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.

HIPAA 103

HIPAA Fraud Health Insurance Medicaid 103

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

The Health Law Firm

JANUARY 28, 2013

A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Fraud 40

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. The ophthalmologist was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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.

Medicaid 40

Medicaid Medicaid Medicare Medicare 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).

HIPAA 107

HIPAA Compliance Medicare Medicare 107

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.,

Fraud 40

Fraud Medicaid Medicaid Medicare 40

Healthcare Compliance Blog

MAY 19, 2022

million to settle allegations that it violated the False Claims Act by submitting false claims to Medicare. The voluntary disclosure and investigation revealed that from June 1, 2013, through May 31, 2019, the hospital submitted claims to Medicare for Intensive Cardiac Rehabilitation (ICR) services provided to Medicare beneficiaries.?Before

US Department of Health and Human Services 59

US Department of Health and Human Services Hospitals Medicare Medicare 59

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.

Fraud 40

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.

Fraud 52

Fraud Governance Licensing FDA 52

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. This type of theft is just one example of healthcare fraud. trillion in 2015.

Fraud 52

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.

HIPAA 111

HIPAA Ransomware Compliance Hospitals 111

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 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. Subsequent Acts of Congress increased the OIG’s regulatory authority to prevent crimes against the Department.

Fraud 52

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

Fraud 52

Fraud Overpayments Overpayment Governance 52

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.,

HIPAA 56

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. The disclosure noted that claims for certain referred services were submitted for payment to Medicare, thus invoking the reach of the implicated federal laws. Care in email and transactional slides is warranted.

Fraud 52

Fraud Governance Compliance Medicare 52

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.

Compliance 52

Compliance Medicare Medicare Due Diligence 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?

HIPAA 133

HIPAA Due Diligence Compliance Fraud 133

Provider Trust

MAY 18, 2022

Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. Moon , for submitting claims while excluded from March 2006 through July 2013.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

CMS.gov

OCTOBER 2, 2018

Administrator, Centers for Medicare & Medicaid Services. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion. It also enhances the ability to identify potential fraud and improve program efficiency. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Jeremy.Booth@c….

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

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).

Licensing 52

Licensing Medicaid Medicaid Governance 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

CMS releases Medicare OPPS and ASC proposed rule. cancer, cardio lab fraud. Long Beach Memorial avoids losing Medicare funding after serious patient care lapses. New York confirms 1st national polio case since 2013. 10 procedures CMS proposes moving off the inpatient-only list in 2023. CMS pitches outpatient payment rule.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? When listening to those advocating ‘Medicare for All’ it’s good to be skeptical about their promises. keya.joy-bush@…. Fri, 11/02/2018 - 21:32.

Governance 55

Governance Medicare Medicare ACA 55

Drug & Device Law

DECEMBER 29, 2023

2023) (rejecting any express anti-preemption presumption in Medicare case) ( here ); Baker v. 2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. The G/N MDL was created in 2013 and mostly settled in 2016. Executive Health Resources, Inc. , UnitedHealthcare, Inc. , 3d 239 (Cal. Croda Inc. , 3d 191 (Del.

FDA 105

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

Drug & Device Law

JANUARY 30, 2023

472 (2013), implied preemption decisions, cited only by the dissent in Wyeth v. 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. Kent , 552 U.S. Albrecht , 139 S. Bartlett , 570 U.S.

FDA 72

FDA Fraud Governance Medicare 72