Verisys

MARCH 8, 2024

Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network.

Fraud 52

Fraud Medicaid Medicaid Medicare 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

Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How do people end up on the Medicaid Exclusion List, what are the consequences of being on the list, and can you ever get off the list?

Medicare 52

Medicare Medicare Fraud HIPAA 52

The Health Law Firm

OCTOBER 31, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019.

Fraud 40

Fraud Medicare Medicare Doctors 40

Medisys Compliance

APRIL 19, 2023

The Medicaid program in Florida provides medical services and assistance to low-income individuals and families. To participate in the Medicaid program, healthcare providers must meet several general requirements set forth by the Agency for Health Care Administration (AHCA).

Medicaid 52

Medicaid Medicaid Medical Billing Outsourcing Licensing 52

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?

Fraud 98

Fraud Compliance Medicaid Medicaid 98

The Health Law Firm

OCTOBER 3, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019.

Fraud 40

Fraud Doctors Medicare Medicare 40

Verisys

NOVEMBER 8, 2023

The NPI improves the Medicare and Medicaid programs, other federal and private health programs, and the overall effectiveness and efficiency of the healthcare industry by simplifying administration and enabling the efficient electronic transmission of health information. Providers also need an NPI to enroll in Medicare.

Fraud 97

Fraud HIPAA Medicare Medicare 97

The Health Law Firm Blog

MAY 12, 2023

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her [.]

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors? Department of Justice (DOJ), the U.S.

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

Provider Trust

SEPTEMBER 12, 2022

In 2006, New York’s Office of the Medicaid Inspector General (OMIG) was established as an independent office within New York State’s Department of Health to combat fraud and abuse in New York State’s Medicaid program. What is New York's OMIG List of Restricted and Excluded Providers?

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

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?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

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.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

The Health Law Firm Blog

FEBRUARY 15, 2022

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her.

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

MedTrainer

JANUARY 12, 2024

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. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. organizations that receive any funds from Medicare, Medicaid, TRICARE, or other federal programs cannot afford to employ individuals or entities excluded from even one program. Medicare opt out.

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Medicaid 52

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 77

Hospitals Fraud Licensing HIPAA 77

Med-Net Compliance

SEPTEMBER 7, 2022

A 49-year-old Texas physician assistant was arrested and charged for his role in a scheme to defraud Medicaid by working with a suspended medical license. On July 20, 2021, the Texas Medical Board allegedly ordered the immediate suspension of his physician assistant license, deeming him to be a “continuing threat to public welfare.”

Medicaid 59

Medicaid Medicaid Licensing Medical Personnel 59

Innovaare Compliance

OCTOBER 6, 2022

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. However, such allowance is not extended beyond March 31, 2023.

Medicare 52

Medicare Medicare Compliance Public Health 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

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Med-Net Compliance

JULY 19, 2022

In order to participate in the Medicare, Medicaid, and all federal healthcare programs once the term of exclusion ends, the individual or entity must apply for reinstatement and receive written notice from OIG that reinstatement has been granted. OIG maintains a list of all currently excluded individuals and entities called the?

US Department of Health and Human Services 59

US Department of Health and Human Services Licensing Medicare Medicare 59

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 99

Licensing Health Insurance Fraud HIPAA 99

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.

Licensing 52

Licensing Governance Compliance Fraud 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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 115

Health Insurance Licensing Fraud HIPAA 115

HIPAA Journal

JULY 4, 2023

As a precaution against identity theft and fraud, affected individuals have been offered 24 months of complimentary credit monitoring services. Affected individuals had one or more of the following exposed: name, address, driver’s license number, health insurance information, medical information, date of birth, and Social Security number.

Medicaid 73

Medicaid Medicaid Health Insurance Licensing 73

The Health Law Firm

MARCH 2, 2016

Board Certified by The Florida Bar in Health Law The owner of a diagnostic imaging company in Maryland is facing life in prison after a federal jury found him guilty on February 17, 2016, of health care fraud. Rafael Chikvashvili, was found guilty of billing Medicare and Medicaid for more than $7.5 Indest III, J.D.,

Fraud 40

Fraud Licensing Medicaid Medicaid 40

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 107

Health Insurance Licensing Ransomware Fraud 107

C&M Health Law

SEPTEMBER 11, 2023

Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (“CMS”) issued a much anticipated and contested proposed rule that seeks to establish minimum staffing level requirements for nursing homes. HPRD from licensed practical nurses, and 2.38 On September 1, 2023, the U.S. HPRD from NAs.

Nursing Homes 98

Nursing Homes Nurses Medicaid Medicaid 98

MedTrainer

FEBRUARY 12, 2024

Non-compliance can lead to significant fines, legal battles, and the loss of license or accreditation. For example, healthcare fraud or intentional non-compliance with regulations can lead to criminal charges. These actions can include fines, sanctions, or even revocation of licenses or certifications.

Compliance 52

Compliance Licensing Governance Fraud 52

MedTrainer

JANUARY 12, 2024

Licensing and credentialing were introduced to regulate healthcare professionals and ensure minimum standards of care. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance evolved to include performance reporting and quality metrics.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

YouCompli

DECEMBER 7, 2022

These exclusions are generally related to criminal activity like fraud or healthcare-related misconduct. Felony convictions for other healthcare-related fraud, theft, or other financial misconduct. Excluded people are ineligible to perform services that are reimbursed by federal healthcare programs. Patient abuse or neglect.

Fraud 52

Fraud US Department of Health and Human Services Compliance Medicaid 52

Provider Trust

JULY 17, 2023

Medicare and Medicaid’s growing presence in managed care was also heavily discussed, with OIG urging healthcare organizations to become increasingly aware of risk adjustment payment scams. To combat this fraud, waste, and abuse, the OIG introduced a three-part plan called the PRO framework to guide the oversight of nursing homes.

Compliance 52

Compliance Nursing Homes Nurses Fraud 52

Verisys

JANUARY 6, 2022

Payments from Medicare, Medicaid, TRICARE, CHIP, and other federal programs are a significant source of funds for nearly every healthcare organization and provider. The OIG through the Social Security Act has the power to bar individuals and entities from receiving federal payments as the result of intentional fraud or abuse.

US Department of Health and Human Services 52

US Department of Health and Human Services Fraud Medicaid Medicaid 52

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

MedTrainer

MARCH 14, 2024

The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Maintaining compliance helps protect against fraud, waste, and abuse. Meets compliance standards: Both processes verify a provider has met compliance standards.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52