Due Diligence and Fraud - Health Care Compliance Brief

Your Healthcare Compliance Due Diligence Checklist

Compliancy Group

MARCH 25, 2024

A healthcare compliance due diligence checklist is one essential tool that can help organizations in their quest for compliance. What is a Healthcare Compliance Due Diligence Checklist? A healthcare compliance due diligence checklist outlines the steps and processes to ensure organizational compliance.

Due Diligence

Due Diligence Compliance Informed Consent Fraud

Is Your Data Supply Chain Ethical? Don’t Restrict Due Diligence to Physical Operations.

C&M Health Law

JUNE 15, 2021

bribery, fraud, misuse). What’s more, core human rights due diligence principles, such as the United Nations Guiding Principles on Business and Human Rights (UNGPs), further influence how businesses should navigate these risks. Rightfully so, as compounding risks in physical production and movement of goods abound upstream (e.g.,

Due Diligence

Due Diligence Licensing Informed Consent HIPAA

New Safe Harbor and General Compliance Program Guidance Provides Opportunity for Buyers to Mitigate Litigation and Fraud Risk

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. But robust pre-closing due diligence is not always practicable. Conduct a thorough risk assessment of seller’s compliance program.

Compliance

Compliance Due Diligence Fraud Governance

Another Resolution by DOJ Pursuant to its Civil Cyber-Fraud Initiative Highlights Continued Efforts to Hold Companies Accountable for Ensuring Data are Secured

Health Care Law Brief

JUNE 5, 2023

We previously wrote about the United States Department of Justice’s (“ DOJ ”) Civil Cyber-Fraud Initiative (“ CCFI ”), which “aims to hold accountable entities or individuals that put U.S. FHKC shut down its website’s application portal shortly thereafter.

Fraud

Fraud Due Diligence Medicaid Medicaid

Changing Tides: DOJ Announces a New Safe Harbor Policy for Voluntary Self-Disclosure in M&A Transactions

Hall Render

NOVEMBER 1, 2023

This Safe Harbor Policy (“Policy”) is aimed at incentivizing acquiring companies to identify and timely disclose misconduct discovered during the due diligence and post-acquisition integration process. Transactions that might have been abandoned or restructured due to the discovery of misconduct can now potentially move forward.

Due Diligence

Due Diligence Compliance Fraud

Settlement Agreed with Florida Children’s Health Insurance Website Contractor to Resolve False Claims Act Allegations

HIPAA Journal

MARCH 15, 2023

While Jelly Bean Communications Design acted as a business associate under HIPAA, the action was taken over violations of the False Claims Act under the Department of Justice’s 2021 Civil Cyber-Fraud Initiative. Attorney’s Office for the Middle District of Florida, with assistance provided by HHS-OIG.

Health Insurance

Health Insurance HIPAA Due Diligence Fraud

PE Firms Face Liability for the Conduct of their Portfolio Companies: Are you Paying Attention?

Healthcare Law Blog

APRIL 3, 2023

These concerns come about as part of an evolving emphasis by the government on preventing fraud and abuse in health care. Participants also discussed the use of the False Claims Act (“FCA”) as a tool for healthcare fraud enforcement. On March 25, 2021, the U.S. The case ultimately settled, with the PE firm paying $1.5

Due Diligence

Due Diligence Governance Fraud Compliance

8 Common Provider Credentialing Mistakes and How to Avoid Them

Verisys

JULY 20, 2023

3: Allowing a physician to treat patients before credentialing is completed Courts have held hospitals liable when a physician falsifies credentials, and the hospital fails to do its due diligence in verifying them. Therefore, due diligence requires background checks to identify current and historical adverse actions.

Due Diligence

Due Diligence Malpractice Licensing Hospitals

Achieving Transparency: How to Close a Critical Gap in Healthcare Compliance

Verisys

JULY 27, 2023

Backed by FACIS ® ( Fraud Abuse Control Information System ), the most comprehensive data platform in the healthcare industry, the accuracy of Verisys’ screening, verification, and monitoring services exceeds the standard set by the Office of Inspector General (OIG). Verisys was created over 30 years ago to address this very issue.

