Healthcare Law Blog

DECEMBER 1, 2023

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released its “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2022 ” (the “Report”), highlighting continued enforcement and recovery actions under the Health Care Fraud and Abuse Control Program (HCFAC).

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COVID-19 Fraud Telemedicine Medicaid 52

American Medical Compliance

MAY 22, 2023

million to settle allegations that it paid kickbacks to healthcare providers committing fraud violations. Department of Justice accused the company of violating the False Claims Act by paying kickbacks to physicians and hospitals in exchange for using their products. DePuy Synthes recently agreed to pay $9.75 Agrees to Pay $9.75

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Fraud Compliance Governance Doctors 52

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.

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COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

HIPAA Journal

JUNE 28, 2023

Good Samaritan Hospital in San Jose, CA, has agreed to settle a class action lawsuit that was filed in response to a data breach that exposed the protected health information of up to 233,835 individuals. The post Good Samaritan Hospital Settles Class Action Data Breach Lawsuit appeared first on HIPAA Journal.

Hospitals 76

Hospitals Fraud Licensing HIPAA 76

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. Hospital-Psychiatric Unit. Report Background. Physician/Psychiatry. Psychologist, Clinical.

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Fraud COVID-19 Nurses Licensing 98

Health Law Checkup

JANUARY 20, 2022

Despite the pandemic, the DOJ is continuing to investigate allegations of health care fraud. A recent settlement from Wheeling Hospital serves as a reminder to hospitals to review their physician compensation arrangements to ensure that they are within fair market value and considered commercially reasonable.

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Fraud COVID-19 Hospitals 52

HIPAA Journal

JANUARY 3, 2023

For this reason, and due to the volume of reports, for the 2022 report, Emsisoft did not compile data for healthcare organizations and instead focused on hospitals and multi-hospital health systems. Out of the 24 confirmed attacks on hospitals, data theft occurred in 17 of those attacks (68%).

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Ransomware Hospitals HIPAA Governance 106

Compliancy Group

FEBRUARY 26, 2024

A comprehensive hospital compliance work plan is pivotal for achieving these objectives. Hospital compliance officers, c-suite executives, and other decision-makers must constantly stay abreast of the latest developments in healthcare compliance. What Are Hospital Compliance Work Plans?

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Compliance US Department of Health and Human Services Hospitals Compliance Officers 52

Healthcare IT Today

OCTOBER 22, 2020

The US Department of Justice has filed charges against 345 defendants, including more than 100 medical professionals, accusing them of engaging in healthcare fraud schemes. The […].

Fraud 61

Fraud COVID-19 Medicaid Medicaid 61

HIPAA Journal

MARCH 21, 2023

Multiple class action lawsuits have been filed against two healthcare providers in Arkansas – Mena Regional Health System (MRHS) and Howard Memorial Hospital – over cyberattacks in which patient data was compromised. The post Multiple Lawsuits Filed Against Arkansas Hospitals Over Data Breaches appeared first on HIPAA Journal.

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Hospitals Fraud Health Insurance HIPAA 68

HIPAA Journal

JUNE 15, 2023

A relatively small data breach was reported to OCR on February 28, 2018, by Yakima Valley Memorial Hospital (formerly Virginia Mason Memorial), a 222-bed non-profit community hospital in Washington state. So far this year, penalties totaling $1,901,500 have been imposed by OCR to resolve violations of the HIPAA Rules.

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HIPAA Hospitals Electronic Medical Records Fraud 89

Florida Health Care Law Firm

JANUARY 14, 2022

Attorney arrested 13 people in a $100 Million healthcare fraud scheme in NY and NJ involving automobile insurance claims. Bribed 911 operators and hospital employees for confidential information of insured drivers. The post Healthcare Fraud Scheme Indictment Starts the New Year first appeared on Florida Healthcare Law Firm.

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Fraud Compliance Hospitals 52

HIPAA Journal

MAY 10, 2023

McPherson Hospital – Ransomware Attack McPherson Hospital in Kansas has recently issued notification letters to 19,020 patients to alert them about a July 2022 ransomware attack. McPherson Hospital said its technical safeguards have been reviewed and enhanced to prevent similar incidents in the future.

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Hospitals Ransomware Health Insurance Fraud 93

Becker's Health IT

JUNE 16, 2023

Insider threats, which include healthcare employees who abuse their access rights to steal patient data to commit identity theft and financial fraud, have affected three hospitals and health systems.

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Hospitals Fraud 44

Verisys

APRIL 2, 2024

Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3 Here is a round up of bad actors: Physician Fraud Physician pays $1.8M

Fraud 52

Fraud Telemedicine Licensing Doctors 52

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The post CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance appeared first on Inovaare.

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Fraud Medicare Medicare Medicaid 52

Natalia Mazina

JUNE 28, 2022

If you see an order that you haven’t placed, then fraud is likely. (I am still wondering why the driver was not apprehended). I thought that this was a stand-alone incident. It is important to remember that a distributor/manufacturer/Board will rarely, if ever, call you to request this type of private information. Verify all orders.

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Fraud Hospitals 52

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

Fraud 52

Fraud Medicaid Medicaid Medicare 52

HIT Consultant

MAY 4, 2023

Monitoring and maintaining the security of IT infrastructure is often overemphasized within hospitals and health systems, while the human side of reducing risk is often under-emphasized. The answer is training, continual training to help create a culture of security within your hospital or health system.

Hospitals 97

Hospitals Regulatory Compliance HIPAA Compliance 97

HIPAA Journal

AUGUST 1, 2022

The post Meta Facing Further Class Action Lawsuit Over Use of Meta Pixel Code on Hospital Websites appeared first on HIPAA Journal.

