The Health Law Firm Blog

FEBRUARY 10, 2023

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] Indest III, J.D.,

Fraud 52

Fraud Health Insurance Overpayments Overpayment 52

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

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

Med-Net Compliance

JULY 7, 2022

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. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

Fraud 59

Fraud COVID-19 Health Insurance Compliance 59

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

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

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

Medicaid 75

Medicaid Medicaid Medicare Medicare 75

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

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

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

The Health Law Firm Blog

JANUARY 8, 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. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 40

Fraud Medicaid Medicaid Overpayments 40

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

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). This is just the beginning.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

The Health Law Firm Blog

NOVEMBER 29, 2022

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

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

DECEMBER 19, 2022

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

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

OCTOBER 14, 2022

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

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

NOVEMBER 7, 2022

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

Fraud 52

Fraud Medicaid Medicaid Overpayments 52

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.

Fraud 52

Fraud Medicare Medicare Compliance 52

Kaiser Health News

APRIL 16, 2024

Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov. “Unfortunately, there’s so much fraud that legitimate agents who are really trying to help people are also being pushed out.”

ACA 133

ACA Health Insurance Governance Medical Billing 133

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. HHS’s suspension and debarment programs are vital to upholding integrity in Federal grants and contracts.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Kaiser Health News

NOVEMBER 11, 2021

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. “You’re not from Medicare,” Heimer told her.

Medicare 142

Medicare Medicare Doctors Fraud 142

Provider Trust

OCTOBER 10, 2023

With new regulations and a changing payer demographic—marked by health plans entering new contracts such as Medicare Advantage—the demands for credentialing support can quickly outpace an organization’s available resources. See the Complete Report Reporting from a Survey of 150 Respondents from Health Insurance Companies

Licensing 52

Licensing Health Insurance Fraud Medicare 52

Verisys

NOVEMBER 8, 2023

Providers, employers, health plans, and payers use these numbers for billing purposes. CMS.gov The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the creation of a standard, unique health identifier for healthcare providers, which the NPI satisfies.

Fraud 97

Fraud HIPAA Medicare Medicare 97

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

HIPAA Journal

FEBRUARY 23, 2022

HIPAA is an acronym for the Health Insurance Portability and Accountability Act. When the Health Insurance Portability and Accountability Act was passed by Congress in 1996, the establishment of federal standards for safeguarding PHI was not one of the primary objectives. What is HIPAA? What is HIPAA Title II?

HIPAA 88

HIPAA Fraud Health Insurance Medicaid 88

HIPAA Journal

JUNE 28, 2023

Individuals that have suffered identity theft, medical fraud, tax fraud, other forms of fraud, and other actual misuses of their personal information, can submit claims for documented, unreimbursed extraordinary losses that are reasonably traceable to the data breach of up to a maximum of $5,000.

Hospitals 75

Hospitals Fraud Licensing HIPAA 75

HIPAA Journal

JUNE 13, 2023

The forensic investigation confirmed the affected systems contained PHI such as names, addresses, phone numbers, birthdates, health insurance account information, Social Security numbers, provider taxpayer ID numbers, and clinical information and that information was in the files exfiltrated from its systems. and Point32Health, Inc.

Ransomware 94

Ransomware Fraud Health Insurance HIPAA 94

Compliancy Group

MAY 15, 2024

OIG compliance and compliance training intends to help hospitals protect patient health and safety, prevent fraud and abuse, ensure legal and regulatory compliance, and safeguard patient privacy, making it an invaluable tool for success.

Compliance 52

Compliance Hospitals Fraud Regulatory Compliance 52

HIPAA Journal

SEPTEMBER 29, 2022

Humana has recently announced that the protected health information of 22,767 individuals has potentially been compromised in a security incident and data breach at one of its business associates – Choice Health – which Human used to sell Medicare products on its behalf.

Health Insurance 104

Health Insurance Medicare Medicare Fraud 104

HIPAA Journal

MAY 25, 2023

In April 2023, Point32Health, the second-largest health insurer in Massachusetts and the parent company of Tufts Health Plan and Harvard Pilgrim Health Care, announced it suffered a ransomware attack that resulted in system outages, including the systems that serviced members, accounts, brokers, and providers.

Ransomware 77

Ransomware Health Insurance Fraud HIPAA 77

Verisys

JANUARY 8, 2024

This includes adherence to standards set by the Health Insurance Portability and Accountability Act (HIPAA) , the Centers for Medicare & Medicaid Services (CMS), and other regulatory bodies. The audit evaluates if the healthcare organization follows billing and coding standards to prevent fraud and abuse.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

MedTrainer

JANUARY 31, 2024

It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. These laws require healthcare providers to establish internal controls and compliance programs to prevent fraud and abuse in the healthcare system. Who started the first healthcare compliance program?

Compliance 52

Compliance Fraud Governance ACA 52

HIPAA Journal

MARCH 21, 2023

During that time they exfiltrated files that contained sensitive patient data, including names, contact information, Social Security number, Medicare/Medicaid IDs, health information, and health insurance information.

Fraud 98

Fraud Health Insurance Medicaid Medicaid 98

HIPAA Journal

OCTOBER 17, 2022

The exposed information included names, dates of birth, Social Security numbers, driver’s license numbers, clinical/diagnosis information, health insurance member ID numbers, medical record numbers, and Medicare or Medicaid numbers.

Health Insurance 113

Health Insurance Licensing Fraud HIPAA 113

MedTrainer

JANUARY 30, 2024

Compliance is Mandatory for Federal Programs One constant is that organizations and facilities that participate in federal healthcare programs, such as Medicare and Medicaid, must have a compliance program. Laboratories: Clinical laboratories that perform tests covered by Medicare or Medicaid.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

MedTrainer

JANUARY 12, 2024

The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

HIPAA Journal

AUGUST 31, 2023

As well as supplying private customers, the company works with more than five hundred health plans, managed care organizations, and other agencies to provide access to meals for people covered by Medicare and Medicare. It is also providing credit monitoring, fraud consultation, and identity theft restoration services for a year.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

HIPAA Journal

MARCH 25, 2022

Ultimate Care said no reports have been received that indicate there has been any misuse of patient information; however, as a precaution against identity theft and fraud, individuals whose Social Security numbers were impacted have been offered complimentary one-year memberships with a credit monitoring service.

Health Insurance 103

Health Insurance Licensing Ransomware Fraud 103

AIHC

AUGUST 30, 2023

Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM Due to the high volume of fraud schemes involving telemarketing revealed by the Department of Justice (DOJ) over recent years, it is important that providers heed “buyer beware” when engaging with a telemarketing firm. “If If it is too good to be true it probably isn't.”

Compliance 52

Compliance Fraud Medicare Medicare 52

HIPAA Journal

SEPTEMBER 9, 2022

Those emails contained patient information such as names, dates of birth, Social Security numbers, medical information, health insurance information, driver’s license numbers, and state ID numbers. As a precaution against identity theft and fraud, complimentary memberships have been offered to a credit monitoring service for 12 months.

Licensing 96

Licensing Health Insurance Fraud HIPAA 96