OIG report suggests telehealth fraud rare in Medicare

Healthcare Dive

A small proportion of providers that billed for telehealth — 1,714 out of 742,000 — posed a high risk of fraud or abuse to Medicare in COVID-19’s first year, regulators found

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Feds brokered record $5B in healthcare fraud cases last year

Healthcare Dive

Cases ranged from improper psychiatric treatment to providing false Medicare claims and illegal kickback schemes

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Florida Pharmacy Owner Pleads Guilty For Role in $8.3 Million Medicare Fraud Scheme

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On September 27, 2022, a Florida pharmacy owner pled guilty to conspiring to commit healthcare fraud in an $8.3 By George F. Indest III, J.D., M.P.A.,

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Customization vs. Configuration in Healthcare Fraud Detection

Fierce Healthcare

Customization vs. Configuration in Healthcare Fraud Detection. mteefey. Wed, 11/09/2022 - 16:55

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Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., M.P.A.,

Massive Telehealth Fraud Charges May Be First Of Many

Healthcare IT Today

The US Department of Justice has filed charges against 345 defendants, including more than 100 medical professionals, accusing them of engaging in healthcare fraud schemes.

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Florida Surgeon Gets 7 Years for Committing $28 Million in Health Care Fraud

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. By George F. Indest III, J.D., M.P.A.,

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Florida Surgeon Handed Seven Years in Prison for $28 Million Health Care Fraud Scheme

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. By George F. Indest III, J.D., M.P.A.,

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Nursing Home Psychologist Convicted of Healthcare Fraud Scheme

Healthcare Compliance Blog

The psychologist was convicted of four counts of healthcare fraud. The FBI and HHS-OIG investigated the case, which was brought as part of the Chicago Strike Force, supervised by the Criminal Division’s Fraud Section and the US Attorney’s Office for the Northern District of Illinois.

Michigan Podiatrist Convicted of $1.8 Million Healthcare Fraud Scheme

Healthcare Compliance Blog

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.

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Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., M.P.A.,

Fraud Detection with Machine Learning For e-Commerce and Retailers

Electronic Health Reporter

There is interesting research in Forbes’ recent article named “How E-Commerce’s Explosive Growth Is Attracting Fraud”. The article Fraud Detection with Machine Learning For e-Commerce and Retailers appeared first on electronichealthreporter.com.

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Does Expanding Healthcare Coverage = an Increasing Risk of Fraud for Healthcare Payers?

Healthcare IT Today

New types of fraud are continually emerging, and it’s also become harder to uncover with traditional approaches. The telehealth market is growing at a significant rate, and fraud is continuing to grow with it. Is Telehealth Fraud Getting Harder to Identify?

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Foreign Medical Student Found Guilty in Home Health Fraud Scheme

Healthcare Compliance Blog

A federal jury in Texas convicted a 65-year-old foreign medical student for conspiracy to commit healthcare fraud. At the trial, the defendant attempted to convince the jury he had no knowledge of fraud and did not have the intent to defraud Medicare. Client Alerts client alerts Fraud

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Healthcare Fraud and Abuse Control Program Fiscal Year 2021 Report

Healthcare Compliance Blog

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.

Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., M.P.A.,

2 DOJ Cyber Fraud Initiative Cases Net Almost $10 Million

Compliancy Group

Department of Justice’s (DOJ) Civil Cyber Fraud Initiative (CCFI). Details of DOJ Cyber Fraud Initiative Settlements. DOJ Cyber Fraud Initiative and the HIPAA Connection. Whistleblower Incentives Within the DOJ Cyber Fraud Initiative.

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Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges

The Health Law Firm Blog

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D., M.P.A., Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3

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Fraud-Proofing Your Telehealth Strategy

HIT Consultant

Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud. Julia Twaddle, Sr.

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Two Men Charged in $39M Personal Protective Equipment Fraud Scheme

Healthcare Compliance Blog

Two Texas men have been charged with conspiracy to commit and committing wire fraud during the COVID-19 pandemic involving medical-grade nitrile gloves. The two men were both charged with conspiracy to commit wire fraud, and defendant 1 also faces an additional five counts of wire fraud.

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Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks

Healthcare Compliance Blog

The post Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks appeared first on Med-Net. Client Alerts client alerts Fraud Kickbacks Medicaid

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Massachusetts AG’s Medicaid Fraud Division Recovers More Than $71M in Federal FY2022

Healthcare Compliance Blog

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. Client Alerts client alerts Fraud Medicaid

Be Vigilant: A Look at Supply Chain Fraud in Healthcare

Healthcare IT Today

According to a survey by Proofpoint, the average healthcare organization received about 200,000 emails from over 10,000 different 3rd party domains. When you consider the thousands of vendors and suppliers that work with a healthcare organization, this isn’t a big surprise.