Compliance

Compliance Due Diligence Licensing Fraud

Seven Elements of a Compliance Program

HIPAA Journal

MARCH 30, 2023

This was in response to the growing level of healthcare fraud and abuse and an alleged “compliance disconnect” at the executive level in many hospitals and health systems. The biggest influence for the creation of the seven elements of a compliance program (fraud prevention) is sometimes overlooked.

Compliance

Compliance Compliance Officers Fraud HIPAA

Achieving Transparency: How to Close a Critical Gap in Healthcare Compliance

Verisys

JULY 5, 2023

That is, until there is a fine, civil monetary penalty, or public lawsuit caused by patient negligence or fraud. Verisys performs verification and due diligence on all possible matches identified through the screening process to determine true and correct matches. Verisys was created over 30 years ago to address this very issue.

Compliance

Compliance Due Diligence Licensing Fraud

What is a HIPAA Violation?

HIPAA Journal

DECEMBER 31, 2022

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was introduced to simplify the administration of healthcare, eliminate wastage, prevent healthcare fraud, and ensure employees could maintain healthcare coverage between jobs. What is HIPAA and Who Does It Apply To? What is considered a HIPAA violation?

HIPAA

HIPAA Due Diligence Compliance Fraud

Top Security Certifications Required for Data Protection

HIT Consultant

FEBRUARY 9, 2023

PCI DSS – The Payment Card Industry Data Security Standard (PCI DSS) is a set of security requirements that helps organizations protect their payment systems from data breaches, fraud, and theft of cardholder data. Organizations must require their cloud vendors to be third-party audited.

Regulatory Compliance

Regulatory Compliance Due Diligence Compliance Compliance Framework

7 Key Value-Adding LOI Terms

Healthcare Law Blog

FEBRUARY 2, 2023

We commonly see definitions of “Fraud”, “Debt”, “Knowledge”, “Loss” and “Material Adverse Effect” (as well as “Fundamental Representations” and “Specified Representations”, as noted above) specified in LOIs or in schedules thereto. Schedule certain defined terms. Define purchase price adjustments.

Due Diligence

Due Diligence Fraud Compliance

Understanding Compliance for Healthcare Vendors

Provider Trust

MAY 17, 2022

For healthcare organizations, vendor services require a more thorough and specific due diligence in order to assess risk and to document compliance with any or all of the following regulations and laws listed below: . How to ensure vendor compliance.

Compliance

Compliance Medicare Medicare Due Diligence

Part 1: Basics of Artificial Intelligence (AI) and Healthcare Compliance

AIHC

JUNE 6, 2023

Due-diligence is necessary to ensure their system has been tested, is compliant to government and payer standards and is affordable moving forward as AI evolves and our system or contract service with the company advances. AI technology would empower these professionals. Beware of new companies offering such services.

Compliance

Compliance Medical Billing HIPAA Due Diligence

Caveat Emptor: Private Equity Firms Are Increasingly Vulnerable to Qui Tam Lawsuits

Health Law RX

AUGUST 10, 2021

It based its position on the grounds that Ancor, through its due diligence prior to the purchase of Alliance, learned about the alleged conduct and had the ability to remedy the conduct after the closing of the transaction. The DOJ also contended that Ancor caused Alliance to submit false claims to governmental programs.

Due Diligence

Due Diligence Compliance Governance Fraud

How HHS-OIG, Regulators Enforce Vendor Compliance

Provider Trust

MAY 18, 2022

This case is unique as the private equity firm that funded the purchase of South Bay facilitated, and its partners paid for part of the damages given the PE firm’s role and knowledge gained during due diligence and review of the operations and billing practices of South Bay. Get Daily Vendor Monitoring.

