Healthcare Compliance Blog

FEBRUARY 15, 2022

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. This is the second largest annual total in False Claims Act history, and the largest since 2014. More than $5.6

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Fraud Governance Compliance Medicare 59

Compliancy Group

AUGUST 23, 2023

September of 2020 marked the month when Cronin, burdened by guilt, reluctantly admitted to a single count of conspiring to orchestrate health care fraud and another count of brazenly committing such deceitful acts. Prosecutors Evan Panich and Chris Looney from the Health Care Fraud Unit, alongside Special Assistant U.S.

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Fraud Medicaid Medicaid Governance 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). 2022 New York EyeMed Vision Care $600,000 2.1 million 78.8

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HIPAA Compliance Ransomware Hospitals 103

HIPAA Journal

APRIL 5, 2024

A lawsuit against CareFirst BlueCross BlueShield that was filed in response to a 2014 data breach has had a contract class certified by a federal judge, 9 years after legal action was initiated. In June 2014, hackers gained access to CareFirst systems, which contained the data of around 1.1

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Fraud HIPAA Health Insurance Compliance 86

Health Law Advisor

FEBRUARY 3, 2022

billion, FY 2021 marks DOJ’s largest annual total FCA recovery since FY 2014, and more than twice the $2.3 With collections amounting to $5.6 billion received in FY 2020. WHISTLEBLOWER ACTIONS AND AWARDS REACH DECADE LOW. 1] DOJ’s FY 2021 is for the period of October 1, 2020 to September 30, 2021.

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Fraud COVID-19 Governance Medicare 52

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. According to the U.S.

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Licensing Fraud Compliance Nurses 52

HIPAA Journal

JUNE 2, 2023

Rico Prunty, 41 years old, of Sierra Vista, Arizona, was previously employed at an Arizona medical facility where he unlawfully accessed the medical intake forms of patients between July 2014 and May 2017. His co-conspirators have already been sentenced for their roles in the identity theft scheme.

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HIPAA Fraud Health Insurance Compliance 56

Healthcare Compliance Blog

MARCH 31, 2022

The DOJ, in coordination with the Medicaid Fraud Control Unit of the Office of the New York State Attorney General, began an investigation after whistleblowers alleged that certain LHCSAs had knowingly defrauded the federal government and New York State by underpaying home health aides in violation of New York’s Wage Parity Act.

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Medicaid Medicaid Governance Fraud 59

Health Care Law Brief

OCTOBER 18, 2023

Consistent with and as has been elaborated in its 2014 Special Fraud Alert , OIG reasoned that such arrangements may implicate and potentially violate the AKS by “disguising” remuneration for FHCP business through the payment of amounts purportedly related to non-FHCP ( e.g. , commercial) business. .

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Regulatory Compliance Fraud Compliance Hospitals 52

HIPAA Journal

JULY 3, 2024

In addition, since January 2014, health plans have had to comply with the HIPAA Operating Rules as required by §1104 of the Patient Protection and Affordable Care Act. How Compliance with the Rules is Enforced Compliance with the HIPAA transactions and code sets rules is enforced by HHS’ Centers for Medicare and Medicaid Services (CMS).

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HIPAA Medicaid Medicaid Compliance 56

Healthcare Law Today

JANUARY 11, 2023

The government alleged that, between April 2014 and April 2019, Jet Medical introduced devices into interstate commerce that were misbranded under the Federal Food, Drug and Cosmetic Act (FDCA) because Jet Medical did not obtain approval or clearance from the U.S. and Martech Medical Products Inc., Pre-submission Meetings.

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FDA Governance Medicare Medicare 59

Hall Render

JANUARY 4, 2023

Mayo Alao (Denver/Indianapolis offices) practices in the area of health care law with a focus on hospital and health system matters, regulatory and compliance issues, corporate transactions and hospital/physician alignment. James Junger (Milwaukee office) focuses his practice on pharmacy and health care compliance issues.

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Hall Render

JANUARY 3, 2024

Liza Brooks is based in the firm’s Detroit office and focuses her practice on supply chain operations, health information technology and clinical research compliance. from the University of Dayton School of Law in 2014. McKinney School of Law with his J.D. Matt graduated with his J.D. McKinney School of Law with her J.D.

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Fraud Hospitals Compliance FDA 40

Innovaare Compliance

AUGUST 24, 2023

The requirement for annual reporting of Medical Loss Ratio (MLR) beginning in contract year 2014 is another attempt to glean from the reported details how Medicare and beneficiary payments are spent to meet the program’s goal. Mistakes discovered in a CMS audit can pose financial setbacks and compliance risks to the reporting plan.

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Medicare Medicare Fraud Medicaid 52

Healthcare Law Blog

FEBRUARY 13, 2023

This topic always involves a legal angle, such as Stark Law or Anti-Kickback compliance, or state fraud and abuse law considerations. 2014), the D.C. For many healthcare attorneys, these types of dual-purpose communications are more common than communications involving only purely “legal” advice. Are bonuses involved?

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Compliance Fraud Governance 52

Healthcare Law Blog

MAY 16, 2022

At the beginning of the applicable contract year, the credit and the use of LOIs will no longer apply and, if the application is approved, the MAO must be in full compliance with network adequacy, including having signed provider and facility contracts. A warning letter = 3 points. A notice of noncompliance = 1 point.

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Medicare Medicare Medicaid Medicaid 52

AIHC

JUNE 3, 2024

Overall firearm-specific older adult homicide rates increased between 2014 and 2017. 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 Of the 6,188 victims, 62% were male.

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Hall Render

FEBRUARY 27, 2023

This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. Health Care Fraud Actions Medicaid. million to resolve allegations that it paid kickbacks to physicians who attended its programs in connection with its multiple sclerosis drugs between 2009 and 2014.

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Nursing Homes Fraud Medicaid Medicaid 40

Drug & Device Law

MARCH 19, 2024

Plaintiff had surgery in 2014 in which the clips were used. Plaintiff was missing any “indicia of fraud, wrongdoing, domination, misuse, or subversion of corporate formalities. Shortly thereafter she began experiencing several adverse symptoms, including pain. In 2021, a CT scan revealed the clips had migrated. at *1-2.

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Drug & Device Law

FEBRUARY 15, 2024

2014)) for determining retroactivity, the recent repealer statute has no specific language stating it should be given retrospective application and the revised statute imposed a new duty (specifically, a new duty on manufacturers/sellers). The two of us recently wrote about the issue of retroactivity of Michigan S.B. Chrysler Grp.,

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FDA Fraud Compliance Hospitals 52

Drug & Device Law

JUNE 9, 2022

In our initial post, we focused on the exception to the presumption, which allows liability to be imposed if a plaintiff alleges and ultimately proves that the defendant manufacturer committed fraud on the FDA. Today’s post focuses not on the exception to the compliance presumption but on the antecedent issue of when the presumption applies.

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