Provider Trust

MARCH 13, 2023

Between 2016 and 2021, over 7,600 fake diplomas were sold to nursing students who used the fraudulent degrees to qualify for the National Council Licensure Exam (NCLEX). So, let’s say they were revoked in 2019; then they would issue the certificate and the diploma as if the student had attended between 2016 and 2017.”

Fraud 52

Fraud US Department of Health and Human Services Licensing Nurses 52

Healthcare Compliance Blog

APRIL 12, 2022

On 18 different occasions from the first quarter of 2016 through the fourth quarter of 2019, she withheld payroll taxes from her employees’ paychecks. However, instead of forwarding those taxes to the government, she kept them for her business. The withheld taxes totaled over $900,000.

Medical Billing 59

Medical Billing Fraud Governance Medicare 59

Healthcare Compliance Blog

APRIL 27, 2022

Under the False Claims Act, the government is entitled to three times damages and civil penalties ranging from $5,500 and $11,000 for each identifiable claim submitted between Nov. 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.

Medicaid 59

Medicaid Medicaid Compliance Governance 59

The Health Law Firm

FEBRUARY 19, 2016

Board Certified by The Florida Bar in Health Law On February 12, 2016, a Florida ophthalmologist accused of bribing his friend, US Sen. Robert Menendez, said that separate allegations against him for Medicare fraud should be dismissed. By George F. Indest III, J.D.,

Medicare 40

Medicare Medicare Fraud Governance 40

C&M Health Law

APRIL 21, 2022

Florida Medicaid is administered by the state but jointly funded by both the state and federal governments. The federal government’s Federal Financial Participation (FFP) share is paid according to statements of expenditures submitted by the state and per the formula described in sections 1903 and 1905(b) of the Medicaid Act.

Medicaid 52

Medicaid Medicaid Governance Fraud 52

Hall Render

AUGUST 22, 2023

Rather, liability under the FCA may still be established if any misrepresentations made by a provider influenced decision-makers and resulted in the submission of false claims to the government. Walgreens learned of the fraud as early as 2016. In United States v. Walgreen Co. ,

Medicaid 40

Medicaid Medicaid Governance Fraud 40

Florida Health Care Law Firm

DECEMBER 2, 2021

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The OIG recognized that there are benefits to disclose potential fraud.

Overpayment 40

Overpayment Overpayments Fraud Medicare 40

Healthcare Compliance Blog

FEBRUARY 8, 2022

One example included in the complaint alleges that in November 2016, the pharmaceutical company paid the psychiatrist a $2,000 speaker’s fee for a presentation in Alabama, but the company’s records show there were no attendees. Failure to promptly report a false claim can result in lawsuits, fines, and other sanctions.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

Healthcare Law Today

JANUARY 2, 2023

In the 2016 Final Rule , CMS agreed “the 60-day time period begins when either the reasonable diligence is completed or on the day the person received credible information of a potential overpayment if the person failed to conduct reasonable diligence and the person in fact received an overpayment. § 401.305(a)(2).

Overpayments 52

Overpayments Overpayment ACA Medicare 52

Health Law RX

NOVEMBER 10, 2022

The United States alleged that, between August 1, 2016 and June 30, 2017, Sutter Health fraudulently billed and received reimbursement from government health programs for lab tests that Sutter Health did not itself perform. Consequently, the best possible defense to such a claim involves disciplined application of clinical guidelines.

Governance 52

Governance Medicare Medicare Medicaid 52

Hall Render

APRIL 11, 2022

However, a separate group of relators had already filed a qui tam action in August of 2016, eight months prior to this suit, alleging the same fraud scheme. These relators filed an amended complaint in January of 2019. This original lawsuit reached settlement in August of 2020. Practical Takeaways.

Governance 40

Governance Fraud 40

Health Law RX

JULY 18, 2023

Information Blocking Background In 2016, the 21st Century Cures Act (Cures Act) made sharing electronic health information (EHI) the new normal in healthcare, with the twin goals of encouraging and incentivizing the free flow of patient information among stakeholders and driving efficiencies in healthcare.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Healthcare IT Today

JUNE 29, 2023

As of November 15, 2017, ASCs are being surveyed on the new requirements of a September 2016 final rule. Audits, fines, repayment demands, and government program suspensions are enforcement actions. Quality reporting provides ASCA members with current requirements and resources to comply. ASC billing compliance has many benefits.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Innocent” Property Can’t Be Seized. To read more on the U.S.

Fraud 40

Fraud Medicare Medicare Governance 40

Verisys

APRIL 13, 2023

Harm isn’t just in the form of medical errors but can also be associated with healthcare fraud. In 2016, an article published by the British Medical Journal (BMJ) listed medical errors as the third cause of death in the United States. This made medical errors the third leading cause of death in 2016.

Fraud 52

Fraud Governance Compliance 52

Verisys

NOVEMBER 17, 2022

The figure published in 2016 by the British Medical Journal (BMJ) is some 250,000 deaths per annum were attributable to medical error. Healthcare fraud and abuse costs billions Estimates range from 3% – 10% of the entire federal healthcare funding is lost to fraud, waste, and abuse.

