Healthcare IT News - Telehealth

SEPTEMBER 20, 2021

Department of Justice announced this past week that it was bringing criminal charges against 138 total defendants for their alleged participation in various healthcare fraud schemes, resulting in about $1.4 billion in alleged losses. More than $1.1 billion of that loss involved allegedly fraudulent claims related to telemedicine.

Fraud 166

Fraud Telemedicine Medicare Medicare 166

Healthcare Compliance Blog

FEBRUARY 2, 2022

The optician fraudulently received approximately $74,000 in Medicaid payments between 2016 and 2019 by billing for the optician services that were not provided. Document that the trainings occurred and place in each employee’s education file.

Nursing Homes 59

Nursing Homes Fraud Medicaid Medicaid 59

Healthcare Compliance Blog

MAY 10, 2022

An ineligible Medicaid provider was arrested in Florida for defrauding Medicaid of more than $68,000. According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application.

Medicaid 59

Medicaid Medicaid US Department of Health and Human Services Fraud 59

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?

Fraud 52

Fraud Compliance Governance Compliance Officers 52

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.

Nursing Homes 59

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

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

Healthcare Compliance Blog

MAY 2, 2022

A behavior analyst who was employed by a Florida home health agency has been arrested for Medicaid fraud. The man provided behavior analyst services for three Medicaid recipients, all of whom had disabilities. The parent of one of the children noticed incorrect information on a Medicaid online portal and reported it.

Medicaid 59

Medicaid Medicaid Fraud 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.

Fraud 59

Fraud Compliance Medicaid Medicaid 59

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.

Fraud 59

Fraud Compliance Governance Medicaid 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.

Fraud 59

Fraud US Department of Health and Human Services Medicare Medicare 59

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. Billing Medicare or Medicaid for services that were not provided is fraudulent activity that is often punishable by fines and imprisonment.

Fraud 59

Fraud Nurses Medicaid Medicaid 59

Medisys Compliance

APRIL 19, 2023

The Medicaid program in Florida provides medical services and assistance to low-income individuals and families. To participate in the Medicaid program, healthcare providers must meet several general requirements set forth by the Agency for Health Care Administration (AHCA).

Medicaid 52

Medicaid Medicaid Medical Billing Outsourcing Licensing 52

Healthcare Law Blog

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

Medicaid 52

Medicaid Medicaid Compliance Overpayments 52

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.

Fraud 52

Fraud Compliance Medicare Medicare 52

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. Additionally, the Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), announced that it took administrative actions against 52 providers involved in similar schemes.

Fraud 59

Fraud Telemedicine Medicare Medicare 59

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. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

Fraud 52

Fraud Medicare Medicare Compliance 52

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

Fraud 59

Fraud Doctors Elder Abuse Medicare 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.

Fraud 52

Fraud Nursing Homes Nurses Medicaid 52

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

Fraud 52

Fraud Compliance Medicare Medicare 52

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.

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds.

Medicaid 59

Medicaid Medicaid Compliance Governance 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.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These audits should occur once per year.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

Med-Net Compliance

JUNE 16, 2022

Attorney General John O’Connor announced that a former Oklahoma-based medical supply company has agreed to pay $363,116 to resolve allegations that the company violated the Oklahoma Medicaid False Claims Act by inflating prices and shipping charges of durable medical equipment. Update policies and procedures as needed.

Fraud 59

Fraud Medicaid Medicaid Medicare 59

MedTrainer

SEPTEMBER 20, 2023

If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Accreditation.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

Compliancy Group

MAY 15, 2024

OIG compliance and compliance training intends to help hospitals protect patient health and safety, prevent fraud and abuse, ensure legal and regulatory compliance, and safeguard patient privacy, making it an invaluable tool for success. Billing Integrity Hospitals must ensure that all billing practices adhere to federal laws and regulations.

Compliance 52

Compliance Hospitals Fraud Regulatory Compliance 52

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. Remember: If it isn’t documented, it didn’t happen.

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Document that these trainings occurred and file the signed document in each employee’s education file.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

MedTrainer

JANUARY 12, 2024

Here are some of the key organizations involved in regulating healthcare compliance: Centers for Medicare & Medicaid Services (CMS): CMS is a federal agency within the U.S. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

HIPAA Journal

JUNE 28, 2023

The total settlement fund has not been disclosed; however, all class members are entitled to claim up to $1,500 as reimbursement for ordinary expenses, which are documented expenses that were incurred as a result of the data breach. A lawsuit – Young, et al.

Hospitals 76

Hospitals Fraud Licensing HIPAA 76

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. Update as needed.

Fraud 59

Fraud Nursing Homes Medicaid Medicaid 59

Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Compliance Medicaid 59

Med-Net Compliance

SEPTEMBER 14, 2022

A subsequent investigation by DPH resulted in a suspension of the aide’s license and a referral to the Attorney General’s Medicaid Fraud Division. Document that the training occurred, and record in each employee’s education file.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Medicaid Medicaid 59

Med-Net Compliance

SEPTEMBER 23, 2022

A physician pleaded guilty in federal court to falsely certifying that products and tests were medically necessary for more than 2,000 Medicare and Medicaid patients in Missouri whom he never met or examined. Accordingly, he knew his false and fraudulent statements and documents were untrue when he made them.

Fraud 59

Fraud Medicaid Medicaid Telemedicine 59

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

The Health Law Firm

OCTOBER 7, 2022

This agency investigates allegations of fraud, waste, and abuse against Medicare, Medicaid, and other federally funded healthcare programs. These subpoenas are very broad, usually requiring the production of thousands of pages of documents. Indest III, J.D., Click here to see a sample of a subpoena duces tecum issued by the OIG.

US Department of Health and Human Services 52

US Department of Health and Human Services Fraud Medicaid Medicaid 52