HIPAA Journal

MARCH 30, 2022

Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. Furthermore, it could also be argued that neither Rule was effectively enforced until the Omnibus Final Rule was published in 2013. Abuse and Fraud in the Health Care Industry.

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HIPAA Fraud Health Insurance Health Care Reform 137

The Health Law Firm

SEPTEMBER 20, 2013

Board Certified by The Florida Bar in Health Law A Broward County, Florida, home health care company is accused of overbilling the Medicaid program for patient services by almost $500,000, according to the Sun Sentinel. Click here to read the Sun Sentinel article from September 18, 2013. By George F. Indest III, J.D.,

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Medicaid Medicaid Fraud 40

The Health Law Firm

FEBRUARY 21, 2014

Board Certified by The Florida Bar in Health Law A licensed speech therapist faces up to five years in prison for allegedly defrauding Medicaid during the summer of 2013. Indest III, J.D., Click here to read the press release from the AG.

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Medicaid Medicaid Fraud Licensing 40

HIPAA Journal

FEBRUARY 23, 2022

Title II: Preventing health care fraud and abuse; administration simplification; medical liability reform. The provisions related to administrative simplification are discussed below, while the provisions for medical liability reform (of which there are few) only relate to whistle blower protection for reporting fraud and abuse.

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HIPAA Fraud Health Insurance Medicaid 103

The Health Law Firm

APRIL 22, 2013

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. We blogged about this case in February 2013, when Ms.

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Medicaid Medicaid Fraud 40

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. FHKC shut down its website’s application portal shortly thereafter.

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Fraud Due Diligence Medicaid Medicaid 52

C&M Health Law

APRIL 21, 2022

Department of Justice (DOJ) to resolve allegations that it had made donations in order to improperly inflate the funding four of its hospitals received from the federal Medicaid program. Florida Medicaid is administered by the state but jointly funded by both the state and federal governments.

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Medicaid Medicaid Governance Fraud 52

The Health Law Firm

AUGUST 19, 2013

million to settle civil allegations under the False Claims Act, according to the Department of Justice (DOJ) on August 16, 2013. 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.

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Medicaid Medicaid Fraud Governance 40

The Health Law Firm

SEPTEMBER 24, 2013

Leider with The Health Law Firm will be giving a presentation on Thursday, September 26, 2013, to the members of the Medical Office Resources of Florida (MOROF) and attending health care providers. This presentation is called, “Medicare and Medicaid Audits: Ready or Not, Here They Come.” Brown and Lance O. until 9:00 a.m.

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Medicaid Medicaid Medicare Medicare 40

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Use this information as part of your auditing and monitoring efforts to prevent fraud, waste, and abuse of government funds.

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Medicare Medicare Medicaid Medicaid 59

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

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Medicaid Medicaid Fraud Health Outcomes 40

The Health Law Firm

SEPTEMBER 23, 2013

million, according to the Department of Justice (DOJ) on September 13, 2013. The providers were accused of defrauding Medicare, Medicaid and TRICARE by performing unnecessary and improperly supervised procedures from 2007 until 2011. Indest III, J.D.,

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Fraud Medicaid Medicaid Medicare 40

The Health Law Firm

MARCH 6, 2014

Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) continues to stop fraudulent repayment claims before they happen. The agency performed a similar enrollment moratorium in July 2013. Indest III, J.D., Click here to read the press release from CMS.

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Fraud Medicaid Medicaid Medicare 40

Pharmacy Law Blog

MARCH 13, 2018

The relator McKenzie Stepe, a former RS sales representative, originally filed her complaint in December 2013. She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. fraud suit – judge.” The Relator’s FCA Suit. Florida compounding pharmacy must face U.S.

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Fraud Governance Licensing FDA 52

The Health Law Firm

MARCH 4, 2013

A report released by the Government Accountability Office (GAO) on February 27, 2013, announced that Medicare will remain a "high-risk" program with respect to its fraud and waste vulnerability. Leider, J.D., The Health Law Firm.

Medicare 40

Medicare Medicare Fraud Medicaid 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. In 2013, HHS confirmed that paper-to-paper, non-digital faxes are not covered transactions). billion and $11.5

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HIPAA Compliance Medicare Medicare 107

American Medical Compliance

JANUARY 9, 2024

This type of theft is just one example of healthcare fraud. Through Medicare, Medicaid, and the Children’s Health Insurance Program, the federal government and state governments offer health care coverage to nearly 100 million individuals. As a result of their large size, these healthcare systems are easy targets for fraud.

