Healthcare Compliance Blog

JANUARY 10, 2022

A South Carolina man has been arrested for financial transaction card fraud and exploitation of a vulnerable adult who was a resident of a nursing home. Due to his past criminal record, he also faces enhancement to the financial transaction card fraud charge.

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Healthcare Compliance Blog

FEBRUARY 8, 2022

The United States has filed a lawsuit against an Alabama psychiatrist for improper prescribing of Nuedexta to nursing home residents. The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta.

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Nursing Homes Nurses Compliance Medicare 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

MedTrainer

JANUARY 30, 2024

In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them. Nursing Homes: Skilled nursing facilities, long-term care facilities, and other types of nursing homes.

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Governance Compliance Nursing Homes Medicaid 52

Provider Trust

JULY 17, 2023

Their guidance aims to improve a number of potential risks within the healthcare space by improving care at nursing homes and strengthening the program integrity in managed care. OIG pointed to the increased instances of patient neglect abuse as well as the need for oversight within nursing homes.

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Compliance Nursing Homes Nurses Fraud 52

MedTrainer

SEPTEMBER 20, 2023

Examples of covered entities include health plans, clearinghouses, and certain health care providers including but not limited to: doctors, clinics, psychologists, dentists, chiropractors, nursing homes, and pharmacies. There are a number of laws built to fight against Medicare/Medicaid noncompliance and fraud.

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Medicaid Medicaid Medicare Medicare 97

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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MedTrainer

JANUARY 10, 2024

The OIG is making major investments to systematically detect and prosecute fraud. In this guidance it’s clear the OIG expects healthcare organizations and suppliers to understand their role and responsibilities to fight fraud, waste, and abuse. We all should be a LOT more prepared!

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Healthcare Compliance Blog

MAY 11, 2022

The South Carolina Attorney General announced that his office’s Medicaid Fraud Control Unit (SCMFCU) had arrested a 57-year-old woman on two counts of Exploitation of a Vulnerable Adult and two counts of Breach of Trust with Fraudulent Intent, value of $10,000 or more.

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Fraud Nursing Homes Medicaid Medicaid 59

Hall Render

FEBRUARY 27, 2023

This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. Health Care Fraud Actions Medicaid. The Medicaid program was a target in 2022. COVID-10 Related Fraud. It also recovered $70.7 One hospice organization paid $5.5 Standard of Care.

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Nursing Homes Fraud Medicaid Medicaid 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. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. By George F. 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

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. The woman, 45, pleaded guilty to an amended charge of Reckless Conduct (Class A Misdemeanor).

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Nurses Nursing Homes Licensing Fraud 59

MedTrainer

NOVEMBER 6, 2023

While specific compliance requirements vary depending on the type of facility — from large hospitals and surgery centers to clinics and nursing homes — having a well-structured compliance plan is essential for all medical settings. But what exactly is a compliance plan in healthcare, and why is it so crucial?

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Compliance Fraud Nursing Homes Governance 52

YouCompli

JANUARY 4, 2022

Unger, Chief of Medicaid Fraud Division, Office of the Massachusetts Attorney General; and Patrick Callahan, Healthcare Fraud Unit, US Attorney’s Office. Unger reported that her unit is focused on about 65% Medicare fraud and about 35% abuse and neglect. Millions in dollars in fraud are happening this way,” Callahan said.

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Fraud Compliance Elder Abuse Medicaid 40

Med Law Blog

MAY 1, 2023

Howell, Constantine Yannelis and Abhinav Gupta positing that their research shows that “PE ownership increases short term mortality of Medicare patients by 10%, in nursing homes”.

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Nursing Homes Malpractice Hospitals Nurses 52

Hall Render

JULY 12, 2023

Selection Approach In establishing the proposed SFP, CMS examined the Special Focus Facility program for nursing homes and its methodology for facility selection. Hall Render blog posts and articles are intended for informational purposes only. CMS’ goal is to select SFP hospices starting in 2024. Markette, Jr.,

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Medicare Medicare Nursing Homes Fraud 40

Verisys

NOVEMBER 20, 2022

If you are looking for something to read prior to turkey or afterwards, here is a round up of bad actors: Pharma Fraud: . Pharma Fraud. Pharma Fraud . Pharma Fraud. Fraud Scheme. The group steered members to bill Medicaid rather than going through the NICA. Fraud Scheme. Fraud Scheme .

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Fraud Medicaid Medicaid Nursing Homes 52

Healthcare Law Blog

NOVEMBER 16, 2023

Department of Health and Human Services’ Centers for Medicare and Medicaid Services (“CMS”) will publish a final rule requiring Medicare skilled nursing facilities (“SNFs”) and Medicaid nursing facilities (“Facilities”) to provide more detailed ownership, managerial and other information on Form CMS-855A (the “Final Rule”). [1]

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Nurses Medicaid Medicaid Medicare 52

AIHC

FEBRUARY 16, 2024

The GCPG standardized the seven Elements of a Successful Compliance Program, which differs slightly from the individual compliance guidance documents (CPGs) directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers.

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Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

The GCPG standardized the seven Elements of a Successful Compliance Program, which differs slightly from the individual compliance guidance documents (CPGs) directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Hall Render

APRIL 14, 2023

NATIONAL 94% of Organizations Experienced a Cyberattack in 2022 AHA blog: Strengthening crisis management in rural health care Biden signs bill ending Covid-19 national emergency Cancer drug shortages are creating dire circumstances for some patients CMS Releases FY24 IPPS Proposed Rule, Seeks to Boost Rates by 2.8%

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Nursing Homes US Department of Health and Human Services Nurses COVID-19 40

Drug & Device Law

JANUARY 17, 2024

O’Lear is a criminal case, in which the defendant was convicted by a jury of healthcare fraud (billing Medicare and Medicaid for fictitious mobile X-rays at nursing homes) and aggravated identity theft. (The Ninth Circuit okayed such exclusions in a couple of unpublished memoranda dispositions.)

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COVID-19 Nursing Homes Fraud FDA 98