HIPAA Journal

MARCH 20, 2025

1,500,000 Settlement 2012 Blue Cross Blue Shield of Tennessee $1,500,000 Settlement 2012 Phoenix Cardiac Surgery $100,000 Settlement 2012 The Hospice of Northern Idaho $50,000 Settlement 2011 Cignet Health of Prince George’s County $4,300,000 Civil Monetary Penalty 2011 General Hospital Corp. &

HIPAA 111

HIPAA Ransomware Compliance Hospitals 111

The Health Law Firm

SEPTEMBER 10, 2012

Federal court records from August 13, 2012, show that a former Florida Hospital employee faces fraud-conspiracy charges after he illegally accessed patient records in a solicitation scheme, according to the Orlando Sentinel. When the news broke about a privacy breach at Florida Hospital back in October of 2011, we wrote about this incident.

Hospitals 40

Hospitals Fraud 40

The Health Law Firm

APRIL 22, 2013

She made more than $400,000 in false claims between January 2008 and June 2011. Edna Lorraine Watkins, the owner of Homecare Unlimited, LLC, in Jacksonville, Florida, has been sentenced to six years in prison for defrauding Medicaid, according to the Florida Office of the Attorney General (AG). Watkins was sentenced on April 2, 2013.

Medicaid 40

Medicaid Medicaid Fraud 40

The Health Law Firm

SEPTEMBER 19, 2012

The woman was arrested for allegedly stealing money from 11 clients in 2010 and 2011. Investigation by the Medicaid Fraud Control Unit (MFCU) Led to Arrest. To see the press release from the AG, click here.

Fraud 40

Fraud Medicaid Medicaid 40

The Health Law Firm

APRIL 20, 2016

The verdict comes from a complex scheme in which referring physicians received substantial kickbacks for services over a three-year period from 2008 to 2011. Details of the Complex Fraud Scheme. Indest III, J.D., Board Certified by The Florida Bar in Health Law On April 14, 2016, a jury in California awarded Aetna Inc. more than $37.4

Fraud 40

Fraud 40

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. Only one penalty was issued in each of 2008 and 2009, 2 in 2010, 3 in 2011, and 6 in 2012.

HIPAA 107

HIPAA Compliance Medicare Medicare 107

HIPAA Journal

NOVEMBER 17, 2022

Salud Family Health said affected employees and patients have been offered free credit monitoring and identity fraud protection services, and security policies and procedures are being reviewed and will be updated to protect against future cyberattacks. New York-Presbyterian Hospital Discovers Breach Affecting up to 12,000 Patients.

Ransomware 81

Ransomware Health Insurance Fraud HIPAA 81

Health Care Law Brief

JANUARY 18, 2023

The United States Department of Justice (“DOJ”) resolved allegations that, from January 1, 2011 to December 31, 2016, Dr. Pandya violated the FCA when they submitted false claims to Federal health care programs for medically unnecessary cataract extraction surgeries and YAG laser capsulotomies (“Civil Settlement Agreement”).

Medicare 52

Medicare Medicare Compliance Fraud 52

Verisys

JULY 13, 2023

Verisys’ former VP of Pharma and Pharmacy Solutions, Joe Thompson, shared a prime example of how speaker programs introduce risk to the pharmaceutical company: “In 2011, one of the most prominent endocrinologists in my sales region was an active speaker for my previous company. He led multiple programs for us each year.

Compliance 52

Compliance Due Diligence Pharmaceutical Industry Fraud 52

CMS.gov

NOVEMBER 2, 2018

Medicare has a plethora of misaligned financial incentives that work to increase costs for taxpayers and beneficiaries, and create challenges related to fraud and abuse. percent from 2011-2016, from $17.6 Less than two-tenths of one percent of Medicare’s one billion annual claims are reviewed for program integrity issues.

Governance 55

Governance Medicare Medicare ACA 55

C&M Health Law

JANUARY 25, 2023

hospitalizations and emergency department visits) and to audit Medicare claims to assess potential fraud. The Act’s health care offset title includes Section 4163, which extends the 2% Budget Control Act of 2011 Medicare sequester for six months into FY 2032 and lowers the payment reduction percentages in FYs 2030 and 2031.

