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

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

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HIPAA Journal

MARCH 20, 2025

Many of the hacking incidents between 2014 and 2018 occurred many months – and in some cases years – before they were detected. NY Health Plan 9,358,891 Hacking/IT Incident 10 2023 Perry Johnson & Associates, Inc. dba PJ&A NV Business Associate 9,302,588 Hacking/IT Incident 11 2023 Maximus, Inc.

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HIPAA Ransomware Compliance Hospitals 110

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

The Health Law Firm

MAY 29, 2014

Board Certified by The Florida Bar in Health Law Talk about cracking down on Medicare fraud. On May 14, 2014, a Brevard County radiation oncologist received his final judgment in a whistleblower Medicare fraud case. The doctor was charged with defrauding Medicare under the False Claims Act. Indest III, J.D.,

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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 six-month moratorium began January 31, 2014. Indest III, J.D., Click here to read the press release from CMS.

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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.,

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Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

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HIPAA Journal

JULY 3, 2024

Indeed, many of the classification systems that would eventually be adopted as the HIPAA transactions and code sets rules were already mandated for use in some federal and state healthcare programs – including Medicare and Medicaid. The post HIPAA Transactions and Code Sets Rules appeared first on The HIPAA Journal.

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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

Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). The FCA is a fraud statute, requiring intent. Potential Impact.

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Overpayments Overpayment ACA Medicare 52

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

Hall Render

APRIL 1, 2022

Fraud plagues California’s hospice industry, audit finds. Court sides with HHS in Indiana hospitals’ challenge to Medicare payment calculation. over MassHealth fraud. Oregon’s private insurers spent millions more than Medicare for same hospital services. California nurses begin strike.

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