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Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme

Healthcare Compliance Blog

He was convicted of one count of healthcare fraud and one count of making a false claim. The post Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme appeared first on Med-Net. Client Alerts client alerts Fraud Medicaid Medicare

OIG warns of telehealth fraud risks in wake of DOJ crackdown

Healthcare Dive

The special alert to healthcare providers describes how fraudsters recruit and reward practitioners in schemes to exploit the growth of telemedicine

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Pharmacy Fraud: Data Tells the Story

Florida Health Care Law Firm

Fraud in these cases is generally easy to prove. Simply verifying inventory, orders and dispensing records yields incredible data that when combined with comparative data from peer pharmacies can be used by law enforcement to establish that fraud has been committed.

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Justice Department Charges Dozens for $1.2 Billion in Healthcare Fraud

Healthcare Compliance Blog

In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds. Billion in Healthcare Fraud appeared first on Med-Net. Client Alerts client alerts Fraud

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Former Theranos exec Sunny Balwani found guilty of fraud

Mobi Health News

A jury found Balwani guilty on all 12 charges he faced, including ten counts of wire fraud and two counts of conspiracy to commit wire fraud

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HIPAA Seal of Compliance = Consumer Fraud

Healthcare IT Today

The Federal Trade Commission (FTC) announced a consumer fraud settlement against a company that displayed a ‘HIPAA Compliant’ seal on its website.

Healthcare Fraud Scheme Indictment Starts the New Year

Florida Health Care Law Firm

Attorney arrested 13 people in a $100 Million healthcare fraud scheme in NY and NJ involving automobile insurance claims. The post Healthcare Fraud Scheme Indictment Starts the New Year first appeared on Florida Healthcare Law Firm. The U.S.

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Licensed Professional Counselor Sentenced to Prison for $1.3 Million Medicaid Fraud Scheme

The Health Law Firm Blog

By George F. Indest III, J.D., M.P.A., Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 million, announced the U.S. Attorney for the U.S. District of Connecticut. [.].

Michigan Registered Nurse Pleads Guilty in COVID-19 Vaccination Record Card Fraud

Healthcare Compliance Blog

A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Participating in the fraud can result in the person(s) being prosecuted. Client Alerts client alerts COVID-19 Fraud Vaccination

5 Tactics to Combat Healthcare Fraud

JNC Compliance

The post 5 Tactics to Combat Healthcare Fraud appeared first on JNC Healthcare Compliance Group. In this series, I shared that the government recovered five billion dollars from the healthcare False Claims Act in 2021, one of the most significant recoveries […].

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Texas Adult Day Care Owner Sentenced for Healthcare Fraud Scheme

Healthcare Compliance Blog

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. In March 2020 she pleaded guilty to one count of healthcare fraud, one count of wire fraud, and one count of theft of government funds. Client Alerts client alerts Fraud

DOJ cracks down on 'largest and most wide-ranging' COVID-19 fraud

Healthcare Dive

Defendants — including doctors, medical business executives and fake vaccination card manufacturers — caused nearly $150 million in false billings to federal programs, the DOJ alleged

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DOJ charges 36 over $1.2B in phony telehealth claim fraud schemes

Fierce Healthcare

in phony telehealth claim fraud schemes. DOJ charges 36 over $1.2B rking. Wed, 07/20/2022 - 16:49

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Florida Healthcare Clinic Owners, Employees Sentenced for Roles in Multiple Fraud Schemes

Healthcare Compliance Blog

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. Issue: Healthcare fraud affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year.

Two Indicted for Exploiting Adult Day Care Patients in Medicare Fraud Scheme

Healthcare Compliance Blog

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.?. Uncategorized client alerts medicare fraud

Telemedicine Pharmacy Fraud Trial Ends in Convictions

Florida Health Care Law Firm

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. The post Telemedicine Pharmacy Fraud Trial Ends in Convictions first appeared on Florida Healthcare Law Firm.

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Telemedicine Special Fraud Alert

Med Law Blog

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”.

Five Individuals and Two Nursing Facilities Indicted on Healthcare Fraud Charges

Healthcare Compliance Blog

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. Client Alerts client alerts Fraud

Judge denies Elevance Health's bid to toss Medicare Advantage fraud suit

Fierce Healthcare

Judge denies Elevance Health's bid to toss Medicare Advantage fraud suit. pminemyer. Wed, 10/05/2022 - 15:12

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UnitedHealth lawsuit claims TeamHealth upcoded claims for $100M in fraud

Fierce Healthcare

UnitedHealth lawsuit claims TeamHealth upcoded claims for $100M in fraud. pminemyer. Thu, 10/28/2021 - 12:21

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