3 providers to pay $22.5M to settle Medicaid fraud allegations in California
Fierce Healthcare
DECEMBER 8, 2022
to settle Medicaid fraud allegations in California. 3 providers to pay $22.5M Thu, 12/08/2022 - 16:58.
Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks
Med-Net Compliance
JUNE 13, 2022
Three independent clinical laboratories, their owner and holding company, an additional independent clinical laboratory and its owner, two laboratory marketing companies, and a Massachusetts physician have been charged in connection with Medicaid fraud, money laundering, and kickbacks involving urine drug tests?that
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Massachusetts AG’s Medicaid Fraud Division Recovers More Than $71M in Federal FY2022
Med-Net Compliance
NOVEMBER 2, 2022
Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.
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Missouri Woman Sentenced for Medicare and Medicaid Fraud
Healthcare Compliance Blog
JANUARY 25, 2022
A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. Update your policies and procedures as needed.
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OIG: Most states not doing enough to monitor Medicaid telehealth fraud for behavioral health services
Fierce Healthcare
SEPTEMBER 21, 2021
OIG: Most states not doing enough to monitor Medicaid telehealth fraud for behavioral health services. Tue, 09/21/2021 - 16:26.
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Massachusetts Medicaid Fraud Division Recovers Over $55 Million in 2021
Healthcare Compliance Blog
JANUARY 24, 2022
On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.
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Physician Indicted for Medicaid Fraud and Invasive and Medically Unnecessary Testing
Med-Net Compliance
AUGUST 5, 2022
New York Attorney General Letitia James announced the indictment of a physician and his company for defrauding Medicaid by forcing patients to get unnecessary and invasive medical tests. He then directed his staff to submit claims for payment to Medicaid for those medically unnecessary tests. ?.
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Ineligible Medicaid Provider Arrested for Defrauding Medicaid of More Than $68K
Healthcare Compliance Blog
MAY 10, 2022
An ineligible Medicaid provider was arrested in Florida for defrauding Medicaid of more than $68,000. According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application.
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Dozens charged in sprawling $1.2B telehealth and genetics fraud crackdown
Healthcare IT News - Telehealth
JULY 22, 2022
billion in alleged fraud involving telehealth, phony genetic testing and durable medical equipment. Meanwhile, the Centers for Medicare and Medicaid Services' Center for Program Integrity also announced that it has taken administrative actions against more than 50 healthcare providers alleged to be involved in similar schemes.
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Supreme Court To Review Scope of Identity Theft in Medicaid Fraud Case
The Health Law Firm
DECEMBER 6, 2022
In the case the Supreme Court accepted for review, the petitioner, a managing partner at a psychological services company, was convicted of Medicaid fraud in Texas in 2013.
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General Requirements for Medicaid Providers in Florida
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).
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Former Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000
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. The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her [.]
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Verisys- Healthcare Fraud and Abuse
Verisys
MARCH 23, 2023
3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. government or a government contractor.
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DOJ charges dozens in $1.1B telehealth fraud crackdown
Healthcare IT News - Telehealth
SEPTEMBER 20, 2021
Department of Justice announced this past week that it was bringing criminal charges against 138 total defendants for their alleged participation in various healthcare fraud schemes, resulting in about $1.4 billion in alleged losses. More than $1.1 billion of that loss involved allegedly fraudulent claims related to telemedicine.
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Florida Behavior Analyst Arrested for Falsifying Timesheets to Defraud Medicaid
Healthcare Compliance Blog
MAY 2, 2022
A behavior analyst who was employed by a Florida home health agency has been arrested for Medicaid fraud. The man provided behavior analyst services for three Medicaid recipients, all of whom had disabilities. The parent of one of the children noticed incorrect information on a Medicaid online portal and reported it.
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New York Optician Convicted of Medicaid Fraud for Nursing Home Residents
Healthcare Compliance Blog
FEBRUARY 2, 2022
The optician fraudulently received approximately $74,000 in Medicaid payments between 2016 and 2019 by billing for the optician services that were not provided. The post New York Optician Convicted of Medicaid Fraud for Nursing Home Residents appeared first on.
10 Charged Over BEC Scams Targeting Medicare, Medicaid, and Private Insurance Programs
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. Medicare, Medicaid, and private health insurers suffered losses of more than $4.7
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Attention New York Medicaid Providers: It’s Time to Upgrade Your Compliance Program
Healthcare Law Blog
FEBRUARY 3, 2023
Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.
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Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000
The Health Law Firm Blog
FEBRUARY 11, 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. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.]
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Dental Office Manager Sentenced to 12 Months in Prison for Defrauding Medicaid Out of More Than $813,000
The Health Law Firm Blog
JANUARY 28, 2023
On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By Carole C. Schriefer, J.D. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.
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Florida Attorney Says AHCA Must Put Medicaid Final Orders Online
The Health Law Firm Blog
MAY 16, 2023
Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]
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California Handed Its Medicaid Drug Program to One Company. Then Came a Corporate Takeover.
