Compliancy Group

DECEMBER 20, 2024

In May of 2015, the NYPD informed Montefiore Medical Center that there was evidence that patient information had been stolen from the hospitals database – leading Montefiore to investigate and discover that the theft had taken place two years earlier. OCR gave Gums a chance in December to submit written evidence of mitigating factors.

Ransomware 98

Ransomware HIPAA Fraud Electronic Medical Records 98

The Health Law Firm

JUNE 23, 2015

The Health Law Firm On June 9, 2015, the US Department of Health and Human Services, Office of the Inspector General issued a special fraud alert on physician compensation arrangements. By: Lance O. Leider, J.D.,

US Department of Health and Human Services 52

US Department of Health and Human Services Fraud 52

HIPAA Journal

OCTOBER 26, 2022

The lawsuit alleges the plaintiffs and class members have been exposed to an ongoing risk of fraud and identity theft, which requires them to constantly monitor their financial accounts and credit reports as their personal information is in the hands of cybercriminals.

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HIPAA Fraud Health Insurance 129

HIPAA Journal

MARCH 31, 2023

The lawsuit was initially filed in 2015 but was dismissed by a lower court in 2016 due to lack of injury, but was resurrected by a federal appeals court in 2017. million individuals who were registered to use CareFirst’s websites and online services. In 2018, the U.S.

Fraud 107

Fraud HIPAA 107

Health Care Performance

JULY 20, 2022

Mole billing fraud scheme totals $4.1 million in fraudulent payments between 2015 and 2021. Compliance lesson: Enforcement agencies are actively using data analytics to identify, investigate and prosecute providers with unusual billing activity – and so should you. million in false claims over 7 years.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

The Health Law Firm

JUNE 22, 2015

Board Certified by the Florida Bar in Health Law and Shelby Root The largest criminal health care fraud takedown in the history of the US Justice Department, in terms of both loss amount and arrests, took place June 18, 2015. Indest III, J.D.,

Fraud 40

Fraud Medicare Medicare Licensing 40

HIPAA Journal

MARCH 20, 2025

The loss/theft of healthcare records and electronic protected health information dominated the breach reports between 2009 and 2015. MN Business Associate 190,000,000 Hacking/IT Incident 2 2015 Anthem Inc. 2015 was particularly bad due to three massive data breaches at health plans: Anthem Inc, Premera Blue Cross, and Excellus.

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HIPAA Ransomware Compliance Hospitals 111

The Health Law Firm

DECEMBER 15, 2015

Board Certified by The Florida Bar in Health Law On Thursday, December 10, 2015, 24-year-old, Daniel Suarez, was sentenced to nine years in prison and ordered to pay nearly $21 million in restitution by US District Judge Donald Middlebrooks, for his alleged leading role in a Medicare fraud scheme in Miami, Florida. Indest III, J.D.,

Fraud 40

Fraud Medicare Medicare 40

The Health Law Firm

MAY 31, 2016

Board Certified by The Florida Bar in Health Law On May 9, 2016,Michael John Veit, 64, the former chief procurement officer for Arizona's state Medicaid program, was sentenced to 10 years in prison for his role in the fraud scheme that resulted in the theft of 5.9 The Original Fraud and Theft Charges. Indest III, J.D., million dollars.

Fraud 40

Fraud Medicaid Medicaid 40

The Health Law Firm

JULY 10, 2017

Year Sentence for Role in Fraud. Gonzalez fled to Cuba in 2015 after being charged with conspiracy and other charges. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law 4.5 A Miami Man voluntarily returned to Miami from Cuba and was immediately met with a 4.5-year year long prison sentence.

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Fraud 40

Healthcare IT Today

FEBRUARY 13, 2025

For instance, Sarbanes-Oxley (SOX) followed the Enron fraud, updates to FISMA came after the 2015 Office of Personnel Management (OPM) breach, and the Securities and Exchange Commissions cybersecurity disclosure provisions were implemented after breaches at Equifax and SolarWinds.

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Compliance HIPAA Ransomware Fraud 59

Florida Health Care Law Firm

DECEMBER 7, 2021

Telemedicine pharmacy arrangements continue to be of significant interest to fraud enforcement. The federal jury trial in the billion-dollar telehealth pharmacy fraud scheme resulted in conviction on 22 counts of mail fraud, conspiracy to commit health care fraud and introduction of misbranded drugs into interstate commerce.

Fraud 40

Fraud Telemedicine Governance Compliance 40

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.,

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Fraud HIPAA Health Insurance Compliance 86

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.

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Fraud FDA Medicaid Medicaid 91

The Health Law Firm

NOVEMBER 17, 2015

The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its 2016 Annual Work Plan (Work Plan) on November 2, 2015, with an effective date of October 1, 2015.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

Healthcare IT Today

JUNE 3, 2023

Read more… Know Your Patient and Prevent Insurance Fraud. For busy CISOs, fraud prevention can easily slip under the radar. Verifying patient identity and requiring authentication on an ongoing basis can help safeguard providers against fraud , said Bala Kumar at Jumio.