Fraud 52

Fraud Governance Compliance 52

Health Law Advisor

APRIL 13, 2023

These FAQs address subjects including “ General Questions Regarding Certain Fraud and Abuse Authorities ,” the “ Application of Certain Fraud and Abuse Authorities to Certain Types of Arrangements ,” and “ Compliance Considerations.” The vast majority of the principles articulated in the updated FAQs will undoubtedly be familiar to many.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

Kaiser Health News

APRIL 8, 2022

What happened in the two years between the contract award and the start of the program is a case study in what can go wrong when government outsources core functions to the private sector. For example, Centene has a history of taking over California contracts after an acquisition — it did so when it purchased Health Net in 2016.

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Medicaid Medicaid Health Insurance COVID-19 103

AIHC

JUNE 3, 2024

Elder Abuse is a Serious Problem According to the Centers for Disease Control (CDC) and other government agencies (DOJ, FBI), elder abuse is a serious problem in the United States. From 2002 to 2016, more than 643,000 older adults were treated in the emergency department for nonfatal assaults and over 19,000 homicides occurred.

Elder Abuse 52

Elder Abuse Compliance Nursing Homes Compliance Officers 52

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Standard Contract Requirements/Coordination of Benefits.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Verisys

MARCH 24, 2022

government can still impose fines for doing business with these companies, even if an organization’s non-compliance was not intentional. In 2016, Alcon Laboratories was slapped with a $7.6 Additionally, they failed to self-disclose this violation to the government. However, the U.S.

ACA 52

ACA Compliance Governance Medicaid 52

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

The “Cobra” - In the late 1800s-early 1900s when India was ruled by the British government, there was a problem with venomous cobras invading major cities. The British government decided to take action and offered citizens a bounty to redeem for dead cobras. The government eventually found out and stopped the financial incentives.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Bill of Health

SEPTEMBER 29, 2022

” While the wording of the rules have not changed, the recent USPTO notice explicitly brings all kinds of new materials within the ambit of the disclosure requirement, including: Conflicting statements made to other Government agencies (e.g., MPEP § 2016. The Duty of Reasonable Inquiry.

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FDA Governance Fraud Licensing 130

CMS.gov

NOVEMBER 2, 2018

Just another name for a government-run, single payer system. Just another name for a government-run, single payer system. As head of the agency that serves over 58 million Medicare beneficiaries, I deal first-hand with the challenges of government run healthcare. percent from 2011-2016, from $17.6 keya.joy-bush@….

Governance 55

Governance Medicare Medicare ACA 55

Hall Render

AUGUST 23, 2024

AG says they have buyer for Sharon Regional Medical Center Pregnancy-related deaths in Pennsylvania rose by almost 80% in one year, new data shows New court documents suggest potential fraud in Pennsylvania health facilities RHODE ISLAND Lifespan in position to acquire two Steward hospitals; Mass.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

AUGUST 26, 2024

AG says they have buyer for Sharon Regional Medical Center Pregnancy-related deaths in Pennsylvania rose by almost 80% in one year, new data shows New court documents suggest potential fraud in Pennsylvania health facilities RHODE ISLAND Lifespan in position to acquire two Steward hospitals; Mass.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

FEBRUARY 10, 2023

Dunleavy proposes extending Medicaid coverage for new mothers ARIZONA Banner Health pays $1.25M penalty over HIPAA failures from 2016 breach Arizona nursing school at risk of losing accreditation St. billion since pandemic U.S. million to UMass Memorial Health Care for COVID-19 costs Four Mass.

US Department of Health and Human Services 40

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

Hall Render

NOVEMBER 17, 2023

Jill Biden will lead new initiative to boost federal government research into women’s health Joint Commission says acute, critical access hospitals must join safety network Lawsuit claims UnitedHealth AI wrongfully denies elderly extended care Most Rural U.S. Compensation is key Is spine surgery expansion next for ASCs? Many more are waiting.

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Drug & Device Law

DECEMBER 29, 2023

2023) (federal government may unilaterally obtain dismissal of FCA claims, and calling the constitutionality of the FCA’s private enforcement mechanism into question) ( here ); Quishenberry v. 2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. The G/N MDL was created in 2013 and mostly settled in 2016.

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

Drug & Device Law

OCTOBER 7, 2022

1938 (2016), but the lack of a presumption meant plaintiff’s claim was preempted. Obviously, under Buckman direct fraud-on-the-FDA claims, however titled, are impliedly preempted. The purported misrepresentations to doctors “flow factually from her allegations of fraud-on-the-FDA,” so they were also preempted.

FDA 59

FDA Fraud Doctors Public Health 59

Drug & Device Law

AUGUST 8, 2022

The unfortunate truth is that ECFMG was also a victim of this fake doctor’s fraud. Furthermore, trade associations often serve to assist the government in areas that it does not regulate. 2016) (association’s “adoption of rules, policies, and procedures. . . According to the opinion, he repeatedly sought to defraud the ECFMG ?

Doctors 52

Doctors Fraud Licensing Compliance 52

Drug & Device Law

MARCH 3, 2022

have dockets heavy on administrative cases and other cases involving the functioning of the federal government and light on product liability cases. The MDL was established in June 2016. With more than eight years on the federal bench, that is not many decisions. Part of that may be that the D.D.C. Even the D.C. The first is pace.

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FDA Fraud Governance 59