Health Law Advisor

FEBRUARY 3, 2022

FY 2021 was also a record-shattering year for DOJ as it relates to health care fraud enforcement; over $5 billion (90% of the total) was obtained from cases pursued against individuals and entities in the health care and life sciences industries. With collections amounting to $5.6 billion received in FY 2020.

Fraud 52

Fraud COVID-19 Governance Medicare 52

HIPAA Journal

MAY 18, 2023

The Department of Health and Human Services’ Office for Civil Rights is the main enforcer of HIPAA compliance; however, state Attorneys General also play a role in enforcing compliance with the Rules of the Health Insurance Portability and Accountability Act (HIPAA). million individuals and for delayed breach notifications. million 78.8

HIPAA 103

HIPAA Compliance Ransomware Hospitals 103

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fraud, waste, & abuse. 2018 Medicare Fee-For-Service improper payment rate is lowest since 2010 Significant progress in saving $4.59B in estimated improper payments for the Medicare Fee-For-Service program. Jeremy.Booth@c…. Fri, 11/16/2018 - 18:46.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

HIPAA Journal

OCTOBER 21, 2022

For example, the Administrative Requirements (Part 162) helped reduce insurance fraud and accelerated eligibility inquiries, authorization requests, and claims processing. Consequently, when data breaches occurred due to a lack of compliance by Business Associates, there was no accountability.

HIPAA 107

HIPAA Compliance Medicare Medicare 107

AIHC

JUNE 3, 2024

The estimated homicide rate for men increased by 7% from 2010 to 2016. The article states that Americans over 60 years of age fell victim to so-called elder fraud crimes more frequently last year than during any other year and accounted for an estimated $3.4 billion in total reported losses.

Elder Abuse 52

Elder Abuse Compliance Nursing Homes Compliance Officers 52

Health Care Law Brief

APRIL 12, 2023

405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. MA plans will be required to have a Utilization Management Committee that conducts annual reviews of policies to ensure compliance with the foregoing. 2010) (quoting S. Final Rule at p. 3d 173, 191 (D.D.C. rather than a ‘limited duty to inquire.”

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Innovaare Compliance

FEBRUARY 9, 2021

The Affordable Care Act of 2010 mandates the CMS to make quality bonus payments (QBPs) to Medicare Advantage (MA) organizations that achieve at least four stars in a 5-star quality rating system and, starting in 2012, the CMS incentivizes health plans to improve member experiences by increasing the QBP amount, based on their star rating.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Healthcare IT News - Telehealth

JULY 19, 2021

The practice was an early adopter of telehealth back in 2010, implementing it as a way to care for people unable to attend in-person sessions. Unsecure telehealth connections can open the door for fraud, phishing and ransomware attacks, with serious reputational and financial consequences. THE PROBLEM. " PROPOSAL.

COVID-19 162

COVID-19 HIPAA Ransomware Governance 162

HIPAA Journal

JANUARY 24, 2023

The theft of protected health information places patients and health plan members at risk of identity theft and fraud, but by far the biggest concern is the threat to patient safety. That task has become increasingly difficult due to the increase in data breaches, which have tripled since 2010. million records in 2021 to 51.9

HIPAA 124

HIPAA Ransomware Hospitals Fraud 124

Hall Render

NOVEMBER 28, 2023

Due to CMS’s increasing concern “about program integrity issues within the hospice community, particularly (though not exclusively) potential and actual criminal behavior, fraud schemes, and improper billing,” it proposed to increase the risk screening category into which hospices were placed. Hospice 36-Month Rule.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Health Law Advisor

MARCH 1, 2023

1] Originally enacted in 2010, the Online Prescribing Act has allowed health care providers to register with the State to prescribe and dispense certain FDA-approved drugs via online pharmacies and utilization of telehealth visits.

Telemedicine 52

Telemedicine COVID-19 Fraud Licensing 52

C&M Health Law

JANUARY 25, 2023

hospitalizations and emergency department visits) and to audit Medicare claims to assess potential fraud. Section 1001 of the Act delays the 4% Statutory Pay-As-You-Go Act of 2010 (PAYGO) sequester for two years, through the end of calendar year 2024.

Medicaid 104

Medicaid Medicaid Medicare Medicare 104

Drug & Device Law

AUGUST 8, 2022

The unfortunate truth is that ECFMG was also a victim of this fake doctor’s fraud. So if compliance with an industry standard is a defense, this plaintiff went a step further and sued the organizations that created the standards. Smith, LLC , 2010 WL 11566367, at *7 (N.D. has no power to enforce compliance”), aff’d , 405 F.

Doctors 52

Doctors Fraud Licensing Compliance 52

Drug & Device Law

FEBRUARY 15, 2024

2022) (recognizing the following product defect liability theories: “(1) negligent design of the product; (2) negligent manufacture of the product; (3) negligent failure to warn about some aspect of the product; (4) breach of express or implied warranty; or (5) misrepresentation or fraud”). 09-cv-10248, 2010 WL 4982899, at *5-6 (E.D.

FDA 52

FDA Fraud Compliance Hospitals 52