article thumbnail

Building an OIG Compliance Program for Physicians

Compliancy Group

Since the start of the data privacy rule in 2003 alone, there have been at least 350,000 Health Insurance Portability and Accountability Act complaints with 1,188 compliance reviews. Being placed on this list means that an individual or entity has committed fraud or harmed a patient(s).

article thumbnail

HHS-OIG Excludes Theranos Founder and CEO from Federal Health Programs for 90 Years

HIPAA Journal

The Theranos Scandal Theranos was a blood testing startup founded by Elizabeth Holmes in 2003. Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors.

Fraud 83
Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

Sentencing Guidelines: Third Circuit Rejects Use of “Intended” Loss in Favor of “Actual” Loss

Healthcare Law Today

Sentencing in federal fraud cases is driven by loss amounts. In health care fraud cases, the government frequently asserts a high “intended loss” based on amounts billed to payers, even when amounts actually paid were far less. Health care fraud cases are a prime example. In United States v. Banks Decision.

Fraud 52
article thumbnail

What Does the HIPAA Security Rule Cover?

HIPAA Journal

Most of Title II of HIPAA addresses fraud and abuse against federal health programs. These two instructions led to the publication of the “ Standards for Electronic Transactions ” in August 2000 and the “ Security Rule Standards ” in February 2003. As health insurance premiums are tax deductible, this would impact federal tax revenues.

HIPAA 45
article thumbnail

Planned Parenthood Pays $4.3 Million to Settle Allegations of Medicaid Fraud in Qui Tam/Whistleblower Case

The Health Law Firm

The nonprofit organization is accused of fraudulently billing Medicaid and other government programs for health services provided by some of its Texas clinics between 2003 and 2009, according to the DOJ. Indest III, J.D., Board Certified by The Florida Bar in Health Law Planned Parenthood Gulf Coast recently paid $4.3

article thumbnail

The Supreme Court Clarifies the Government’s FCA Dismissal Power and Invites Constitutional Challenge to the FCA’s Qui Tam Provision

Health Law RX

The First Circuit placed an onus on the relator to avoid dismissal by showing that the Government’s motion was “transgress[ing] constitutional limitations” or “perpetrating a fraud on the court” ( Borzilleri v. Circuit found the Government’s dismissal authority to be “unfettered” ( Swift v. 3d 250, 252 (D.C. Bayer Healthcare Pharms.,

article thumbnail

The Rise of Healthcare Governance, Risk, and Compliance

MedTrainer

It also supports financial compliance by implementing accurate billing practices and fraud prevention mechanisms, which are crucial for maintaining the organization’s financial health. Healthcare GRC programs are relatively new, having gained prominence over the past two decades.