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. When the services are DHS for purposes of the PSL (e.g.,

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

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

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

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. Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare 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

HIPAA 107

HIPAA Compliance Medicare Medicare 107

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. This type of theft is just one example of healthcare fraud. trillion in 2015.

Fraud 52

Fraud Medicare Medicare Compliance 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. In total, the agencies submitted over 8,000 claims to Medicare for the cost of home healthcare and hospice services.

Medicare 59

Medicare Medicare Nurses Fraud 59

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

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

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. Subsequently, it was incorporated into the CMS’s Medicare Prescription Drug Benefit Manual (“Manual”) in December of 2006.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

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

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

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.

Overpayment 52

Overpayment Overpayments ACA Medicare 52

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.

Compliance 52

Compliance HIPAA Telemedicine ACA 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

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?

HIPAA 133

HIPAA Due Diligence Compliance Fraud 133

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 billion decrease in estimated improper payments from 2015 to 2018. Jeremy.Booth@c….

Medicare 20

Medicare Medicare Overpayments Overpayment 20

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

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

Provider Trust

MAY 18, 2022

Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. In January 2015, the OIG settled for $96,259 with a Minnesota Pharmacist, Joseph C.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Hall Render

APRIL 22, 2022

San Francisco’s Laguna Honda Hospital Loses Medicaid, Medicare Funding. Colorado Springs health clinic to pay settlement in fraud lawsuit. Maryland Doctor Among 18 Indicted In COVID-19 Healthcare Fraud Scheme, Allegedly Overbilled For COVID-19 Tests. Founders of Texas labs plead guilty in $300M fraud scheme.

COVID-19 40

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

DECEMBER 29, 2023

NATIONAL 4 largest healthcare data breaches of 2023 Anesthesia practices sue CMS over reimbursement method Antitrust enforcements hit a high in 2022, with health deals impacted ASCs face leadership exodus CMS floats appeals process over observational stays CMS proposes additional Medicare appeals processes FTC eyes healthcare mergers, report shows (..)

Nursing Homes 40

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

Hall Render

DECEMBER 22, 2023

fraud scheme UConn Health is in financial trouble. health care spending hits $4.5 approval for obstetrics services in Prince George’s County Maryland health system gets state OK for $300M labor, delivery unit Maryland hospitals must pay back millions to poor patients.

Nursing Homes 40

Nursing Homes Nurses COVID-19 Hospitals 40

Hall Render

APRIL 21, 2023

health care fraud scheme SA cancer research company entering Dallas market as it eyes more U.S., 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

Drug & Device Law

DECEMBER 29, 2023

2023) (rejecting any express anti-preemption presumption in Medicare case) ( here ); Baker v. 2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. Executive Health Resources, Inc. , UnitedHealthcare, Inc. , 3d 239 (Cal. Croda Inc. , 3d 191 (Del. 2023) (no medical monitoring in Delaware) ( here ); Brown v. 3d 949 (N.H.

FDA 105

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

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