Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. Court documents show that between 2008 and 2016 the former owner defrauded the Texas Medicaid program by billing for items and services that had not been provided to the clients of the day care centers. US Attorney Ashley C.

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The Health Law Firm

DECEMBER 5, 2017

Board Certified by The Florida Bar in Health Law 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 US Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D.,

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The Health Law Firm

FEBRUARY 12, 2016

Board Certified by The Florida Bar in Health Law A central Florida ophthalmologist with offices in Windermere and Leesburg, was found guilty of 20 counts of Medicare fraud on September 29th. was convicted of health care fraud this past Tuesday by a Jacksonville federal jury. Indest III, J.D., David Ming Pon, M.D.,

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The Health Law Firm

DECEMBER 6, 2016

Board Certified by The Florida Bar in Health Law On December 1, 2016, Sheila Kahl pled guilty in a New Jersey federal court that she took part in a $1 million Medicare fraud scheme. The participants in the scheme received "commissions" each time the labs were paid by Medicare or a private insurer. By George F.

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The Health Law Firm

MAY 1, 2016

Board Certified by The Florida Bar in Health Law On April 18, 2016, Dr. Henry Lora, a doctor in Miami was sentenced to nine years in federal prison for his role in a scheme to defraud the Medicare system out of around $30 million in phony reimbursements. Indest III, J.D.,

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The Health Law Firm

JULY 13, 2016

Board Certified by The Florida Bar in Health Law On June 22, 2016, Federal officials completed a three-day nationwide takedown announcing charges against 301 medical professionals who allegedly defrauded Medicare of more than $900 million in fraudulent billings. By George F. Indest III, J.D.,

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The Health Law Firm

MARCH 21, 2016

Board Certified by The Florida Bar in Health On February 3, 2016, the US District Court for the Eastern District of Michigan denied a motion to suppress all evidence of health care fraud seized by the government pursuant to a search warrant of Naseem Minhas’s home health care agency. By George F. Indest III, J.D.,

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Compliancy Group

DECEMBER 20, 2024

The contractor used the ePHI to generate medical claims for services that were not actually rendered, resulting in approximately 6,500 false Medicare claims. OCR investigated the claim and found that from May of 2016 to January of 2019, the ePHI of roughly 1.5

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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.,

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Healthcare IT Today

MAY 6, 2023

Read more… Preventing Genetic Testing Fraud: 5 Actions for Health Plans. Medicare payments for genetic testing quadrupled from 2016 to 2019, which has unfortunately led to a rise in a rise in fraud, waste, and abuse. On the heels of ViVE and HIMSS, they also discuss whether in-person conferences are back.

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HIT Consultant

NOVEMBER 24, 2022

– Delivery model : Whether to ship OTC products to a hearing clinic where the consumer can receive professional diagnosis, fitting and support, or ship directly to the consumer’s home thereby providing convenience but no professional support (and increased fraud risk), or offer both options? – Fraud. Epub 2016 Aug 23.

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HIPAA Journal

MARCH 20, 2025

TX Healthcare Provider 3,998,163 Hacking/IT Incident 27 2016 Banner Health AZ Healthcare Provider 3,620,000 Hacking/IT Incident 28 2021 Florida Healthy Kids Corporation FL Health Plan 3,500,000 Hacking/IT Incident 29 2015 Medical Informatics Engineering IN Business Associate 3,500,000 Hacking/IT Incident 30 2016 Newkirk Products, Inc.

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HIT Consultant

NOVEMBER 2, 2021

In 2016, the Centers for Medicare and Medicaid Services (CMS) followed by issuing guidance on how states should move forward with modularity of their MMIS with a goal of providing enhanced flexibility to change systems. Prior to 2016, large vendors controlled the market and monopolized state MMISs. Current State of the Market.

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The Health Law Firm

DECEMBER 12, 2016

Board Certified by The Florida Bar in Health Law Walter Beich, an Illinois pharmacist, pled guilty on November 17, 2016 to defrauding Medicare, Medicaid and several private insurers out of $2.4 By George F. Indest III, J.D.,

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Healthcare Compliance Blog

FEBRUARY 25, 2022

In 2006, the excluded psychiatrist was convicted in Florida of conspiracy to commit healthcare fraud. In February 2016, the psychiatry company and its owner hired the excluded psychiatrist as a clinical director. This conviction led to the psychiatrist being excluded from all federal healthcare programs.

