HIT Consultant

MAY 11, 2023

1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation’s $2.26 2 FWA estimates from commercial health plans range as high as $230 billion annually, or 10% of total healthcare spending.

Fraud 98

Fraud Governance Public Health 98

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. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

HIPAA Journal

MARCH 24, 2022

14 of the 16 critical infrastructure sectors reported at least one ransomware attack, although the healthcare and public health sector was the worst affected, accounting for 148 of those attacks, followed by financial services with 89 attacks, and the information technology sector with 74.

Ransomware 120

Ransomware Public Health Fraud HIPAA 120

MedTrainer

OCTOBER 4, 2023

These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. These requirements are designed to protect patient rights, privacy, and safety, as well as to prevent fraud, abuse, and other improper practices within healthcare organizations.

Compliance 52

Compliance Fraud HIPAA Governance 52

Healthcare Law Blog

DECEMBER 12, 2022

The COVID-19 Public Health Emergency (“PHE”) led to a rapid expansion in the utilization of telehealth. Now, almost three years later, governmental entities have focused their attention on telehealth services and the potential for fraud and abuse. in healthcare fraud for fraudulent telemedicine schemes. Looking Forward.

COVID-19 52

COVID-19 Fraud Telemedicine Public Health 52

Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders.

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

Healthcare Law Today

JANUARY 11, 2023

The government alleged that, between April 2014 and April 2019, Jet Medical introduced devices into interstate commerce that were misbranded under the Federal Food, Drug and Cosmetic Act (FDCA) because Jet Medical did not obtain approval or clearance from the U.S. Food and Drug Administration (FDA) prior to distribution.

FDA 59

FDA Governance Medicare Medicare 59

Healthcare IT News - Telehealth

JUNE 8, 2022

The Department of Health and Human Services once again (for the ninth time) extended the public health emergency this past month , stretching it beyond mid-July. But sooner or later, that provision of the Public Health Service Act will draw to a close. State government executive orders.

US Department of Health and Human Services 179

US Department of Health and Human Services Compliance Overpayments Overpayment 179

Healthcare IT News - Telehealth

JANUARY 26, 2022

The evergreen concern about virtual care is that of fraud, waste and abuse and how to balance it with the demonstrated value of extended medical services to patients who are either geographically or economically underserved. at the Orange County Convention Center in room W206A.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

YouCompli

AUGUST 2, 2022

Healthcare compliance history has shown that when the government disperses significant funds, audits and enforcement associated with the disbursement of those funds will shortly follow. The Federal government spent unprecedented trillions of dollars throughout the COVID public health emergency (PHE). Let’s look at a few.

COVID-19 Vaccine 52

COVID-19 Vaccine COVID-19 Nursing Homes Compliance Officers 52

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. Health Care Fraud Actions. That figure does not include even more funds recovered for state Medicaid programs.

Fraud 40

Fraud Governance Medicare Medicare 40

Hall Render

FEBRUARY 27, 2023

The government initiated 296 FCA cases on its own last year without input of a relator, which is the highest volume of DOJ initiated cases since the 1986 FCA amendments. This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022.

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud.

Licensing 52

Licensing Fraud Compliance Nurses 52

Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. It can also include health insurance, pension plans, or educational assistance.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

YouCompli

JULY 12, 2022

National fraud takedown: $1.1 Department of Justice (DOJ) announced a national health care fraud enforcement action involving over $1.4 billion alleged losses, telemedicine related fraud accounted for the vast majority at $1.1 billion in false and fraudulent claims to Medicare and other government insurers.

COVID-19 52

COVID-19 Medicare Medicare Telemedicine 52

Healthcare Law Blog

JULY 5, 2022

Many programs focused on the government’s response to the pandemic, including how the government may change its policies once the public health emergency (“PHE”) ends. Presenters discussed how regulatory agencies like CMS remain focus on developing and expanding value-based care, including through new safe harbors (e.g.,

Fraud 52

Fraud Governance Ransomware Licensing 52

Health Law Advisor

APRIL 13, 2023

Department of Health and Human Services’ Office of Inspector General (“OIG”) updated its Frequently Asked Questions (“FAQs”), drafting 13 FAQs aimed at easing the transition from COVID-era flexibilities to the end of the Public Health Emergency (“PHE”) on May 11, 2023.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

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 59

Compliance Medical Billing HIPAA Due Diligence 59

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 52

Compliance Medical Billing HIPAA Due Diligence 52

Healthcare IT News - Telehealth

SEPTEMBER 28, 2022

Accountable Care Compliance & Legal Government & Policy Telehealth Workforce Healthcare organizations must urge the Senate to pass critical telehealth legislation, and enact at least a two-year extension of the important PHE-era policies while working toward a permanent solution. In January 2020, then-Secretary of the U.S.