Compliance

Compliance Due Diligence Medicaid Medicaid

Part 1: Basics of Artificial Intelligence (AI) and Healthcare Compliance

AIHC

JUNE 6, 2023

Due-diligence is necessary to ensure their system has been tested, is compliant to government and payer standards and is affordable moving forward as AI evolves and our system or contract service with the company advances. AI technology would empower these professionals. Beware of new companies offering such services.

Compliance

Compliance Medical Billing HIPAA Due Diligence

Updated Compliance Tool for Developers of Mobile Health Apps

Hall Render

JANUARY 11, 2023

As payor coverage expands for certain telemedicine services and technology, app and digital health technology developers will need to do their due diligence in determining coverage and reimbursement under federal and state health care programs and be cognizant of any fraud and abuse laws that apply under the various programs.

Compliance

Compliance HIPAA FDA Due Diligence

Statute of Limitations for PPP and EIDL Fraud Extended to Ten Years

Healthcare Law Blog

AUGUST 8, 2022

On August 5, President Biden signed two bills into law that extend to ten years the statute of limitations for civil and criminal enforcement actions for fraud on the Paycheck Protection Program (“PPP”) and Economic Injury Disaster Loans (“EIDL”).

Fraud

Fraud Due Diligence COVID-19 Governance

What Is Provider Credentialing?

MedTrainer

AUGUST 2, 2023

Listen to a candid discussion on lessons learned from the 2023 federal investigation that uncovered fraudulent medical practice nationwide in this on-demand webinar: Moving Forward From the Nursing Fraud Scheme. But how do you know which one to choose?

Malpractice

Malpractice Due Diligence Compliance Licensing

How to Tackle Pharma’s 3 Biggest Compliance Risks Head-On with Verisys

Verisys

JULY 13, 2023

Throughout that process, he was still on our payroll, and we hadn’t been doing our due diligence to screen him.” These issues can cause reputational damage to the manufacturer if they aren’t monitoring their faculty. He was sentenced to life in prison, and the story received national attention.

Compliance

Compliance Due Diligence Pharmaceutical Industry Fraud

Health Care Compliance Brief

Your Healthcare Compliance Due Diligence Checklist

Is Your Data Supply Chain Ethical? Don’t Restrict Due Diligence to Physical Operations.

Trending Sources

New Safe Harbor and General Compliance Program Guidance Provides Opportunity for Buyers to Mitigate Litigation and Fraud Risk

Another Resolution by DOJ Pursuant to its Civil Cyber-Fraud Initiative Highlights Continued Efforts to Hold Companies Accountable for Ensuring Data are Secured

Changing Tides: DOJ Announces a New Safe Harbor Policy for Voluntary Self-Disclosure in M&A Transactions

Settlement Agreed with Florida Children’s Health Insurance Website Contractor to Resolve False Claims Act Allegations

PE Firms Face Liability for the Conduct of their Portfolio Companies: Are you Paying Attention?

8 Common Provider Credentialing Mistakes and How to Avoid Them

Achieving Transparency: How to Close a Critical Gap in Healthcare Compliance

Seven Elements of a Compliance Program

Achieving Transparency: How to Close a Critical Gap in Healthcare Compliance

What is a HIPAA Violation?

Top Security Certifications Required for Data Protection

7 Key Value-Adding LOI Terms

Understanding Compliance for Healthcare Vendors

Part 1: Basics of Artificial Intelligence (AI) and Healthcare Compliance

Caveat Emptor: Private Equity Firms Are Increasingly Vulnerable to Qui Tam Lawsuits

How HHS-OIG, Regulators Enforce Vendor Compliance

Part 1: Basics of Artificial Intelligence (AI) and Healthcare Compliance

Updated Compliance Tool for Developers of Mobile Health Apps

Statute of Limitations for PPP and EIDL Fraud Extended to Ten Years

What Is Provider Credentialing?

How to Tackle Pharma’s 3 Biggest Compliance Risks Head-On with Verisys

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