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

American Medical Compliance

MAY 22, 2023

million to settle allegations that it paid kickbacks to healthcare providers committing fraud violations. US Efforts to Crack Down on Fraud Violations Kickbacks are illegal under the False Claims Act because they can lead to overuse or misuse of medical products, harming patients and increasing healthcare costs. DePuy Synthes, Inc.

Fraud 52

Fraud Compliance Governance Doctors 52

HIPAA Journal

MARCH 16, 2022

This is the first settlement to be reached under the DOJ Civil Cyber Fraud Initiative, which was launched in 2021. Some staff members expressed concern about the insecure storage of private medical information, but CHS took no action to address the issue and failed to ensure medical records were only stored in the EMR system.

Fraud 99

Fraud Electronic Medical Records Governance HIPAA 99

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.

Fraud 123

Fraud Telemedicine Ransomware COVID-19 123

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

Compliancy Group

AUGUST 31, 2022

A pair of government contractors recently agreed to settlements of alleged violations of the False Claims Act (FCA) for nearly $10 million as part of the U.S. 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.

Fraud 52

Fraud HIPAA Governance Electronic Medical Records 52

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.

Fraud 59

Fraud Medicaid Medicaid Compliance 59

Healthcare Compliance Blog

APRIL 29, 2022

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. She used the money instead for her own personal gain. US Attorney Ashley C.

Fraud 59

Fraud Compliance Governance Medicaid 59

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 99

Fraud Health Insurance Ransomware HIPAA 99

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.

COVID-19 Vaccine 59

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

Med-Net Compliance

JULY 20, 2022

He was convicted of one count of healthcare fraud and one count of making a false claim. Healthcare providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties can use the OIG’s Provider Self-Disclosure Protocol to voluntarily disclose self-discovered evidence of potential fraud.

Fraud 59

Fraud Doctors Medicare Medicare 59

HIT Consultant

DECEMBER 10, 2021

What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. For more information, download the full report here. Report Background.

Fraud 97

Fraud COVID-19 Nurses Licensing 97

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.

Fraud 59

Fraud Medicaid Medicaid Nursing Homes 59

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. The post Two Women Sentenced for Conspiracy to Commit Healthcare Fraud appeared first on.

Fraud 59

Fraud Medicare Medicare Governance 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. Trust is core to the provider-patient relationship.

Fraud 52

Fraud Medicare Medicare Compliance 52

Florida Health Care Law Firm

APRIL 18, 2022

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. So what information did the DOJ have at its disposal in this case?

Fraud 52

Fraud Medicaid Medicaid Medicare 52

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 69

Fraud Health Insurance Ransomware HIPAA 69

Florida Health Care Law Firm

DECEMBER 7, 2021

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.

Fraud 40

Fraud Telemedicine Governance Compliance 40

Hall Render

AUGUST 22, 2023

Rather, liability under the FCA may still be established if any misrepresentations made by a provider influenced decision-makers and resulted in the submission of false claims to the government. Walgreens learned of the fraud as early as 2016. Practical Takeaways Altering a patient’s medical information is fraudulent under the FCA.

Medicaid 40

Medicaid Medicaid Governance Fraud 40

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

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. Follow us at [link] for updates as DOJ continues its CCFI enforcement efforts.

Fraud 52

Fraud Due Diligence Medicaid Medicaid 52

Hall Render

SEPTEMBER 12, 2022

Healthsouth of Sarasota Limited Partnership, et al , the Eleventh Circuit held that for a plaintiff to qualify as engaging in “protected activity,” the plaintiff must demonstrate that they had both a subjectively reasonable belief of fraud and an objectively reasonable belief of fraud. Background. 3730(h)(1). Practical Takeaways.

Fraud 40

Fraud Governance Compliance 40

Healthcare IT Today

JANUARY 19, 2024

This is mainly due to misuse, such as unintentionally compromising consumer credentials, Personal Identifiable Information (PII), and Personal Health Information (PHI). Governments are starting to act in response to the growing amount of cyber threats in the healthcare industry. AI should also be used for identity governance.

