The Health Law Firm Blog

FEBRUARY 8, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

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HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4 million, and $6.4

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The Health Law Firm Blog

JANUARY 18, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

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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. Abuse of government healthcare programs is a federal offense with severe penalties. government or a government contractor.

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The Health Law Firm Blog

DECEMBER 28, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

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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?

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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. Medicare and Medicaid data demonstrated that he was identified as an outlier and the highest biller for this procedure in New York State.

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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.

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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.

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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.

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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.

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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.

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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.

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Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

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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.

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Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. With Medicaid, the challenges are equally formidable.

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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.

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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. million from Medicare Part D Plans and Medicaid drug plans.

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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. But what exactly is considered fraud, waste, and abuse?

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HIT Consultant

FEBRUARY 13, 2023

Tom Wriggins, Principal Industry Advisor at SAS John Maynard, CPA, CFE, AHFI Principal Solutions Architect at SAS In 2022, the Center for Medicare and Medicaid Services (CMS) established health equity as a pillar of its future work. Health outcomes and Medicaid program integrity Health outcomes are a function of the quality of care.

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Healthcare IT Today

SEPTEMBER 21, 2022

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. For example telehealth utilization increased 63x (in Medicare alone!) Is Telehealth Fraud Getting Harder to Identify?

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HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

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Healthcare Compliance Blog

MARCH 2, 2022

An indictment was filed on February 25, 2022, against ten persons in Florida for their alleged roles in a $67 million healthcare fraud, wire fraud kickback, and money laundering scheme. Healthcare fraud and anti-kickback violations are each punishable by a maximum penalty of 10 years in prison.

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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.

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Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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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. An example of this is the investigation into OCR’s governance of cybersecurity threats.

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Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. The ophthalmologist was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers.

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American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. This type of theft is just one example of healthcare fraud. trillion in 2015. trillion in 2015.

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Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

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Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

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MedTrainer

FEBRUARY 12, 2024

government collected $2.2B Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022.

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Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

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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.

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MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. 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.

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HIT Consultant

MAY 2, 2023

Modern NEMT solutions streamline the ride booking and scheduling process, introduce new modalities, improve the overall experience for patients, and decrease fraud, waste and abuse (FWA). As Medicare Advantage and Medicaid plans continue to grow, NEMT partners will play an increasingly important role in scaling transportation benefits.

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Total Medical ComplianceHIPAA

APRIL 12, 2024

These programs are governed by regulations outlined in sections 1128 and 1156 of the Social Security Act, with oversight by the Office of Inspector General (OIG). The OIG is authorized to exclude individuals and entities from federally funded healthcare programs.

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Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

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