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. Often, these test results or durable medical equipment were not provided to the patients or were worthless to their primary care doctors.?. Billion in Healthcare Fraud appeared first on Med-Net.

Fraud 59

Fraud Telemedicine Medicare Medicare 59

The Health Law Firm

MARCH 14, 2022

Board Certified by The Florida Bar in Health Law On March , 2022, a New York ophthalmologist was sentenced to 96 months in prison for fraudulently obtaining two government-guaranteed small business loans and for a seven-year fraudulent healthcare billing scheme, the Justice Department announced. Indest III, J.D.,

COVID-19 98

COVID-19 Fraud Governance Doctors 98

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

Florida Health Care Law Firm

DECEMBER 7, 2021

Telemedicine pharmacy arrangements continue to be of significant interest to fraud enforcement. The federal jury trial in the billion-dollar telehealth pharmacy fraud scheme resulted in conviction on 22 counts of mail fraud, conspiracy to commit health care fraud and introduction of misbranded drugs into interstate commerce.

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Fraud Telemedicine Governance Compliance 40

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

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Fraud Medicaid Medicaid Doctors 98

Kaiser Health News

APRIL 16, 2024

District Court for the Southern District of Florida, two such call centers paid tens of thousands of dollars a day to buy names of people who responded to misleading advertisements touting free government “subsidies” and other rewards.

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ACA Health Insurance Governance Medical Billing 137

Healthcare IT News - Telehealth

AUGUST 11, 2021

Grimm: "It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse or misuse." "This is going to be a whole-of-government and whole-of-industry approach," he added. billion, with a B, of alleged fraud.

US Department of Health and Human Services 149

US Department of Health and Human Services Fraud Medicare Medicare 149

The Health Law Firm

DECEMBER 24, 2016

Board Certified by The Florida Bar in Health Law On December 7, 2016, Banio Koroma was convicted in a northern Illinois court of falsely certifying elderly patients for in-home care will spend the next three years in prison and be forced to reimburse the government for the $1.5 Indest III, J.D., Paying For His Crimes.

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Fraud Medicaid Medicaid Doctors 40

American Medical Compliance

JANUARY 9, 2024

This type of theft is just one example of healthcare fraud. Through Medicare, Medicaid, and the Children’s Health Insurance Program, the federal government and state governments offer health care coverage to nearly 100 million individuals. trillion in 2015. trillion in 2015.

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

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Fraud Medicaid Medicaid Medicare 52

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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Fraud Medicare Medicare COVID-19 52

Verisys

FEBRUARY 24, 2023

At the emergency room, the doctors begin a series of tests to discover what’s wrong with her knee. It will take months for her to recover, and as she does, Sue will visit multiple clinics and doctors. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52

Verisys

FEBRUARY 24, 2023

At the emergency room, the doctors begin a series of tests to discover what’s wrong with her knee. It will take months for her to recover, and as she does, Sue will visit multiple clinics and doctors. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 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. The defendants allegedly paid kickbacks and bribes to telemedicine companies in exchange for doctors’ orders for tests and durable medical equipment.

Medicare 45

Medicare Medicare Fraud Compliance 45

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. State licensing boards verify practitioner license type and status. The policy issuer for malpractice insurance verifies insurance coverage. .…

Governance 52

Governance Licensing Malpractice Medicaid 52

The Health Law Firm

JUNE 30, 2015

For over three decades, the American Medical Association (AMA), a prominent physician group in the United States, had successfully argued that a doctor’s right to privacy outweighed the public’s interest in knowing how its tax dollars were used.

Medicare 40

Medicare Medicare Fraud Doctors 40

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. They were alleged to have paid doctors to prescribe DME with no patient interaction or only a brief telephonic conversation. Some The $73 million fraud scheme was discovered and busted. 

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Fraud Compliance Medicare Medicare 52

YouCompli

AUGUST 22, 2023

Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs. OIG’s audits, evaluations, and investigations have demonstrated that risks of fraud, waste, and abuse in managed care are real and significant.”

Medicare 52

Medicare Medicare US Department of Health and Human Services Compliance 52

YouCompli

OCTOBER 17, 2023

The government alleged that the provider knowingly caused false claims to be submitted by billing for E&M services at a higher rate of reimbursement than they were entitled to. The Justice Department also reported that the doctor instructed employees to bill for both COVID-19 testing, and high-level evaluation and management visits.

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COVID-19 Compliance Fraud Doctors 52

Kaiser Health News

NOVEMBER 11, 2021

Yet federal officials say complaints are rising from seniors tricked into buying policies — without their consent or lured by questionable information — that may not cover their drugs or include their doctors. She found out when she visited her doctor, who did not accept her new insurance.