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Hospitals HIPAA Fraud 129

Bill of Health

OCTOBER 30, 2023

In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. Public Health Awareness First, hospitals might try to reach patients through engaging ads that deploy emojis. The Stark Law requires hospital advertisements disclose when physicians may have financial conflicts of interest.

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Doctors Hospitals Fraud Health Insurance 284

Healthcare Law Blog

FEBRUARY 9, 2024

Following the resolution of this case, hospitals are encouraged to revisit their arrangements with private physician groups to ensure that proper safeguards are in place to mitigate FCA risk. Hospitals may also want audit rights to ensure that it has the ability to monitor billing compliance by private physicians on a regular basis.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

HIPAA Journal

MAY 10, 2023

District Court for the Southern District of Iowa that alleges University of Iowa Hospitals and Clinics (UIHC) unlawfully, negligently, and recklessly disclosed patients’ private information to Facebook, without obtaining patient consent. A lawsuit has been filed in the U.S. A study that was recently published in Health Affairs found 98.6%

Hospitals 75

Hospitals HIPAA Fraud 75

Bill of Health

FEBRUARY 21, 2024

Center for Reproductive Medicine , involves plaintiffs seeking punitive damages from an Alabama fertility clinic for the “wrongful death” of their embryos that were destroyed when a patient in the hospital where they were stored removed them from the cryotank. A recently introduced federal fertility fraud bill is a prime example.

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Fraud Licensing Medicaid Medicaid 257

Healthicity

OCTOBER 5, 2022

The Office of Inspector General recently made Work Plan updates that impact price transparency rules, Medicaid fraud referrals, and inpatient rehabilitation. If you support compliance for hospitals or hospital systems, listen up! Have you heard? Our latest eBrief covers the updates you need to know.

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Fraud Medicaid Medicaid Compliance 98

Hall Render

FEBRUARY 25, 2022

Under the Donors’ agreement with the Children’s Hospital (“Agreement”), the Hospital and the Fund would pay all out-of-pocket costs incurred by qualified families for their child’s medical care in the cancer, cardiac or neurosurgical programs, referred to as the “Initial Supported Programs.”

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Fraud Hospitals Medicare Medicare 40

The Health Law Firm

JANUARY 23, 2019

On January 23, 2019, a Miami woman pled guilty to conspiring to defraud the government and paying and receiving kickbacks as part of a $1 billion health care fraud scheme. The former Director of Outreach Programs at Larkin Community Hospital will face a prison sentence of up to five years on the single count.

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Fraud Governance Hospitals 40

Healthcare Compliance Blog

MAY 19, 2022

An acute care hospital in Oklahoma has paid over $1.1 Following an internal review and audit, the hospital discovered irregularities regarding its billing of certain services, and proactively contacted the United States to self-disclose the issues.? Throughout the investigation, the hospital cooperated with the above entities.

US Department of Health and Human Services 59

US Department of Health and Human Services Hospitals Medicare Medicare 59

Healthcare IT Today

DECEMBER 16, 2022

The scope of facial recognition’s impact on the healthcare industry is vast, spanning insurance fraud and improved admin systems, all the way to reducing drug crime. A Seamless and Fraud Free Check-In. Protection from insurance policy fraud. Healthcare fraud is estimated to cost around $54 billion a year in America.

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Fraud Hospitals 57

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. But what exactly is considered fraud, waste, and abuse? These complaints can trigger an audit. Data Analysis and Trends.

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Fraud Compliance Medicaid Medicaid 98

HIPAA Journal

JANUARY 6, 2023

Anne Hospital, St. Elizabeth Hospital, St. Anthony Hospital, St. Clare Hospital, St. Francis Hospital, St. Joseph Hospital, and St. Lawsuits often fail when they are based solely on an elevated risk of identity theft and fraud. Virginia Mason Franciscan Health operates St. Michael Medical Center.

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Ransomware Fraud Electronic Medical Records Hospitals 82

Healthcare IT Today

SEPTEMBER 24, 2021

According to a survey by Proofpoint, the average healthcare organization received about 200,000 emails from over 10,000 different 3rd party domains. When you consider the thousands of vendors and suppliers that work with a healthcare organization, this isn’t a big surprise.

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Fraud Hospitals 85

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. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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Fraud Medicare Medicare Governance 40

Healthcare IT Today

FEBRUARY 9, 2024

Currently, in-patient and facility claims (such as extended hospital stays) account for a significant portion of costs in healthcare — as high as 45%. Even worse, up to 10% of this spending is rife with waste, abuse, and fraud. In other words, nearly half of all U.S. healthcare spending goes unaudited today.

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Fraud Governance Hospitals Licensing 106

Hall Render

MAY 17, 2024

in Federal Funds to 19 Nursing Schools Steward Health Plans to Sell Its Hospitals in Hope, Texarkana UAMS Researcher Awarded $1.6M in Federal Funds to 19 Nursing Schools Steward Health Plans to Sell Its Hospitals in Hope, Texarkana UAMS Researcher Awarded $1.6M in PE funds: WSJ Kaiser posts $935M operating profit in Q1 S.F.

Nurses 40

Nurses Nursing Homes Hospitals Ransomware 40

Compliancy Group

FEBRUARY 9, 2024

These programs encompass a wide range of areas, including: Fraud Prevention Privacy Protection Billing Accuracy Ethical Conduct The guidance documents provide detailed instructions on developing policies and procedures tailored to the specific needs of each healthcare setting.

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Compliance Fraud Hospitals 52

Compliancy Group

FEBRUARY 7, 2024

CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary. Given their significant impact, healthcare organizations must take UPIC audits seriously.

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Fraud Compliance Medicare Medicare 52