The Health Law Firm Blog

FEBRUARY 8, 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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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. 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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Fraud Medicare Medicare US Department of Health and Human Services 52

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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Fraud Medicaid Medicaid Medicare 52

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 [.]

Medicare 52

Medicare Medicare Fraud Governance 52

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 [.]

Medicare 52

Medicare Medicare Fraud Governance 52

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds.

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Medicaid Medicaid Compliance Governance 59

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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

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Fraud Compliance Medicaid Medicaid 98

MedTrainer

FEBRUARY 12, 2024

government collected $2.2B Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022.

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Compliance Fraud Medicaid Medicaid 52

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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Compliance Fraud Medicaid Medicaid 52

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

Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. During the fiscal year 2021, the report states that the federal government won or negotiated over $5 billion in healthcare fraud judgments and settlements. Because of these efforts, close to $1.9

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Fraud Medicaid Medicaid Medicare 52

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. We’ll also review why both processes are vital for healthcare organizations.

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Licensing Governance Compliance Fraud 52

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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Compliance Fraud Regulatory Compliance Regulations Compliance 52

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

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Medicaid Medicaid Medicare Medicare 52

Hall Render

AUGUST 22, 2023

The Fourth Circuit recently held that providers may not defend a False Claims Act (“FCA”) lawsuit by arguing that eligibility requirements violate the Medicaid Act. the government alleged a clinical pharmacy manager for a Tennessee Walgreens falsified twelve different patients’ medical records between January 2015 and June 2016.

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Medicaid Medicaid Governance Fraud 40

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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Fraud Medicare Medicare Governance 40

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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US Department of Health and Human Services Fraud Compliance Medicaid 59

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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Fraud Governance Medicaid Medicaid 52

Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. 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

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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Governance Compliance Regulatory Compliance Compliance Framework 52

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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Compliance Compliance Officers Fraud Governance 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. Moderated by David S.

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Fraud COVID-19 Compliance Medicaid 52

Verisys

JANUARY 8, 2024

Verisys Corporation, through its FACIS (Fraud and Abuse Control Information System), plays a crucial role in ensuring OIG compliance for healthcare organizations. FACIS Level 1M : Includes everything in Level 1 plus additional state Medicaid sanctions and other sources.

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Compliance Licensing Governance Fraud 52

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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COVID-19 Fraud Governance Compliance 59

Verisys

MAY 9, 2023

Reducing your organization’s fraud risk through internal policies and procedures that satisfy laws, regulations, and standards can help ensure quality of care and patient safety. These actions don’t necessarily result in automatic exclusion, but the OIG can choose to exclude for several reasons.

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Compliance Fraud Governance Licensing 52

MedTrainer

OCTOBER 4, 2023

These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. These requirements are designed to protect patient rights, privacy, and safety, as well as to prevent fraud, abuse, and other improper practices within healthcare organizations.

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Compliance Fraud HIPAA Governance 52

Provider Trust

FEBRUARY 3, 2023

The government and private whistleblowers have increasingly targeted PE firms’ portfolio companies and the firms themselves. One recent settlement we covered on our blog detailed the Massachusetts Attorney General’s case against South Bay Mental Health Centers. Do you have any risk based on poor standards of practice?

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Compliance Fraud Nurses Telemedicine 52

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Standard Contract Requirements/Coordination of Benefits.

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Medicaid Medicaid Medicare Medicare 40

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.

Compliance 52

Compliance Licensing Governance Fraud 52

Bill of Health

FEBRUARY 10, 2023

This replacement, “neoliberalism,” has as its central tenet that markets are, in all ways and at all times, superior to government in allocating societal resources. That is why the ACA’s Medicaid expansion doesn’t exist in 11 states , why the penalties for failing to have insurance under the “individual mandate” has been set to $0.00.

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Hall Render

FEBRUARY 27, 2023

The government initiated 296 FCA cases on its own last year without input of a relator, which is the highest volume of DOJ initiated cases since the 1986 FCA amendments. This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. COVID-10 Related Fraud.

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Nursing Homes Fraud Medicaid Medicaid 40

Healthcare Law Blog

MARCH 3, 2023

This surge was facilitated, in part, by certain flexibilities authorized by the Centers for Medicare & Medicaid Services in its response to the public health emergency (“PHE”) declared in March of 2020 and which was repeatedly renewed until now. federal government. trillion omnibus spending bill intended to fund the U.S.

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Fraud Nurses Telemedicine COVID-19 52

Verisys

DECEMBER 1, 2022

A check of government exclusion lists is essential because many healthcare groups receive financing from federal sources. The goal of healthcare professionals, organizations, and others is to give patients high-quality care while safeguarding them against fraud and abuse. FACIS Level 3 background screening of federal sources.

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Medicaid Medicaid Fraud Governance 52

MedTrainer

NOVEMBER 6, 2023

In this blog post, we’ll break down the fundamental concepts of healthcare compliance plans, exploring their purpose and components. It serves as a structured framework that guides healthcare organizations in adhering to legal requirements, preventing fraud and abuse, protecting patient privacy, and maintaining the highest ethical standards.

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Compliance Fraud Nursing Homes Governance 52

Verisys

DECEMBER 5, 2023

An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs.

Governance 52

Governance Licensing Malpractice Medicaid 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

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

Healthcare Compliance Blog

MARCH 2, 2022

An indictment was filed on February 25, 2022, against ten persons in Florida for their alleged roles in a $67 million healthcare fraud, wire fraud kickback, and money laundering scheme. Healthcare fraud and anti-kickback violations are each punishable by a maximum penalty of 10 years in prison.

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Medicare Medicare Fraud Compliance 45