Compliancy Group

FEBRUARY 16, 2024

This month, fraud in the medical industry has been making headlines fairly frequently. We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. Each charge also comes with five years probation, while the fraud charge includes 18 months of house arrest.

Fraud 52

Fraud Licensing Medicaid Medicaid 52

The Health Law Firm Blog

APRIL 8, 2024

Attorney's Office, in the Middle District of Florida, announced that a Florida man pled guilty to conspiring to commit health care fraud in a $36.2 million telemedicine fraud scheme. Indest III, J.D., Board Certified by The Florida Bar in Health Law On March 20th, 2024, the U.S. As part of [.]

Fraud 52

Fraud Medicare Medicare Telemedicine 52

Fierce Healthcare

OCTOBER 27, 2023

The Department of Justice (DOJ) has filed charges against a former HealthSun Health Plans executive as part of an alleged multimillion-dollar Medicare fraud scheme. | The Department of Justice has filed charges against a former HealthSun Health Plans executive as part of an alleged multimillion-dollar Medicare fraud scheme.

Fraud 128

Fraud Medicare Medicare 128

Healthcare Dive

JUNE 29, 2023

The multi-state bust that targeted 78 individuals represents “one of the largest healthcare fraud schemes ever prosecuted by the Justice Department,” Attorney General Merrick Garland said.

Fraud 130

Fraud 130

HealthIT Answers

MARCH 31, 2024

22 for civil fraud and false claims settlements and judgments recovered for taxpayers by the agency in fiscal 2023, or from Oct. The post Justice Department Sleeping at the Healthcare Fraud Wheel appeared first on Health IT Answers. By David R. Burda - Here are the DOJ stats released on Feb. 1, 2022, through Sept.

Fraud 52

Fraud 52

Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Secure your success by choosing Verisys.

Fraud 52

Fraud Licensing Telemedicine Compliance 52

Fierce Healthcare

FEBRUARY 15, 2024

ACOs could face lasting financial difficulties because of a recent, alleged $2 billion Medicare catheter fraud scheme. Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months.

Fraud 127

Fraud Medicare Medicare Governance 127

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

HIT Consultant

DECEMBER 15, 2023

What You Should Know: Healthcare Fraud Shield (HCFS) , a leading provider of fraud, waste, abuse, and error (FWAE) protection solutions for the healthcare insurance market, today launched FWA360Leads , a new product that automatically identifies and prioritizes FWA leads based on order of importance and impact severity.

Fraud 52

Fraud 52

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 160

Fraud Telemedicine Medicare Medicare 160

Healthcare IT News - Telehealth

MARCH 1, 2021

Department of Health and Human Services' Office of Inspector General recognized telehealth's potential while cautioning that steps must be taken to ensure virtual care will not be compromised by fraud. Grimm in her statement also differentiated between telehealth fraud and "telefraud" schemes. THE LARGER TREND.

Fraud 186

Fraud Telemedicine Department of Veterans Affairs COVID-19 186

Compliancy Group

DECEMBER 15, 2023

Differentiating Fraud, Abuse, and Waste Detecting and stopping fraud, abuse, and waste rely on distinguishing these behaviors in the healthcare context. What is Healthcare Fraud? Providers commit Medicare and Medicaid fraud when they knowingly submit or contribute to the submission of a false claim for financial gain.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT Today

JUNE 2, 2023

With those competing priorities, fraud prevention does not always make its way to the top of the list of considerations, even when it should. According to the National Health Care Anti-Fraud Association, fraud costs the U.S. healthcare industry more than $50 billion each year. What Exactly is KYP?

Fraud 89

Fraud Ransomware Licensing Governance 89

Healthcare IT News - Telehealth

APRIL 21, 2022

Attorney's Office for the Eastern District of New York announced Thursday that an orthopedic surgeon had been arrested and charged with healthcare fraud. Federal law enforcement has brought the hammer down on alleged telehealth fraud in several highly publicized cases. " ON THE RECORD.