Medicaid 104

Medicaid Medicaid Medicare Medicare 104

Drug & Device Law

DECEMBER 29, 2023

2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. Since the FDA requires pre-approval of any warnings about off-label uses, preemption at some point should have been pre-ordained under the Mensing ( 2011+1 ) independence principle, but off-label use did not really figure in Zofran ’s analysis. Monsanto Co. ,

FDA 105

FDA US Department of Health and Human Services COVID-19 COVID-19 Vaccine 105

Drug & Device Law

DECEMBER 21, 2023

The logic of the consumer fraud claim made no sense. Letting plaintiffs use RICO (or the False Claims Act) to bring fraud on the FDA claims (preemption only applies to state law) is a distinct minority position, but the Ninth Circuit has. In Shikada , the ultimate result was a nuclear penalty of over $800 million.

FDA 52

FDA Fraud Informed Consent 52

Drug & Device Law

NOVEMBER 10, 2023

Not a single state, including Pennsylvania, allows recover of medical monitoring for “breach of warranty or fraud or violation of consumer protection statutes,” and Valsartan doesn’t cite any precedent for its contrary conclusion. 2023 WL 1818922, at *36. Rohm & Haas Co. , 3d 255, 268 (3d Cir. 2023 WL 1818922, at *35.

FDA 59

FDA Governance Fraud 59

Drug & Device Law

JULY 24, 2023

Nonetheless, the Ninth Circuit’s PATDC82 I allowed a RICO claim alleging that, between 1999 and 2011, defendants concealed that risk from the FDA and that, as a result, every TPP in the country paid for Actos prescriptions that it otherwise would not have reimbursed. The federal rules don’t treat fraud that way. 1 (highlights).

Fraud 52

Fraud FDA Doctors 52

Drug & Device Law

MARCH 31, 2023

Criticizing attempts to sue publishers of scientific content, here in 2011, and again, here in 2013. Scientific literature about the risks and benefits of prescription medical products does not – at least in the absence of academic fraud such as the actual falsification of data (see, here ) – subject the speaker to tort liability.

Medical Personnel 59

Medical Personnel COVID-19 Fraud Doctors 59

Drug & Device Law

JANUARY 30, 2023

470 (1996), was decided – removing express preemption as a defense for manufacturers of §510(k) products So defendants moved on fraud on the FDA under an implied preemption theory and won. Bartlett , 570 U.S. 472 (2013), implied preemption decisions, cited only by the dissent in Wyeth v. Levine , 555 U.S. 555 (2009), and rated only a “ cf.

FDA 72

FDA Fraud Governance Medicare 72

Drug & Device Law

DECEMBER 12, 2022

223, 231-33 (2011), holding that the Vaccine Act preempted all design defect claims asserted by claimants who rejected Vaccine Act awards and sought to litigate their claims instead. The Supreme Court did its part in Bruesewitz v. Wyeth LLC , 562 U.S. Now comes DeCostanzo v. Olin Corp. , 3d 148, 154 (2d Cir. 300aa-22(b)(1).

FDA 115

FDA Public Health Fraud Hospitals 115

Drug & Device Law

OCTOBER 7, 2022

Plaintiff had the device implanted in 2011 and explanted more than seven years later, apparently not because of any symptoms or known injury. Obviously, under Buckman direct fraud-on-the-FDA claims, however titled, are impliedly preempted. The facts of Garcia are sparse. 2022 WL 4536240, *1.

FDA 59

FDA Fraud Doctors Public Health 59

Drug & Device Law

MARCH 7, 2022

Here, Plaintiffs fail to supply factual support showing Defendant acted with “oppression, fraud, or malice,” relying instead upon conclusory allegations. 2011 WL 2149095, at *5 (N.D. May 31, 2011). “[I]n the actions or omissions of the defendant demonstrate malice or aggravated or egregious fraud. Burlington Insurance Co.

Fraud 59

Fraud FDA Licensing Pharmaceutical Industry 59

Drug & Device Law

FEBRUARY 10, 2022

A federal court applying Florida law has refused to dismiss fraud and misrepresentation claims brought by a patient against a medical-device manufacturer, rejecting the manufacturer’s contention that such claims are categorically barred by the learned-intermediary doctrine. 2011 WL 3583743, at *5 (S.D. Ethicon, Inc., Devices Rep.

Fraud 52

Fraud Doctors FDA 52

Drug & Device Law

FEBRUARY 2, 2022

Rather, parents filed class actions alleging that the smaller dose and higher priced “infants” version of OTC acetaminophen-based pain relievers, when compared to the “children’s” version with the same formula, violated Illinois and Texas consumer fraud statutes. Section 379r(a)(2). That was not always the case.

Fraud 59

Fraud FDA 59