AIHC

FEBRUARY 17, 2025

When Audit Managers Knowingly Skew Audit Results Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. on fraud detection and prevention in healthcare.

Fraud 52

Fraud Compliance Overpayment Overpayments 52

Compliancy Group

APRIL 25, 2024

Maintaining Medicare compliance and avoiding legal and financial repercussions requires Medicare compliance training for employees at all organizational levels. Examples of Medicare fraud include billing for unrendered services and using a billing code or a service that’s more expensive than what a patient received.

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Fraud Medicare Medicare Compliance 59

MedTrainer

MAY 3, 2024

Healthcare fraud, waste, and abuse is a costly problem for both public and private payers. The National Health Care Anti-Fraud Association estimates financial losses due to healthcare fraud could be as much as $300 billion annually. Keep in mind that these are just examples of provider fraud!

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Fraud Compliance Compliance Officers Licensing 94

Provider Trust

SEPTEMBER 29, 2022

Mendez, who was a physician assistant at CCI Therapy Counseling Centers International, was working with a suspended medical license. However, despite his suspended medical license, Mendez continued to treat patients at various mental health clinics in Brownsville, Harlingen, and Pharr, TX. How Often Should You Verify Employee Licenses?

Licensing 52

Licensing Fraud Medicaid Medicaid 52

The Health Law Firm

FEBRUARY 14, 2022

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Additionally, the doctor indicated that he was sought to directly address CMS and the Medical Practice's ability to bill Medicare and Medicaid. Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Doctors 52

Verisys

DECEMBER 29, 2024

Credentialing services perform this verification by contacting primary sources, such as medical schools and licensing boards, to confirm the physician’s education and qualifications. Without proper credentialing, physicians cannot apply for privileges, bill for services, or receive reimbursement from Medicare and other payers.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. The psychologist was convicted of four counts of healthcare fraud.

Nursing Homes 59

Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Verisys

MARCH 6, 2025

The Centers for Medicare and Medicaid Services (CMS) Regulates reimbursement policies and ensures healthcare organizations adhere to the standards necessary to participate in federal healthcare programs. Imagine a healthcare system caught up in fraudulent billing, submitting false claims to Medicare. link] The HIPAA Journal.

Compliance 52

Compliance HIPAA Licensing Governance 52

Verisys

NOVEMBER 3, 2023

Healthcare Fraud Crackdown! Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc. Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc.

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Fraud Compliance Medicare Medicare 52

Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys.

Fraud 52

Fraud Telemedicine Licensing Doctors 52

Compliancy Group

DECEMBER 15, 2023

Unfortunately, some Medicare and Medicaid funds are lost to fraudulent and wasteful behaviors. Knowing how to detect, report, and prevent inappropriate use of funds associated with the Centers for Medicare and Medicaid Services (CMS) is essential. What is Healthcare Fraud? taxpayers over $100 billion annually.

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Fraud Medicaid Medicaid Medicare 52

The Health Law Firm Blog

JULY 13, 2023

Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.]

Licensing 52

Licensing Medicaid Medicaid Fraud 52

The Health Law Firm

JUNE 22, 2015

Board Certified by the Florida Bar in Health Law and Shelby Root The largest criminal health care fraud takedown in the history of the US Justice Department, in terms of both loss amount and arrests, took place June 18, 2015. The individuals have been charged with submitting fake billing for Medicare that totaled approximately $712 million.

Fraud 40

Fraud Medicare Medicare Licensing 40

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

Healthcare Law Today

DECEMBER 22, 2022

Department of Health and Human Services Office of Inspector General (HHS-OIG) Special Fraud Alert on telefraud, and the rise of asynchronous telehealth, among other topics. In July 2022, HHS-OIG published a Special Fraud Alert about arrangements with telemedicine companies to serve as an extra level of guidance to the industry at large.

Telemedicine 119

Telemedicine Fraud Doctors COVID-19 119

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. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Verisys

APRIL 3, 2025

Licensure actions Disciplinary actions from state medical boards, like suspensions or revoked licenses. Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Civil judgments Lawsuits that reveal unethical behavior or misconduct.

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

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

Compliancy Group

NOVEMBER 25, 2024

The Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) helps prevent fraud, ensure high-quality levels of care, and keep businesses aligned with regulatory measurements.

Compliance 52

Compliance Fraud 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. Valle De Sol said it has not received any reports from patients to suggest any misuse of their data.

Health Insurance 135

Health Insurance Licensing Fraud HIPAA 135

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 the OIG Exclusion Database Came to Be HHS oversees the CMS (Center for Medicare Services), which administers the Medicare program.

Medicare 52

Medicare Medicare Fraud HIPAA 52

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.

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Fraud HIPAA Medicare Medicare 97

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.

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Licensing Health Insurance Fraud HIPAA 118

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 101

Hospitals Fraud Licensing HIPAA 101

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 119

Health Insurance Licensing Ransomware Fraud 119

HIT Consultant

APRIL 1, 2024

to settle a civil fraud lawsuit filed by the U.S. Specifically, the government claims that TRG: Failed to ensure adequate review of radiology scans: TRG allegedly used contractors located outside the United States, who were not licensed to practice medicine in the US, to prepare draft interpretations of radiology scans.

Governance 97

Governance Licensing Fraud Medicare 97

MedTrainer

JANUARY 21, 2025

Understanding the OIG Exclusion List The OIG maintains the List of Excluded Individuals/Entities (LEIE), which provides comprehensive information to the healthcare industry on those currently excluded from participating in Medicare, Medicaid, and any other federal healthcare programs.

Compliance 52

Compliance Fraud Regulatory Compliance Medicare 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

Fraud 52

Fraud Medicaid Medicaid Nurses 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

Verisys

APRIL 8, 2025

At a minimum, FACIS Level 1M satisfies the requirements of the OIG and CMS (Centers for Medicare & Medicaid Services) by screening providers for exclusions, debarments, disciplinary actions, and related issues. A Guide to the Fraud Abuse Control Information System appeared first on Verisys. The post What is FACIS?

Fraud 52

Fraud Medicaid Medicaid Compliance 52

The Health Law Firm Blog

APRIL 18, 2022

Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.].

Licensing 40

Licensing Medicaid Medicaid Fraud 40

Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). This year’s report also shows greater participation from managed care organizations (MCOs) as a key trend.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

HIPAA Journal

NOVEMBER 12, 2024

Orthopedics Rhode Island said it is unaware of any misuse of that information but has advised all affected individuals to be vigilant against identity theft and fraud. The breach has recently been reported to the HHS’ Office for Civil Rights as affecting 500 individuals.

Health Insurance 84

Health Insurance Fraud Licensing HIPAA 84

Verisys

MAY 13, 2024

With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Here is a round up of bad actors: Doctor sentenced to 10 years in prison for unlawfully dispensing controlled substances ( Full Story ) Doctor Convicted for $5.4M

Fraud 52

Fraud COVID-19 Doctors Licensing 52

Verisys

MAY 13, 2024

With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Here is a round up of bad actors: Doctor sentenced to 10 years in prison for unlawfully dispensing controlled substances ( Full Story ) Doctor Convicted for $5.4M

Fraud 52

Fraud COVID-19 Doctors Licensing 52

Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. This year’s 129-page report also includes information about the amounts deposited and appropriated to the Medicare Trust Fund, as well as the source of such deposits. Monetary Penalties. Of this $1.9

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