Fraud 160

Fraud Telemedicine Medicare Medicare 160

Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Healthcare IT News - Telehealth

FEBRUARY 22, 2021

Department of Justice announced earlier this month that an Indian Rocks Beach, Florida-based woman has pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return. The DOJ describes the case as involving one of the largest healthcare fraud schemes in U.S. Kelly Wolfe and her company, Regency, Inc.,

Fraud 179

Fraud Telemedicine US Department of Health and Human Services Medicare 179

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

Healthcare IT News - Telehealth

JULY 22, 2022

billion in alleged fraud involving telehealth, phony genetic testing and durable medical equipment. "The Department of Justice is committed to prosecuting people who abuse our healthcare system and exploit telemedicine technologies in fraud and bribery schemes," said Assistant Attorney General Kenneth A. WHY IT MATTERS.

Fraud 127

Fraud Telemedicine Medicare Medicare 127

Fierce Healthcare

JUNE 29, 2023

The Department of Justice (DOJ) uncorked healthcare fraud charges against 78 defendants whose alleged telemedicine, prescription drug, opioid distribution and clinical lab testing schemes billed fo | Among the charges was an alleged $1.9

Fraud 85

Fraud Telemedicine 85

HIT Consultant

OCTOBER 18, 2021

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. The second type, indirect fraud, involves several bad actors that coordinate their efforts.

Fraud 98

Fraud COVID-19 Public Health Medicare 98

The Health Law Firm Blog

MARCH 14, 2024

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Verisys

NOVEMBER 3, 2023

Healthcare Fraud Crackdown! Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc. Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc.

Fraud 52

Fraud Compliance Medicare Medicare 52

The Health Law Firm Blog

FEBRUARY 23, 2024

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Healthcare IT News - Telehealth

DECEMBER 17, 2021

Department of Justice announced this past Friday that it had charged four people, one of whom is a licensed physician, in an international telehealth fraud and kickback scheme. million in a case the DOJ described as one of the "largest healthcare fraud schemes in United States history. WHY IT MATTERS. " ON THE RECORD.

Fraud 123

Fraud Telemedicine Nurses Licensing 123

HealthIT Answers

OCTOBER 5, 2023

The post Introduction to Fraud, Impersonation, and Operational Controls appeared first on Health IT Answers. By Kyle Neuman - Part 2 of 5 - Let’s dig deeper into identity credentials and focus on one specific facet of identity credentials: identity proofing.

Fraud 69

Fraud 69

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.

Fraud 98

Fraud COVID-19 Medicare Medicare 98

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

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

Fraud 59

Fraud HIPAA Medicare Medicare 59

American Medical Compliance

APRIL 6, 2023

Incidence of Healthcare Fraud Numerous scammers view this as a method to make quick, yet unlawful, money. Officials state that Florida, along with the rest of the nation, has been plagued by healthcare fraud. The post Nursing Diploma Fraud appeared first on American Medical Compliance. Reference NPR. 2023, January 27).

Fraud 52

Fraud Nurses Licensing Compliance 52

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. government or a government contractor.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT Today

JANUARY 19, 2021

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

Fraud 135

Fraud HIPAA Compliance Hospitals 135

The Health Law Firm Blog

AUGUST 22, 2023

Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,

Fraud 52

Fraud Licensing FDA Nurses 52

The Health Law Firm Blog

FEBRUARY 1, 2024

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

American Medical Compliance

MARCH 13, 2023

The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. Healthcare organizations must take all possible steps to prevent instances of fraud. Employees should receive training that educates them on how to identify, report, and combat fraud, waste, and abuse in the workplace.

Fraud 52

Fraud Medicare Medicare Compliance 52

The Health Law Firm Blog

JANUARY 13, 2024

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 Indest III, J.D., million scheme. The scheme involved securing orders for medically unnecessary prescriptions billed to Medicare and paying bribes and kickbacks, [.]

Fraud 52

Fraud Medicare Medicare Medicaid 52

Mobi Health News

JULY 7, 2022

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.

Fraud 94

Fraud 94

The Health Law Firm Blog

AUGUST 8, 2023

Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,

Fraud 52

Fraud FDA Licensing Nurses 52