Kaiser Health News
APRIL 8, 2022
Prescription drug costs for California’s massive Medicaid program were draining the state budget, so in 2019 Gov. The new Medicaid drug program debuted this January, with a private company in charge. Centene was already a big player in state Medicaid drug programs — but one with a questionable record. SACRAMENTO, Calif.
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Dozens of Defendants Charged with Healthcare Fraud
American Medical Compliance
MARCH 13, 2023
The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. The Centers for Medicare & Medicaid Services investigates these cases and prioritizes protecting patients. Healthcare organizations must take all possible steps to prevent instances of fraud. course today.
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Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations
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. In addition, [.].
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Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations
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. In addition, [.].
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Dental Healthcare Fraud, Waste, and Abuse (FWA) Training
American Medical Compliance
FEBRUARY 15, 2023
The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. The Centers for Medicare and Medicaid Services (CMS) require FWA training.
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Nursing Home Psychologist Convicted of Healthcare Fraud Scheme
Med-Net Compliance
OCTOBER 27, 2022
The psychologist was convicted of four counts of healthcare fraud. The FBI and HHS-OIG investigated the case, which was brought as part of the Chicago Strike Force, supervised by the Criminal Division’s Fraud Section and the US Attorney’s Office for the Northern District of Illinois.
Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme
Med-Net Compliance
JULY 20, 2022
A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.
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Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations
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. In addition, [.].
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Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations
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. In addition, [.].
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HHS watchdog: State oversight needed for behavioral telehealth
Healthcare IT News - Telehealth
SEPTEMBER 27, 2021
The brief, which examined oversight efforts as of January and February 2020, stemmed from a survey of Medicaid directors from 37 states, as well as structured interviews with relevant stakeholders. Conduct monitoring for fraud, waste and abuse, and support state efforts to oversee telehealth for behavioral health services.
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Another Resolution by DOJ Pursuant to its Civil Cyber-Fraud Initiative Highlights Continued Efforts to Hold Companies Accountable for Ensuring Data are Secured
Health Care Law Brief
JUNE 5, 2023
We previously wrote about the United States Department of Justice’s (“ DOJ ”) Civil Cyber-Fraud Initiative (“ CCFI ”), which “aims to hold accountable entities or individuals that put U.S.
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President Biden Signs End-of-Year Legislation Including Telehealth, Medicare & Medicaid, Mental Health, Pandemic Preparedness, and Other Health Care Provisions
C&M Health Law
JANUARY 25, 2023
hospitalizations and emergency department visits) and to audit Medicare claims to assess potential fraud. In November 2020, the Centers for Medicare & Medicaid Services (CMS) announced the Acute Hospital Care At Home program to provide hospitals expanded regulatory flexibility and allow them to care for eligible patients in their homes.
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Healthcare Fraud and Abuse Control Program Fiscal Year 2021 Report
Med-Net Compliance
JULY 11, 2022
The report says that in FY 2021 the DOJ opened 831 new criminal healthcare fraud investigations. Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, and a total of 312 defendants were convicted of healthcare fraud related crimes during the year. 2,947 investigations were pending at the end of FY 2021.
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Fraud, Waste and Abuse Training for Workers in Emergency Medical Services (EMS)
American Medical Compliance
FEBRUARY 15, 2023
The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.
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Healthcare Professionals: Do You Know How to Prepare For, and Respond To, a Medicaid Audit Request?
The Health Law Firm
AUGUST 18, 2022
., Board Certified by The Florida Bar in Health Law Florida healthcare providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country. Unfortunately, the unfortunate truth is that Florida has become synonymous with healthcare fraud.
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Blog Browse: What can recent FCA decisions tell us about the Seventh Circuit pleading standard for health care billing fraud claims?
Health Law Checkup
JANUARY 20, 2022
Can a whistleblower successfully allege Medicaid/Medicare fraud if the whistleblower lacked direct access to records related to the alleged fraud? While the appellate circuits are still split on this issue, we look at recent decisions that indicate a possible shift in the Seventh Circuit’s pleading standard.
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Florida Surgeon Gets 7 Years for Committing $28 Million in Health Care Fraud
The Health Law Firm Blog
JUNE 1, 2023
., Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. The scheme involved performing hundreds of medically unnecessary, [.]
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Fraud-Proofing Your Telehealth Strategy
HIT Consultant
OCTOBER 18, 2021
Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud. The second type, indirect fraud, involves several bad actors that coordinate their efforts.
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Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000
The Health Law Firm Blog
DECEMBER 31, 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. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.].
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How to Prevent Medicare Advantage Fraud, Waste, and Abuse
Provider Trust
MARCH 21, 2023
Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.
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Texas Adult Day Care Owner Sentenced for Healthcare Fraud Scheme
Healthcare Compliance Blog
APRIL 29, 2022
in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. Court documents show that between 2008 and 2016 the former owner defrauded the Texas Medicaid program by billing for items and services that had not been provided to the clients of the day care centers. US Attorney Ashley C.
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Georgia Rehabilitation Center Submitted 808 False Claims to Medicaid/Tricare
Healthcare Compliance Blog
APRIL 27, 2022
A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds.
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