Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. In January 2015, the OIG settled for $96,259 with a Minnesota Pharmacist, Joseph C. However, healthcare receives federal funding, and thus OFAC is an additional sanction list that you should add to your vendor compliance plan/program. Case Study: S. Martino-Fleming v.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

HIPAA Journal

JULY 3, 2024

For example, ICD-9-CM code sets were replaced by ICD-10-CM in October 2015, Healthcare Common Procedure Coding System (HCPCS) code sets are updated quarterly , and the National Drug Code Directory is updated daily. Covered entities can test compliance with the HIPAA transactions and code sets rules and file complaints via CMS’ ASETT portal.

HIPAA 58

HIPAA Medicaid Medicaid Compliance 58

HIPAA Journal

JULY 11, 2023

2015 Health Plan 78,800,000 Hacking/IT Incident American Medical Collection Agency 2019 Business Associate 26,059,725 Hacking/IT Incident HCA Healthcare 2023 Healthcare Provider 11,000,000+ Hacking/IT Incident Premera Blue Cross 2015 Health Plan 11,000,000 Hacking/IT Incident Excellus Health Plan, Inc.

HIPAA 68

HIPAA Fraud Doctors Hospitals 68

Healthcare Compliance Blog

FEBRUARY 8, 2022

From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta. Routine audits should be conducted, and the results of the audits should be reported at the compliance and ethics committee meetings and in reports to the governing body.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

HIPAA Journal

JANUARY 23, 2024

Carreyrou published the story in 2015 that revealed the company was using third-party technology rather than its own, as its own technology was inefficient. Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors.

Fraud 83

Fraud FDA Medicaid Medicaid 83

HIPAA Journal

APRIL 5, 2024

CareFirst announced the data breach in May 2015 and explained that a single database was compromised that stored data that members and other individuals enter to access CareFirst’s websites and online services. In response to major data breaches at Anthem Inc.,

Fraud 77

Fraud HIPAA Health Insurance Compliance 77

Compliancy Group

JANUARY 25, 2022

This is the second-largest number of records reported breached on the government site since 2015. The 2015 total included the largest single healthcare data breach on record – health insurer Anthem’s 77.8 Let’s Simplify Compliance Learn how to protect your business from breaches in our upcoming webinar!

HIPAA 98

HIPAA Ransomware Governance Fraud 98

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Health Law Advisor

FEBRUARY 3, 2022

FY 2021 was also a record-shattering year for DOJ as it relates to health care fraud enforcement; over $5 billion (90% of the total) was obtained from cases pursued against individuals and entities in the health care and life sciences industries. With collections amounting to $5.6 billion received in FY 2020. KEY TAKEAWAYS.

Fraud 52

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. Donna Thiel. Linkedin.

Licensing 52

Licensing Fraud Compliance Nurses 52

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. Mayo graduated from the Saint Louis University School of Law in 2015.

Fraud 40

Fraud Compliance Hospitals 40

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

HIPAA 103

HIPAA Compliance Ransomware Hospitals 103

HIPAA Journal

JANUARY 12, 2023

Despite the challenges of compliance and the gaps in HIPAA , the legislation has provided many benefits for healthcare organizations, healthcare professionals, patients, and health plan members. Before the introduction of HIPAA, healthcare fraud was rife and was costing the healthcare industry around $7 billion a year.

HIPAA 98

HIPAA Compliance Fraud COVID-19 98

Hall Render

JUNE 1, 2022

For more than 15 years, Ritu has been an active member of AHLA and has held leadership roles consistently since 2015. Ritu also serves as the Chair of the Hospitals and Health Systems Practice Group and has been a member of the Editorial Board for the Health Care Compliance Professionals Manual since 2019.

Compliance 40

Compliance Fraud Governance Hospitals 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. Consequently, when data breaches occurred due to a lack of compliance by Business Associates, there was no accountability. billion and $11.5

HIPAA 107

HIPAA Compliance Medicare Medicare 107

HIPAA Journal

DECEMBER 31, 2022

To best answer the question what is a HIPAA violation, it is necessary to explain what HIPAA is, who it applies to, and what constitutes a violation; for although most people believe they know what a HIPAA compliance violation is, evidence suggests otherwise. What is HIPAA and Who Does It Apply To? Other Types of HIPAA Law Violation.

HIPAA 135

HIPAA Due Diligence Compliance Fraud 135

Health Law RX

JULY 18, 2023

Those subject to the CMP Final Rule should consider prioritizing their compliance efforts because the OIG will begin enforcing the Rule on September 1, 2023. As context, between 2015 and 2022, the DOJ reported FCA settlements with health IT vendors in an amount exceeding $500 million.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Med-Net Compliance

JULY 27, 2022

A California home healthcare and hospice agencies’ owner was sentenced to 18 months in prison for one count of conspiracy to commit healthcare fraud and one count of conspiracy to pay and receive healthcare kickbacks.

