MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

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Total Medical Compliance Resources

MAY 11, 2023

trillion is spent on healthcare in the United States, of which an estimated $60 billion is attributable to fraud and abuse. In order to combat this, HIPAA established the Healthcare Fraud and Abuse Control Program (HCFAC). Criminal Health Care Fraud Statute – 18 U.S.C. Every year a minimum of $4.3

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HIT Consultant

AUGUST 17, 2023

Erin Rutzler, VP of Fraud, Waste, and Abuse at Cotiviti As behavioral health claim volumes continue to increase, there’s a growing need for health plans to be vigilant in spotting fraud, waste and abuse. But not every plan has access to a large SIU to combat fraud, waste and abuse in behavioral health.

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Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas. The psychologist was convicted of four counts of healthcare fraud.

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Nursing Homes Fraud US Department of Health and Human Services Nurses 59

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. Document that the trainings occurred and file the signed document in each employee’s education file.

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Healthcare IT News - Telehealth

JANUARY 27, 2021

Department of Justice announced Monday that four people and one company have recently pleaded guilty in a telemedicine pharmacy healthcare-fraud conspiracy that allegedly lasted for years. "Telemarketing fraud is a major threat to the integrity of government and commercial insurance programs," said Derrick L. ON THE RECORD.

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AIHC

APRIL 5, 2022

Only appeal claims when you have evidence and supporting documentation to substantiate your right to payment. Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. However, it also includes documentation of a supporting diagnosis.

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Med-Net Compliance

JULY 20, 2022

According to court documents and evidence presented at trial, the doctor billed Medicare and Medicaid for an incision procedure of the external ear for hundreds of patients, when in fact all he actually performed was an ear exam or ear wax removal. He was convicted of one count of healthcare fraud and one count of making a false claim.

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Fraud Doctors Medicare Medicare 59

Med-Net Compliance

JULY 11, 2022

The report says that in FY 2021 the DOJ opened 831 new criminal healthcare fraud investigations. Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, and a total of 312 defendants were convicted of healthcare fraud related crimes during the year. 2,947 investigations were pending at the end of FY 2021.

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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.

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COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

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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Fraud Medicare Medicare Overpayments 62

Med-Net Compliance

JUNE 13, 2022

Three independent clinical laboratories, their owner and holding company, an additional independent clinical laboratory and its owner, two laboratory marketing companies, and a Massachusetts physician have been charged in connection with Medicaid fraud, money laundering, and kickbacks involving urine drug tests?that

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Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. Court documents show that between 2008 and 2016 the former owner defrauded the Texas Medicaid program by billing for items and services that had not been provided to the clients of the day care centers. US Attorney Ashley C.

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Fraud Compliance Governance Medicaid 59

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

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Med-Net Compliance

AUGUST 16, 2022

Five individuals and two for-profit skilled nursing facilities (SNFs) in Pennsylvania were indicted on charges of conspiracy to defraud the United States and related healthcare fraud charges. Also review your policies and procedures for accurate billing that is supported by documentation detailing provision of services.

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Healthcare IT News - Telehealth

APRIL 10, 2019

Hundreds of thousands patients were lured into worldwide criminal healthcare fraud schemes involving telemedicine and durable medical equipment (DME) executives, according to the FBI and Department of Justice. WHY IT MATTERS. billion in losses. ON THE RECORD.

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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. As alleged in court documents, medical professionals made referrals for expensive and medically unnecessary cardiovascular and cancer genetic tests, as well as durable medical equipment.

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Fraud Telemedicine Medicare Medicare 59

Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

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Fraud COVID-19 Health Insurance Compliance 59

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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Med-Net Compliance

JUNE 15, 2022

Division of Medi-Cal Fraud and Elder Abuse (DMFEA) and the US Attorney’s Office for the Eastern District of California intervened in the? During the course of the investigation, documentation from his office revealed five categories of medical services which were the focus of the fraudulent billing schemes. prison term?of

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American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare 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. Documentation of this distribution is required.