Fraud 81

Fraud Governance Ransomware Compliance 81

Kaiser Health News

APRIL 16, 2024

District Court for the Southern District of Florida, two such call centers paid tens of thousands of dollars a day to buy names of people who responded to misleading advertisements touting free government “subsidies” and other rewards.

ACA 137

ACA Health Insurance Governance Medical Billing 137

Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. These status changes will help organizations identify which individuals may be at risk of their license becoming invalid due to the government investigation.

Fraud 52

Fraud US Department of Health and Human Services Licensing Compliance Officers 52

HIPAA Journal

APRIL 24, 2023

Utah has updated its data breach regulations and from May 3, 2023, will require a breached entity to send a notification to the Utah Attorney General in the event of a breach of the personal information of 500 or more Utah residents.

Fraud 87

Fraud Licensing HIPAA Governance 87

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. The GCPG provides voluntary, non-binding guidance to assist all individuals and entities in the healthcare industry to develop and maintain a successful compliance program.

Compliance 52

Compliance Due Diligence Fraud Governance 52

American Medical Compliance

JANUARY 9, 2024

It establishes national standards to protect individuals’ medical records and other individually identifiable health information, which is collectively defined as “protected health information.” It also mandates the implementation of suitable safeguards to preserve the privacy of such information.

Fraud 52

Fraud Compliance HIPAA Health Insurance 52

MedTrainer

FEBRUARY 5, 2024

Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. This process typically involves submitting an application with detailed information regarding the provider’s qualifications and licenses. Timeline Several months and is completed after credentialing.

Licensing 52

Licensing Governance Compliance Fraud 52

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

HIPAA Journal

JANUARY 11, 2024

OIG in healthcare stands for the Department of Health and Human Services (HHS) Office of Inspector General (OIG) – the Office within the HHS responsible for reducing waste, fraud, and abuse in HHS programs and improving efficiency. Probably the most rapidly expanding role for the HHS OIG in healthcare is cybersecurity.

Fraud 84

Fraud HIPAA Compliance Medicare 84

MedTrainer

MARCH 8, 2024

It educates employees on the laws, regulations, and policies governing their work and ensures they understand their responsibilities and obligations as healthcare professionals. Successful training is when team members understand and comply with various laws, regulations, and policies that govern the healthcare industry.

Compliance 52

Compliance Fraud Governance HIPAA 52

HIPAA Journal

JUNE 9, 2023

In 2013, David Dubin was examining a patient when he was informed by his father that the patient’s Medicaid benefits had been exhausted and cut the evaluation short. Under the letter of the law, small-scale fraud and large-scale fraud carry the same sentence for aggravated identity theft.

Fraud 98

Fraud Medicaid Medicaid Doctors 98

Healthcare IT News - Telehealth

JANUARY 30, 2023

FINDINGS Based on the state audit , the department fell short in governance, risk management, and evaluation of the telehealth expansion. It also did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, before implementing the temporary and permanent MBS telehealth items.

COVID-19 135

COVID-19 Governance Medicare Medicare 135

HIPAA Journal

MARCH 15, 2023

The contract was renewed by FHKC through 2020, with the federal government covering 86% of the payments to Jelly Bean Communications Design. Further, the website did not maintain audit logs showing who had accessed the personal information of applicants.

Health Insurance 74

Health Insurance HIPAA Due Diligence Fraud 74

HIPAA Journal

AUGUST 31, 2022

Evil Corp’s primary modus operandi in recent years is conducting digital extortion attacks, including the use of ransomware, and the theft of sensitive information. In addition to running the operation, Yakubets interfaces with the Russian government and is known to have been tasked with projects on behalf of the Russin FSB.

Ransomware 118

Ransomware Fraud Governance HIPAA 118