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Healthcare Compliance Blog

APRIL 12, 2022

By pleading guilty, the business owner admitted that she willfully failed to deposit the Federal Insurance Contributions Act and Medicare (FICA) taxes and income taxes that were withheld from her employees’ wages. Violations of payroll management can be considered fraud and can result in fines and imprisonment.

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Medical Billing Fraud Governance Medicare 59

Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”. He is awaiting sentencing on those charges.

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Compliancy Group

JUNE 21, 2024

The Office of the Inspector General (OIG) has honed in on chiropractic practices over the last few years because of improper payments and claims, and noncompliance with Medicare requirements. The purpose of an OIG audit is to prevent fraud and abuse or to detect it. This is why an OIG compliance manual for chiropractors is essential.

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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).

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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.

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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.

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Healthcare IT Today

JUNE 29, 2023

Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid. ASCs must also meet Medicare’s Conditions for Coverage. Medicare Payment Resources CMS implemented an Ambulatory Payment Classification-based payment methodology in 2008.

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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. Some patients treated were allegedly able to walk without assistance and were ineligible for homebound therapy.

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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 from 2016 to 2018. percent in 2016 to 35.54 Jeremy.Booth@c….

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Medicare Medicare Overpayment Overpayments 20

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.”. Some examples include: United Medical Instruments Inc.

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CMS.gov

OCTOBER 2, 2018

Administrator, Centers for Medicare & Medicaid Services. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion. It also enhances the ability to identify potential fraud and improve program efficiency. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Jeremy.Booth@c….

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Medicaid Medicaid Fraud Health Outcomes 40

Health Care Law Brief

JANUARY 18, 2023

The United States Department of Justice (“DOJ”) resolved allegations that, from January 1, 2011 to December 31, 2016, Dr. Pandya violated the FCA when they submitted false claims to Federal health care programs for medically unnecessary cataract extraction surgeries and YAG laser capsulotomies (“Civil Settlement Agreement”). IA with HHS-OIG.

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Medicare Medicare Compliance Fraud 52

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.

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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. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. Innocent” Property Can’t Be Seized. To read more on the U.S.

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Fraud Medicare Medicare Governance 40

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.

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Public Health Fraud COVID-19 Medicaid 52

The Health Law Firm

JULY 15, 2016

Board Certified by The Florida Bar in Health Law On June 15, 2016, A medical diagnostics company owner found guilty of Medicare and Medicaid fraud for billing $8 million for X-rays whose botched analysis by amateurs led to the death of two patients was sentenced in Maryland federal court to 10 years in prison, the US Department of Justice said.

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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. Actuarial Soundness.

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The Health Law Firm

MARCH 2, 2016

Board Certified by The Florida Bar in Health Law The owner of a diagnostic imaging company in Maryland is facing life in prison after a federal jury found him guilty on February 17, 2016, of health care fraud. Rafael Chikvashvili, was found guilty of billing Medicare and Medicaid for more than $7.5 Indest III, J.D.,

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Verisys

MARCH 24, 2022

Healthcare facilities receive billions of dollars in federal and state funding through the Affordable Care Act (ACA), Medicare, Medicaid, CHIP, and other programs. In 2016, Alcon Laboratories was slapped with a $7.6 When it comes to healthcare, knowing who you’re doing business with matters.

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ACA Compliance Governance Medicaid 52

AIHC

FEBRUARY 16, 2024

The article states “An example of this was Wells Fargo in 2016. I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Both the American Society for Quality (ASQ) and Centers for Medicare and Medicaid Services (CMS) recognize this tool’s usefulness in root cause analysis (RCA).

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

AIHC

FEBRUARY 16, 2024

The article states “An example of this was Wells Fargo in 2016. I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Both the American Society for Quality (ASQ) and Centers for Medicare and Medicaid Services (CMS) recognize this tool’s usefulness in root cause analysis (RCA).

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

CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? When listening to those advocating ‘Medicare for All’ it’s good to be skeptical about their promises. percent from 2011-2016, from $17.6

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