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Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. Discussion Points: Review your policy and procedure for preventing and reporting false claims, kickbacks, or other fraud, waste, and abuse violations.

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Med-Net Compliance

AUGUST 25, 2022

A Texas physician and his employee were charged for their roles in a healthcare fraud scheme involving the submission of more than $3.5 million was billed to Medicare in connection to the fraud scheme.?. Document that the trainings occurred and place in each employee’s education file. million in claims to Medicare.

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Healthcare Compliance Blog

FEBRUARY 22, 2022

Two women, one from Colorado and the other from Houston, have been sentenced in federal court for their roles a multi-million dollar Medicare Fraud Scheme. Each woman pled guilty to one count of conspiracy to commit healthcare fraud. Document that the trainings occurred and place in each employee’s education file.

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Fraud Medicare Medicare Governance 59

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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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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Fraud Medicare Medicare Compliance 52

Med-Net Compliance

AUGUST 5, 2022

Ensure appropriate staff monitor for potential false claims related to unnecessary or inappropriate services that are unsupported by documentation. Document that the trainings occurred and place in each employee’s education file.

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Medicaid Medicaid Fraud 59

Florida Health Care Law Firm

JANUARY 14, 2022

Attorney arrested 13 people in a $100 Million healthcare fraud scheme in NY and NJ involving automobile insurance claims. Payer and governmental presumption is often that financial motives are driving clinical behavior, NOT documented medical necessity. Some of the facts alleged include—. Unnecessary and painful medical procedures.

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Healthcare Compliance Blog

FEBRUARY 2, 2022

Document that the trainings occurred and place in each employee’s education file. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to false claims. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to false claims.

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Nursing Homes Fraud Medicaid Medicaid 59

American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. The Department of Justice recently revealed charges against 78 individuals involved in healthcare fraud schemes. However, they encounter numerous challenges in achieving this goal.

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Healthcare IT News - Telehealth

MAY 13, 2022

The owners of a national telehealth company pleaded guilty this week to charges of conspiracy to violate the federal Anti-Kickback Statute and to commit healthcare fraud. Law enforcement agencies have ramped up the pressure on telehealth fraud, particularly amid the COVID-19 pandemic. According to a statement released by the U.S.

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Verisys

JANUARY 2, 2024

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Civil Settlement with Total Access Urgent Care Over False Claims Allegations Full story Former Co-Owners of New Jersey Marketing Company Sentenced to Prison in $8.8 Million Compounded Prescription Drug Scheme Full Story Phillips Respironics Pays $2.4

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Compliancy Group

FEBRUARY 7, 2024

CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary. Given their significant impact, healthcare organizations must take UPIC audits seriously.

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Healthicity

JANUARY 23, 2024

The Health and Human Services Office of Inspector General (OIG) recently published General Compliance Program Guidance 1 , and one of the many important sections in the document includes a list of a compliance officer’s primary responsibilities.

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HIPAA Journal

MAY 2, 2024

If they were, class members can claim a cash payment of $50 and can claim up to $7,500 for documented expenses incurred as a result of the data breach, including 3 hours of lost time at $25 per hour, and any unreimbursed losses to identity theft and fraud.

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The Health Law Firm

NOVEMBER 8, 2023

For corporate health care providers involved in a civil health care fraud or abuse investigation, the corporation may be required to enter into a Corporate Integrity Agreement (CIA) with the US Department of Health and Human Services (HHS), Office of Inspector General (OIG) to settle the case. By Michelle E. Missigman, J.D.

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US Department of Health and Human Services Fraud 75

HIT Consultant

JULY 26, 2023

What You Should Know: HealthLock , a leading medical fraud and overbilling protection solution, today unveiled insightful findings from a recent attitudinal study exploring how adults in the United States feel about healthcare, from claims and billing to medical fraud and privacy.

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