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Medicare Medicare Doctors Fraud 144

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. Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

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Compliance Licensing Governance Fraud 52

HIT Consultant

DECEMBER 18, 2023

Doctors remotely manage patient data without being tied to a specific medical facility. Confidentiality Laws and regulations govern the confidentiality of medical data. In contrast, Electronic Medical Records capture information about specific visits to a doctor or medical facility, circulating within one institution.

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Electronic Medical Records Doctors HIPAA Pharmaceutical Industry 99

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. That figure does not include even more funds recovered for state Medicaid programs. ” Medicare Part C.

Fraud 40

Fraud Governance Medicare Medicare 40

Healthcare IT Today

DECEMBER 15, 2023

Doctors remotely manage patient data without being tied to a specific medical facility. Confidentiality Laws and regulations govern the confidentiality of medical data. In contrast, Electronic Medical Records capture information about specific visits to a doctor or medical facility, circulating within one institution.

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Electronic Medical Records Doctors HIPAA Hospitals 98

Health Law Blog

MAY 22, 2018

Substance Abuse Treatment Center Fraud Scheme Results in Guilty Plea. The Department of Justice recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.”

Fraud 52

Fraud Overpayments Overpayment Licensing 52

Verisys

FEBRUARY 23, 2022

As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Facilities increasingly rely on healthcare compliance officers (HCOs) to bridge the gap between government regulation and daily operations.

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Compliance Officers Compliance US Department of Health and Human Services Governance 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. Further, Ms.

Licensing 52

Licensing Fraud Compliance Nurses 52

Verisys

MARCH 1, 2022

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. Government and Non-Government Sources. State licensing boards verify practitioner license type and status. National Practitioner Data Bank (NPDB).

Governance 52

Governance Licensing Malpractice Medicaid 52

YouCompli

JULY 12, 2022

National fraud takedown: $1.1 Department of Justice (DOJ) announced a national health care fraud enforcement action involving over $1.4 This announcement included nationwide criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals. In Fall 2021, the U.S.

COVID-19 52

COVID-19 Medicare Medicare Telemedicine 52

YouCompli

APRIL 13, 2022

The government contended the inducements were in the form of free blood glucose testing supplies and waiver of co-payments and deductibles for insulin. The whistleblower who brought this to the attention of the government worked in the business office and was privy to the waiving of copayments. million dollars.

Medicare 40

Medicare Medicare Governance Compliance 40

MedTrainer

FEBRUARY 27, 2024

And like any healthcare professional, HHAs must adhere to the compliance standards that govern quality care. HHAs are trained to make positive differences for people dealing with disabilities or chronic conditions.

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Compliance HIPAA Fraud Licensing 52

HIT Consultant

MAY 4, 2023

If a doctor, nurse, or other hospital employee sees a suspicious package in a hallway, chances are good they will alert the physical security department who will take appropriate measures. As organizations harden their security posture in response to specific threats, new threats emerge that companies may not be aware of.

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Hospitals Regulatory Compliance HIPAA Compliance 91

AIHC

MARCH 2, 2023

At this particular time, I was also a commissioner in city government and was active among many charitable organizations. The role of Compliance Officer for an association with 200 doctors had its challenges. I have also added the CFE, Certified Fraud Examiner through the Association of Certified Fraud Examiners.

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Compliance Officers Compliance Fraud Medical Billing 52

AIHC

APRIL 10, 2024

We can own a Durable Medical Equipment store, see our own doctor, or go and have a test done at a medical facility. Does your organization have materials for patient education and risks of identity theft and medical fraud? Patient information is everywhere. Each of these can cause exposure on behalf of patient information.

Compliance 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

Hall Render

JULY 28, 2023

million for rural hospital expansion Hospices in Arizona & other states receive scrutiny over concerns of fraud, waste & abuse Phoenix Children’s Building New 44,000-Square Foot Level IV Neonatal Intensive Care Unit Firefighters oppose Banner’s planned $400M hospital There’s a growing nurse shortage in Arizona.

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

AIHC

APRIL 10, 2024

We can own a Durable Medical Equipment store, see our own doctor, or go and have a test done at a medical facility. Does your organization have materials for patient education and risks of identity theft and medical fraud? Patient information is everywhere. Each of these can cause exposure on behalf of patient information.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

Compliancy Group

FEBRUARY 9, 2022

Covered entities (like a doctor, clinic, or hospital) and their business associates (like a billing service or payment processor) must protect the rights and privacy of patients as part of their HIPAA compliance strategy. Their security protections include 24/7 monitoring, fraud detection, firewalls, and encryption.

HIPAA 52

HIPAA Compliance Fraud Doctors 52