COVID-19 119

COVID-19 Public Health US Department of Health and Human Services Medicare 119

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

AIHC

SEPTEMBER 5, 2023

OCR released guidance on April 12, 2023 to help covered health care providers and health plans understand how they can use remote communication technologies for audio-only telehealth. This information was published due to the end of the COVID-19 Public Health Emergency (PHE) which began May 12, 2023.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

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. To avoid CMP liability, health care entities should routinely check the list to ensure that new hires and current employees are not on it.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT News - Telehealth

SEPTEMBER 27, 2022

Accountable Care Compliance & Legal Government & Policy Telehealth Workforce Healthcare organizations must urge the Senate to pass critical telehealth legislation, and enact at least a two-year extension of the important PHE-era policies while working toward a permanent solution. In January 2020, then-Secretary of the U.S.

COVID-19 108

COVID-19 Public Health US Department of Health and Human Services Medicare 108

Health Law Advisor

MARCH 1, 2023

In the era of abortion regulation and the wind-down of the COVID-19 public health emergency (“PHE”), new legislation in states such as Utah may be a sign of what is to come for online and telehealth prescribing. Once signed into law, the effect of H.B. 152 , amending Utah Code § 26-60-103.

Telemedicine 52

Telemedicine COVID-19 Fraud Licensing 52

Health Law Advisor

MAY 3, 2022

On April 20, 2022, the Department of Justice (DOJ) announced a nationwide coordinated enforcement action targeting COVID-19-related fraud involving charges against 21 individuals across nine federal districts, and over $149 million in alleged false claims submitted to federal programs. [1]. 2] See id. [3] 2] See id. [3] 2] See id. [3]

COVID-19 52

COVID-19 Fraud COVID-19 Vaccine Medicaid 52

Bill of Health

AUGUST 2, 2022

However, characteristics that make UBI attractive, particularly the direct support it provides, sans bureaucratic red tape, can be applied to other government programs. The government could directly provide all citizens with food or, more simply, with nutrients. With UBNI, government funds are only used for required nutrients.

Governance 144

Governance COVID-19 Fraud Public Health 144

Hall Render

FEBRUARY 23, 2024

Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, with qui tam actions accounting for over $2.3 billion is attributed to cases involving the health care industry, including managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities and physicians.

Compliance 71

Compliance Governance Medicare Medicare 71

Hall Render

JULY 28, 2023

million for rural hospital expansion Hospices in Arizona & other states receive scrutiny over concerns of fraud, waste & abuse Phoenix Children’s Building New 44,000-Square Foot Level IV Neonatal Intensive Care Unit Firefighters oppose Banner’s planned $400M hospital There’s a growing nurse shortage in Arizona.

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

Healthcare Law Blog

MAY 16, 2022

Enrollee Participation in Dual Eligible Special Needs Plan (“D-SNP”) Governance (§ 422.107). CMS believes its proposals would improve Federal and State oversight of D-SNPs (and their affiliated MCOs) through greater information-sharing among government regulators.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

FEBRUARY 24, 2023

health system, not for any form of control, government interference in healthcare, or any other nefarious purpose, but to address a pressing public health and safety issue: To ensure patients can be reliably and accurately connected with their health information. This is far from an isolated example. ” Sen.

HIPAA 98

HIPAA Governance Public Health Fraud 98

Health Law Advisor

MARCH 7, 2023

In the proposed rules regarding buprenorphine DEA says that a practitioner must be registered in the state where he/she is located, however, DEA does not address this issue in its proposed rules governing the special registration requirements generally. Will DEA suggest through its guidance any guardrails for the industry to consider?

Telemedicine 52

Telemedicine COVID-19 FDA Compliance 52

Hall Render

MAY 13, 2022

Oscar Health To Exit Colorado, Arkansas. Prism pays $650K to settle Medi-Cal fraud claims filed in San Diego. Synergy Health Partners Acquires SoCal Anesthesia Solutions, Inc. Newsom Proposes $125M Package To Expand Access To Reproductive Health Care In California. Now Durango’s public health agency is sounding the alarm.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Healthcare Law Blog

MARCH 3, 2023

This surge was facilitated, in part, by certain flexibilities authorized by the Centers for Medicare & Medicaid Services in its response to the public health emergency (“PHE”) declared in March of 2020 and which was repeatedly renewed until now. federal government. trillion omnibus spending bill intended to fund the U.S.

Fraud 52

Fraud Nurses Telemedicine COVID-19 52

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

MARCH 28, 2022

Government Accountability Office (GAO), improper payments have been estimated to total almost $1.7 trillion government-wide from fiscal years 2003 through 2019. Auditing and denying claims after the claims have been paid is “big money” for the government. According to the U.S.

Medicare 52

Medicare Medicare Compliance Governance 52