industry. Healthcare compliance is following and meeting the laws, regulations, and ethical standards that govern the healthcare industry. What is Healthcare Compliance?

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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] of America v. per 30-day supply). [9]

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Healthcare Compliance Blog

FEBRUARY 7, 2022

A Michigan woman has pled guilty to stealing government funds that were designated to aid medical providers in the treatment of patients suffering from COVID-19 and acknowledged using the money for her own personal use. Issue: Misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds.

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Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.

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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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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. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

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MedTrainer

FEBRUARY 12, 2024

In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare. For example, healthcare fraud or intentional non-compliance with regulations can lead to criminal charges.

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Verisys

FEBRUARY 12, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is GRC in Healthcare?

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Healthcare Law Blog

APRIL 3, 2023

While government enforcement has traditionally been an indirect concern for private equity (“PE”) investors, such as looking at whether a target entity has been sanctioned or could be sanctioned in the future, the current trend in government enforcement has been to target PE firms directly. On March 25, 2021, the U.S.

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Hall Render

AUGUST 22, 2023

Rather, liability under the FCA may still be established if any misrepresentations made by a provider influenced decision-makers and resulted in the submission of false claims to the government. Walgreens learned of the fraud as early as 2016. Hall Render blog posts and articles are intended for informational purposes only.

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Pharmacy Law Blog

MARCH 13, 2018

The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner. The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

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