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.

Fraud 52

Fraud Medicaid Medicaid Medicare 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. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders.

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

YouCompli

JULY 12, 2022

In fact, Medicare beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. An initial report from the OIG also notes that, “over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than two in five Medicare beneficiaries.

COVID-19 52

COVID-19 Medicare Medicare Telemedicine 52

Healthcare Law Today

JANUARY 11, 2023

As part of a deferred prosecution agreement, which must be approved by the court, Jet Medical admitted that it distributed misbranded devices and agreed to implement enhanced compliance measures. violated the False Claims Act by causing medical providers to submit false claims to Medicare. and Martech Medical Products Inc.,

FDA 59

FDA Governance Medicare Medicare 59

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”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud.

Licensing 52

Licensing Fraud Compliance Nurses 52

Healthcare Law Blog

DECEMBER 12, 2022

The COVID-19 Public Health Emergency (“PHE”) led to a rapid expansion in the utilization of telehealth. Now, almost three years later, governmental entities have focused their attention on telehealth services and the potential for fraud and abuse. in healthcare fraud for fraudulent telemedicine schemes. Looking Forward.

COVID-19 52

COVID-19 Fraud Telemedicine Public Health 52

Healthcare IT News - Telehealth

APRIL 18, 2022

PPOA is also accused of allegedly submitting or causing the submission of false claims to Medicare by billing for qualitative and quantitative urine drug testing in violation of the physician self-referral law. Department of Health and Human Services Office of Inspector General, under which it will undertake compliance efforts.

COVID-19 140

COVID-19 Telemedicine Fraud Public Health 140

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. Health Care Fraud Actions. ” Medicare Part C. ” Medicare Part C. Boynton of the DOJ Civil Division.

Fraud 40

Fraud Governance Medicare Medicare 40

HIT Consultant

NOVEMBER 24, 2022

– Delivery model : Whether to ship OTC products to a hearing clinic where the consumer can receive professional diagnosis, fitting and support, or ship directly to the consumer’s home thereby providing convenience but no professional support (and increased fraud risk), or offer both options? 4 And compliance decrease over time. .

FDA 98

FDA Public Health Medicare Medicare 98

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Medicare covers many telebehavioral and telemental health services including audio-only services.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 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. Over 77% of the funds recovered were related to the health care industry, which shows the federal government’s commitment to enforcing the FCA. Health Care Fraud Actions Medicaid.

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

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. Each state has a department or agency dedicated to upholding the integrity of Medicaid programs and public health.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Health Law Advisor

APRIL 13, 2023

Department of Health and Human Services’ Office of Inspector General (“OIG”) updated its Frequently Asked Questions (“FAQs”), drafting 13 FAQs aimed at easing the transition from COVID-era flexibilities to the end of the Public Health Emergency (“PHE”) on May 11, 2023. 1395nn) (“Stark Law”) from AKS exceptions.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

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

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

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

Healthcare IT News - Telehealth

NOVEMBER 22, 2021

A survey put forward by the national healthcare, life science and workforce management law firm Epstein Becker Green found that telemental health services have increased in quantity this year – as have fraud-related enforcement actions at the state and federal levels. Healthcare IT News is a HIMSS Media publication.

Fraud 181

Fraud COVID-19 Medicare Medicare 181

Healthcare IT News - Telehealth

SEPTEMBER 28, 2022

Accountable Care Compliance & Legal Government & Policy Telehealth Workforce Healthcare organizations must urge the Senate to pass critical telehealth legislation, and enact at least a two-year extension of the important PHE-era policies while working toward a permanent solution. In January 2020, then-Secretary of the U.S.

COVID-19 125

COVID-19 Public Health US Department of Health and Human Services Medicare 125

Healthcare IT News - Telehealth

SEPTEMBER 27, 2022

Accountable Care Compliance & Legal Government & Policy Telehealth Workforce Healthcare organizations must urge the Senate to pass critical telehealth legislation, and enact at least a two-year extension of the important PHE-era policies while working toward a permanent solution. In January 2020, then-Secretary of the U.S.

COVID-19 114

COVID-19 Public Health US Department of Health and Human Services Medicare 114

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

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.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

Healthcare Law Blog

NOVEMBER 30, 2022

During the COVID-19 pandemic, Medicare coverage expanded to include a vast arsenal of tools that help patients access medical services while keeping patients and practitioners safe. Department of Health & Human Services (“HHS”) declared a Public Health Emergency (the “PHE”). When does the PHE current expire?