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Fraud 91

The Health Law Firm

OCTOBER 8, 2015

Juan Carlos Delgado and his wife, Nereyda Infante, co-owners of the clinic, were charged with conspiracy to commit health care fraud. The pair pleaded guilty on June 24, 2015, before United States District Judge Paul G. Indest III, J.D., million scheme to defraud Medicare will spend the next five years behind bars.

Fraud 40

Fraud Medicare Medicare 40

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 We may look back at 2021 as the year when we moved from the era of identity theft to identity fraud. million individuals.

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HIPAA Ransomware Governance Fraud 98

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 75

HIPAA Fraud Doctors Hospitals 75

American Medical Compliance

JANUARY 9, 2024

This type of theft is just one example of healthcare fraud. trillion in 2015. As a result of their large size, these healthcare systems are easy targets for fraud. As a result of their large size, these healthcare systems are easy targets for fraud.

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Fraud Medicare Medicare Compliance 52

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. 2, 2015–July 31, 2016, and a range of $11,181–$22,363 for violations committed after Jan. Issue: All submitted claims must be accurate and truthful.

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Medicaid Medicaid Compliance Governance 59

The Health Law Firm

SEPTEMBER 12, 2016

The health care industry has found a similar success in recent years, as federal agents use data mining, predictive analytics, and other modeling approaches to catch Medicare fraud. Medicare Strike Force Enhanced to Reduce Billion-Dollar Losses.

Medicare 40

Medicare Medicare Fraud Medicaid 40

Hall Render

MARCH 4, 2025

Although liability under the AKS depends in part on a partys intent, it is incumbent on nursing facilities to identify arrangements with referral sources and referral recipients that present a potential for fraud and abuse under the AKS.

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Compliance Nursing Homes Nurses Medicare 52

HIPAA Journal

MAY 18, 2023

State attorneys general HIPAA cases were relatively rare occurrences, with only 11 settlements reached with HIPAA-covered entities and business associates to resolve HIPAA violations between 2010 and 2015. million 78.8 million Phishing attack and major data breach Multiple violations of HIPAA and state laws 2020 California Anthem Inc $8.7

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HIPAA Compliance Ransomware Hospitals 103

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

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.

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HIPAA Ransomware Hospitals Fraud 138

The Health Law Firm

DECEMBER 24, 2015

Rendon, said of a Westlake, Ohio cardiologist sentenced to 20 years in prison on Friday, December 18, 2015, "This defendant used his medical license as a license to steal."

Licensing 40

Licensing Fraud 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. The passage of HIPAA resulted in multiple benefits for the health insurance industry, the healthcare industry, and the people that they serve. billion and $11.5

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HIPAA Compliance Medicare Medicare 107

The Health Law Firm

AUGUST 18, 2015

Board Certified by The Florida Bar in Health Law On July 14, 2015, Ann Maxwell, Assistant Inspector General for Evaluation and Inspections of the Office of Inspector General (OIG), US Department of Health and Human Services (HHS), gave testimony to Congress on the Medicare Part D Program. By George F. Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Fraud 40

The Health Law Firm

DECEMBER 17, 2015

Board Certified by The Florida Bar in Health Law A husband and wife from Chicago, Illinois, were sentenced to prison terms by US District Judge Richard Mills on Monday, December 14, 2015, for their roles in the misappropriation of $3 million in grant funds. Indest III, J.D., Leon Dingle Jr.

Fraud 40

Fraud 40

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. The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 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

HIPAA Journal

JANUARY 12, 2023

Before the introduction of HIPAA, healthcare fraud was rife and was costing the healthcare industry around $7 billion a year. The standardization of healthcare transactions has helped to reduce significantly reduce fraud.

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HIPAA Compliance Fraud COVID-19 110

Kaiser Health News

JANUARY 19, 2022

Many cited examples beginning with a 2015 case in which an agent allegedly signed up hundreds of people from North Carolina homeless shelters for plans in which the federal government paid the entire premium, often referred to as “zero-premium plans,” by using questionable estimates of their annual income.

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ACA Health Insurance Licensing Governance 80

HIPAA Journal

JULY 27, 2023

Malone was employed by Norton Healthcare between 2015 and 2022 and claims her sensitive information was stolen and attempts have already been made to misuse that information. District Court on behalf of plaintiff Lanisha Malone and similarly situated individuals who had their sensitive data stolen in the attack.

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Ransomware Fraud Licensing Health Insurance 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.

Licensing 52

Licensing Fraud Compliance Nurses 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. The post HIPAA Transactions and Code Sets Rules appeared first on The HIPAA Journal.

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HIPAA Medicaid Medicaid Compliance 56