Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. Since then, the FCA has changed significantly.

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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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Med-Net Compliance

JUNE 22, 2022

A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud. Update your policies as needed.

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Healthcare Law Blog

MAY 11, 2023

The Department of Health and Human Services Office of Inspector General (OIG) recently announced changes to its process for informing healthcare industry stakeholders of new or updated Compliance Program Guidance (CPG). Historically, sector-specific CPG has been published in the Federal Register.

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Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.

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Verisys

JUNE 8, 2023

Data Compliance: How to Identify and Close Data Risk Gaps Using Technology A three-part compliance series that focuses on using technology to help you achieve your compliance goals. Hiring a provider with red flags, even if in the past, can put your organization at risk for non-compliance. Fraud Data Gap The U.S.

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Med-Net Compliance

SEPTEMBER 20, 2022

The defendant was also convicted for falsification of records designed to prevent detection of this fraud and aggravated identity theft for falsely corresponding with Medicare under the name of another physician. Million Healthcare Fraud Scheme appeared first on Med-Net. He is scheduled to be sentenced on Jan.

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Hall Render

NOVEMBER 10, 2023

Department of Health and Human Services (“HHS”) issued new General Compliance Program Guidance (“GCPG”) for members of the health care compliance community and other health care stakeholders. Key Highlights of the GCPG Much of what is covered in the GCPG is not new to the health care compliance industry.

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HIPAA Journal

OCTOBER 21, 2022

A pharmaceutical sales rep has pleaded guilty to conspiring to commit healthcare fraud and wrongfully disclosing and obtaining patients’ protected health information in an elaborate healthcare fraud scheme involving criminal HIPAA violations. Alario pleaded guilty to his role in the healthcare fraud scheme earlier this month.

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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. Donna Thiel, Chief Compliance Officer at ProviderTrust, said, “It’s an opportunity to promote partnership between HR and compliance.

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AIHC

MAY 24, 2022

Once your suspicions have been reported to the Compliance Officer, were you asked to partake in evidence gathering during the investigation? Forensic investigations are specialized in nature, and the work requires detailed knowledge of fraud investigation techniques and the legal framework.

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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. That mean, maintaining compliance standards, efficient reporting, and conducting thorough internal audits are vital.

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Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors?

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Med-Net Compliance

JULY 26, 2022

In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds. Discussion Points: Review policies and procedures regarding the use of telemedicine within the facility and related requirements for preventing fraud, waste, and abuse of government funds.

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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. Practical Takeaways.

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C&M Health Law

DECEMBER 18, 2023

Department of Health and Human Services (HHS) published the General Compliance Program Guidance (GCPG) on November 6, 2023. The GCPG provides updated descriptions of the seven elements of an effective compliance program that health care entities have long relied upon. The Office of the Inspector General (OIG) of the U.S.

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Healthcare IT News - Telehealth

JUNE 8, 2022

based attorney in the health law practice of Baker, Donelson, Bearman, Caldwell & Berkowitz about what providers should be doing to ensure compliance when the PHE finally sunsets. What do you see as the primary compliance issues providers will have to contend with? We spoke recently with Allison M. Cohen, a Washington, D.C.-based

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Healthcare IT News - Telehealth

JUNE 28, 2021

" VanLandingham, who is senior counselor, Medicaid Policy/Acting Health IT at the agency, will be presenting at HIMSS21 this summer, HHS-OIG colleague, Assistant Inspector General for Legal Affairs Lisa Re. " VanLandingham explained that the healthcare fraud space gets "tens of thousands of complaints."

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Healthicity

SEPTEMBER 30, 2022

The explosion of telehealth since 2020 means auditors, compliance managers, and regulators are scrambling.

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Healthcare IT Today

DECEMBER 21, 2023

The following is a guest article by Mitchell Perry, VP Compliance & Security at Access In the ever-evolving landscape of healthcare IT in US healthcare frameworks, integrating electronic health records (EHRs) has become a cornerstone for providers. If healthcare providers fail to comply, the consequences can be costly.

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Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. OIG may exclude the provider if certain circumstances regarding the ownership are present. However, healthcare receives federal funding, and thus OFAC is an additional sanction list that you should add to your vendor compliance plan/program. Case Study: S. Martino-Fleming v.

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Health Care Law Brief

JUNE 2, 2022

For the reasons discussed below, DTC telehealth platforms should re-visit their compliance plans and be prepared for increased state and federal regulatory scrutiny. Variety of Risks Present in Telehealth Arrangements. How will data be used for marketing, in compliance with applicable laws, including HIPAA? Provider Licenses.

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Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. The risk categories are described as follows: Highest Risk—Exclusion: Parties that the OIG determines present the highest risk of fraud will be excluded from Federal healthcare programs to protect those programs and their beneficiaries.

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Med-Net Compliance

JULY 13, 2022

Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud. Participating in the fraud can result in the person(s) being prosecuted.?. Update your policies as needed.

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MedTrainer

SEPTEMBER 20, 2023

Watch this one-demand webinar for insider tips straight from seasoned compliance surveyors. The Joint Commission (TJC) is another national accreditation organization, whereby a healthcare facility that has met Medicare’s requirements and passed a survey can achieve “deemed status.” Compliance. What Is the Scope of a CMS Inspection?

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Healthcare It News

DECEMBER 5, 2022

" Community also said that the investigation has not found evidence that misuse or fraud has occurred as a result of the breach, and it "cannot say with certainty what information was involved."

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Healthcare Law Blog

MAY 8, 2023

Department of Health and Human Services (“HHS”) is responsible for detecting and preventing fraud, waste, and abuse in federal health care programs. Upon request from health care providers and others, the OIG periodically issues advisory opinions concerning the application of fraud and abuse laws to existing or proposed business arrangements.

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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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Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance.

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Hall Render

JANUARY 11, 2023

The Tool presents developers of mobile health apps with a series of questions to help them understand which federal laws and regulations may apply. The Tool does not present a comprehensive list of laws and regulations that may apply to mobile health apps. Regulatory Landscape. Practical Takeaways.

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AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. Diagnosis codes are an important compliance aspect of reporting medical necessity on the claim. Can the investigators “get it wrong”? They can, sometimes!

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Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

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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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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. Donna Thiel. Linkedin.

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Medisys Compliance

OCTOBER 20, 2023

Common Billing Challenges in Emergency Medicine Billing for emergency medical services presents unique challenges, including: Accurate Coding for High-Acuity Services: Emergency medicine involves a wide spectrum of high-acuity services, each requiring precise coding to ensure proper reimbursement.

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HIT Consultant

NOVEMBER 2, 2023

Consequently, businesses should always be ready to handle fraud reports, regardless of their merit. Carry Out Compliance Training Having the best policies and procedures is futile if employees lack the knowledge to integrate them into their daily tasks.

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McGuire Wood

OCTOBER 2, 2023

Further, if ancillary services are involved, there should be analysis to confirm compliance with the Stark Law and the AKS. If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure. DOJ Voluntary Self-Disclosure.

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