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Fraud Medicare Medicare Compliance 52

HIPAA Journal

MARCH 20, 2025

WI Business Associate 4,112,892 Hacking/IT Incident 24 2023 Colorado Department of Health Care Policy & Financing CO Health Plan 4,091,794 Hacking/IT Incident 25 2013 Advocate Health and Hospitals Corporation, d/b/a Advocate Medical Group IL Healthcare Provider 4,029,530 Theft 26 2024 Concentra Health Services, Inc.

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HIPAA Ransomware Compliance Hospitals 111

HIPAA Journal

JULY 24, 2023

The team’s roles are to investigate and audit the Department’s operations to prevent fraud, waste, and abuse within the Department, and also to audit and investigate potential crimes against the Department. In addition to HHS OIG enforcement actions, Medicare Fraud Control Units (MFCUs) operate in every state and territory.

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Fraud Medicare Medicare Medicaid 52

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

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Fraud Overpayments Overpayment Governance 52

Healthcare Law Blog

MAY 31, 2022

For example, services that are billed to Medicaid or Medicare must comply with regulations that may not apply to services that are paid for in cash. Some healthcare services may implicate certain healthcare fraud and abuse laws, such as the Stark law or the federal Anti-Kickback Statute, as well as the equivalent versions at the state level.

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FDA HIPAA Medicare Medicare 90

HIPAA Journal

JULY 4, 2024

Due to concerns that the cost of the reforms would be passed onto plan members and employers, and that this would negatively impact tax revenues, Congress added a second Title to HIPAA – “Preventing Health Care Fraud and Abuse; Administrative Simplification”. Fortunately, the changes since 2013 have been limited in scale (i.e.,

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HIPAA Compliance Fraud Medicare 56

McGuire Wood

OCTOBER 2, 2023

According to the DOJ press release, from January 2013 to July 2018, Oliver Street, doing business as U.S. If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure. DOJ Voluntary Self-Disclosure.

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Fraud Governance Compliance Medicare 52

HIPAA Journal

DECEMBER 31, 2022

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was introduced to simplify the administration of healthcare, eliminate wastage, prevent healthcare fraud, and ensure employees could maintain healthcare coverage between jobs. What is HIPAA and Who Does It Apply To? What is considered a HIPAA violation?

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HIPAA Due Diligence Compliance Fraud 133

Provider Trust

MAY 17, 2022

Federal regulators such as the HHS-OIG, the Department of Justice (DOJ), the Centers for Medicare and Medicaid Services (CMS), and others have regulations and guidelines regarding the prohibition of reimbursements of federal healthcare dollars (Medicaid, Medicare, CHIPS, TriCare, and others) to excluded vendors.

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Compliance Medicare Medicare Due Diligence 52

Verisys

NOVEMBER 14, 2023

Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. Proven software and technology which continuously monitors these sources will ensure that your healthcare organization is in compliance at all times.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Verisys

JANUARY 18, 2022

Verisys’ owned and maintained Fraud Abuse Control Information System (FACIS) is a provider data supersource. ISO 27001:2013 (information security). Proven software and technology which continuously monitors these sources will ensure that your healthcare organization is in compliance at all times. ISO 9001:2015 (quality management).

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Licensing Medicaid Medicaid Governance 52

Provider Trust

MAY 18, 2022

Moon , for submitting claims while excluded from March 2006 through July 2013. In addition, the suit involved alleged submission of false claims for reimbursement to the Massachusetts Medicaid Agency. In January 2015, the OIG settled for $96,259 with a Minnesota Pharmacist, Joseph C. The defendants settled and paid $19.95

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Compliance Due Diligence Medicaid Medicaid 52

Hall Render

DECEMBER 13, 2024

operating margin in Q3 JLL Arranges $13.4M Care Taps Health Net Exec as New CEO COLORADO Aurora’s Fitzsimons plans development opportunities on 60 acres Boulder drug discovery co. 3 in the U.S. for maternity care Healthcare Shifts Driving Demand For Outpatient Facilities In Denver Insider Breach, Email Attacks Net $1.7M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Hospitals Nurses 40

Hall Render

JULY 22, 2022

cancer, cardio lab fraud. Delaware Adds Centene Plan to Medicaid Managed Care Offerings. Key advocates reflect on Hawaii postpartum Medicaid coverage extension. Hospital System Says It’s Hurt by Lack of Medicaid Expansion. Medicaid expansion discussions return as Mississippi hospitals face financial struggles.

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COVID-19 Nursing Homes Nurses Hospitals 40

CMS.gov

NOVEMBER 2, 2018

Seema Verma, Administrator, Centers for Medicare & Medicaid Services . 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. CMS BLOG: Medicare for All? Just another name for a government-run, single payer system.

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