Medicare 52

Medicare Medicare COVID-19 Fraud 52

Hall Render

FEBRUARY 23, 2024

billion is attributed to cases involving the health care industry, including managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities and physicians. Health Care Fraud Actions Medicare Advantage. Another Medicare Advantage plan provider agreed to pay $22.5

Compliance 71

Compliance Governance Medicare Medicare 71

Hall Render

SEPTEMBER 1, 2023

ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M million to Resolve False Claims Act Allegations Michigan Pain Center Owner Pays $6.5M

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Health Law Advisor

MAY 3, 2022

On April 20, 2022, the Department of Justice (DOJ) announced a nationwide coordinated enforcement action targeting COVID-19-related fraud involving charges against 21 individuals across nine federal districts, and over $149 million in alleged false claims submitted to federal programs. [1]. 2] See id. [3] 2] See id. [3] 2] See id. [3]

COVID-19 52

COVID-19 Fraud COVID-19 Vaccine Medicaid 52

Health Law Advisor

MARCH 7, 2023

The proposed rules also clarify that a telemedicine encounter that results in a controlled substance prescription requires the health care professional treating the patient to use an interactive telecommunications system, and directly refers to the Medicare definition of that term at 42 C.F.R. Impact on Pharmacies.

Telemedicine 52

Telemedicine COVID-19 FDA Compliance 52

Hall Render

SEPTEMBER 16, 2022

4 Health Systems Join Provider-Created Data Collective to Improve Care. Full 4th Circuit to tackle Medicaid fraud standard under False Claims Act. House passes reform to Medicare Advantage prior authorizations. Main Line Health shifts pediatric affiliation to CHOP after 25 years with Nemours. Mark Cuban-backed D.C.

US Department of Health and Human Services 40

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

AIHC

MARCH 28, 2022

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?

Medicare 52

Medicare Medicare Compliance Governance 52

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.

Fraud 73

Fraud FDA Medicaid Medicaid 73

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. Hospice 36-Month Rule. Deactivation.

Medicare 40

Medicare Medicare Payment Systems 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. 1395m(m)(4)(C). [4] 2617 § 4113(b). [5] 5] 42 U.S.C. 1395m(m)(4)(E). [6]

Fraud 52

Fraud Nurses Telemedicine COVID-19 52

Hall Render

MAY 19, 2023

Supplemental Grant for Rural Health Programs UAMS to Study Affordable Care Act’s Impact on Breast Cancer Treatment Arkansas Children’s Hospital Auxiliary Donates $1.4 Supplemental Grant for Rural Health Programs UAMS to Study Affordable Care Act’s Impact on Breast Cancer Treatment Arkansas Children’s Hospital Auxiliary Donates $1.4

Nurses 40

Nurses COVID-19 Hospitals Nursing Homes 40

Hall Render

MARCH 31, 2023

County-owned buildings facing potential earthquake risk Gilead drops option to buy cancer therapeutics company Health and Life Organization Inc. in 2022, survey finds Senate votes to end COVID-19 national emergency Why are 600+ rural hospitals at risk of closing? buys industrial property in Rancho Cordova for $5.12

US Department of Health and Human Services 40

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

Hall Render

FEBRUARY 18, 2022

13-year Medicare payment dispute will return to HHS, court rules. Lawmakers call on Biden to end public health emergency. Only 14% of Hospitals Met Price Transparency Rule Compliance. Florida physician convicted of $110M fraud. Florida Health System Uses AI to Predict Hepatitis C Treatment Outcomes.

COVID-19 40

COVID-19 Nursing Homes Nurses COVID-19 Vaccine 40

Hall Render

AUGUST 19, 2022

CDC, amid criticism for COVID-19 response, plans reorganization as public health threats grow. Stockton Doctor and Medical Practice Agree to Pay Nearly $2 Million to Resolve Allegations of Health Care Fraud. UC San Diego Health names new CIO. United Health Centers says patient data was stolen. NEW MEXICO.

COVID-19 40

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

Hall Render

SEPTEMBER 23, 2022

Amazon PillPack Founders to Leave in Latest Health-Care Shakeup. Congress presses Meta about health data privacy after hospitals remove Facebook tracker. Healthcare Compliance Will Be a Challenge in Post-PHE World. Health systems grow apprenticeships to tackle shortages. Centura Health trims 1% of workforce.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

MARCH 3, 2023

million for youth mental health care KENTUCKY Pike County nursing home officials release statement following loss of Medicare agreement Three Humana executives drop $11.2M

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40