Medicare 59

Medicare Medicare Nurses Fraud 59

Verisys

NOVEMBER 14, 2023

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

Licensing 52

Licensing Medicaid Medicaid Governance 52

Total HIPAA

OCTOBER 28, 2019

A federal grand jury indicted a former MedStar Ambulance paramedic on counts of identity theft and fraud. He altered patient records as part of a scheme to steal narcotics from a local hospital from January 2013 to May 2015. How to Maintain Compliance with HIPAA. Keeping detailed logs is the first step toward HIPAA compliance.

HIPAA 52

HIPAA Compliance Fraud Hospitals 52

Health Law RX

AUGUST 10, 2021

The Office of Inspector General has emphasized the importance of Board involvement in and oversight of the provider company’s compliance program. In that way, the Board is ultimately responsible for ensuring the company’s compliance. Moreover, the U.S.

Due Diligence 40

Due Diligence Compliance Governance Fraud 40

HIPAA Journal

DECEMBER 23, 2022

That’s more than any other year to date apart from 2015 when Anthem Inc reported its 78.8 The investigations will uncover whether there have been any HIPAA violations or violations of state law and whether compliance with these regulations would have likely prevented these breaches. million records. million-record data breach.

HIPAA 93

HIPAA Ransomware Health Insurance Compliance 93

Hall Render

APRIL 6, 2022

However, some of the defendant’s customers typically paid less than the retail price for their medications through several discount programs that the defendant offered between 2006 and 2015. Regarding the PBM’s adoption of this definition, the Court stated that this may not serve as the basis of a fraud claim under the FCA.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

HIPAA Journal

JANUARY 24, 2023

For the first time since 2015, there was a year-over-year decline in the number of data breaches reported to the Department of Health and Human Services’ Office for Civil Rights (OCR), albeit only by 1.13% with 707 data breaches of 500 or more records reported. million records in 2021 to 51.9 million records in 2022.

HIPAA 124

HIPAA Ransomware Hospitals Fraud 124

Verisys

JANUARY 18, 2022

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

Licensing 52

Licensing Medicaid Medicaid Governance 52

Healthcare Law Blog

APRIL 19, 2023

Justice Kagan reasoned that the Court in Escobar noted the FCA is grounded in common law fraud principles under which a defendant’s subjective knowledge of the truth or falsity of its statement is relevant to the knowledge inquiry. Circuit, in a decision joined by then D.C. MWI Corp. , 3d 281, 290–91 (D.C.

Governance 52

Governance Fraud Compliance 52

CMS.gov

NOVEMBER 16, 2018

Fraud, waste, & abuse. Improper payments are not necessarily measures of fraud, but instead are payments that did not meet statutory, regulatory, administrative, or other legally applicable requirements. billion decrease in estimated improper payments from 2015 to 2018. percent in 2015 to 17.61 Jeremy.Booth@c….

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Hall Render

DECEMBER 29, 2023

Here’s how to find quality care CEOs turn attention from recovery to growth ARKANSAS Statistics show many northern Arkansas locations considered maternity care deserts How broadband expansion is bolstering rural healthcare Arkansas leaders work to close gap between medical school graduates and in-state residencies Program in south Arkansas provides (..)

Nursing Homes 40

Nursing Homes US Department of Health and Human Services COVID-19 Nurses 40

Drug & Device Law

DECEMBER 29, 2023

2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. Also of interest is Acetaminophen ’s discussion of the FDA’s five reviews of the purported “risk” between 2015 and 2023, all of which ended the same way: that due to “limitations and inconsistent findings,” the science was “unable to support a determination of causality.”

FDA 105

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

Drug & Device Law

AUGUST 8, 2022

The unfortunate truth is that ECFMG was also a victim of this fake doctor’s fraud. So if compliance with an industry standard is a defense, this plaintiff went a step further and sued the organizations that created the standards. 2015 WL 6393869 (S.D. has no power to enforce compliance”), aff’d , 405 F. 471 (11th Cir.

Doctors 52

Doctors Fraud Licensing Compliance 52

Drug & Device Law

MAY 4, 2023

2015), finally gave appellate recognition to the preemption of design defect claims for FDA-approved branded prescription drugs. Ohio is one of several states, with New Jersey being the most notable , with statutes precluding punitive damages in product liability cases based on FDA approval or compliance. Ortho-McNeil-Janssen Pharms.,

FDA 64

FDA Fraud Compliance 64

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. Mensing , 564 U.S. Mensing , 564 U.S. Lohr , 518 U.S. Davidowitz , 312 U.S. Davidowitz , 312 U.S.

FDA 72

FDA Fraud Governance Medicare 72

Drug & Device Law

FEBRUARY 15, 2024

2022) (recognizing the following product defect liability theories: “(1) negligent design of the product; (2) negligent manufacture of the product; (3) negligent failure to warn about some aspect of the product; (4) breach of express or implied warranty; or (5) misrepresentation or fraud”). 15-cv-10133, 2015 WL 8175256, at *3 (E.D.

FDA 52

FDA Fraud Compliance Hospitals 52