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

C&M Health Law

APRIL 21, 2022

Department of Justice (DOJ) to resolve allegations that it had made donations in order to improperly inflate the funding four of its hospitals received from the federal Medicaid program. Florida Medicaid is administered by the state but jointly funded by both the state and federal governments.

Medicaid 52

Medicaid Medicaid Governance Fraud 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 91

Fraud FDA Medicaid Medicaid 91

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. There have been notable changes over the years in the main causes of breaches.

HIPAA 111

HIPAA Ransomware Compliance Hospitals 111

American Medical Compliance

JANUARY 9, 2024

This type of theft is just one example of healthcare fraud. Through Medicare, Medicaid, and the Children’s Health Insurance Program, the federal government and state governments offer health care coverage to nearly 100 million individuals. trillion in 2015.

Fraud 52

Fraud Medicare Medicare Compliance 52

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.

Compliance 52

Compliance Nursing Homes Nurses Medicare 52

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

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

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

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.

HIPAA 56

HIPAA Medicaid Medicaid Compliance 56

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

Kaiser Health News

JANUARY 19, 2022

A spokesperson for the Centers for Medicare & Medicaid Services said in an email that the agency is not seeing a pervasive problem, but he declined to provide data on how often such cases occur or how the agents or brokers get the personal information needed to enroll unsuspecting people. States also can revoke agents’ licenses.

ACA 80

ACA Health Insurance Licensing Governance 80

Hall Render

AUGUST 22, 2023

The Fourth Circuit recently held that providers may not defend a False Claims Act (“FCA”) lawsuit by arguing that eligibility requirements violate the Medicaid Act. the government alleged a clinical pharmacy manager for a Tennessee Walgreens falsified twelve different patients’ medical records between January 2015 and June 2016.

Medicaid 40

Medicaid Medicaid Governance Fraud 40

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance in healthcare began to encompass billing, fraud, and abuse prevention. Compliance evolved to include performance reporting and quality metrics.

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Compliance HIPAA Telemedicine ACA 52

Healthcare IT Today

MARCH 26, 2023

Meanwhile, the latest State of Locum Tenens Report from CHG Healthcare found an 88% increase since 2015 in the number of physicians taking on at least one short-term assignment each year. Those in patient-facing roles spend half their time seeing patients, with 34% of time devoted to administrative work.

Doctors 79

Doctors Fraud Medicaid Medicaid 79

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?

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HIPAA Due Diligence Compliance Fraud 133

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 9001:2015 (quality management). Proven software and technology which continuously monitors these sources will ensure that your healthcare organization is in compliance at all times. ISO 27001:2013 (information security).

Licensing 52

Licensing Medicaid Medicaid Governance 52

Healthcare Law Today

JANUARY 2, 2023

The FCA is a fraud statute, requiring intent. For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question. For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question. Potential Impact. ” United States ex rel. Healthfirst, Inc. ,

Overpayments 52

Overpayments Overpayment ACA Medicare 52

Provider Trust

MAY 18, 2022

In January 2015, the OIG settled for $96,259 with a Minnesota Pharmacist, Joseph C. In addition, the suit involved alleged submission of false claims for reimbursement to the Massachusetts Medicaid Agency. Moon , for submitting claims while excluded from March 2006 through July 2013. The defendants settled and paid $19.95

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Health Law RX

JULY 18, 2023

The CMP Final Rule also addresses enforcement and CMPs for fraud, false claims, or similar conduct in HHS grants, contracts, and other agreements, which are not addressed in this article. 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

CMS.gov

NOVEMBER 16, 2018

Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. One of my commitments as the Administrator of the Centers for Medicare & Medicaid Services (CMS) is to ensure we remain steadfast in our commitment to strengthen Medicare by making sure that tax dollars are spent appropriately. percent in 2015 to 17.61

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Hall Render

DECEMBER 29, 2023

Here’s a look at how 11 area hospitals ranked Kentucky’s registered nurse median salary ranks 38th in U.S. bill would allow IVF therapy for same-sex veteran marriages; VA denies coverage Cancer-killing gel, minimally-invasive brain shunts: Here are recent startups spun out of area hospitals UMass Memorial named one of top U.S.

Nursing Homes 40

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

Hall Render

APRIL 22, 2022

Supreme Court tosses Medicaid work requirement cases. San Francisco’s Laguna Honda Hospital Loses Medicaid, Medicare Funding. Colorado Springs health clinic to pay settlement in fraud lawsuit. Louisiana AG sues UnitedHealth, alleging drug overcharges in Medicaid. Hospitals to receive a proposed 3.2% CONNECTICUT.

COVID-19 40

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

Hall Render

DECEMBER 22, 2023

fraud scheme UConn Health is in financial trouble. fraud scheme UConn Health is in financial trouble. health care spending hits $4.5

Nursing Homes 40

Nursing Homes Nurses COVID-19 Hospitals 40

Hall Render

JANUARY 3, 2025

in Medicare fraud settlement 10 behavioral health policy changes taking effect in 2025 An uncertain era for Stark law: 12 updates in 2024 CMS launches campaign to support nursing home staffing rule CMS taps 4 states for behavioral innovation model: 5 things to know Epic files to dismiss antitrust lawsuit Healthcare company to pay $15.2

Nursing Homes 40

Nursing Homes Fraud Nurses Hospitals 40

Hall Render

APRIL 21, 2023

health-tech startup MemoryWell pivots, eyes new funding to roll out software for insurers Department of Veterans Affairs health system kicks off multiyear Greater Washington expansion Georgetown to open Southeast D.C.

US Department of Health and Human Services 40

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