Provider Trust

MARCH 13, 2023

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.” Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail.

Fraud 52

Fraud US Department of Health and Human Services Licensing Nurses 52

Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. Watch the Webinar During the Keynote Speech at the HCCA Compliance Institute this year, Office of Inspector General (OIG) Christi A.

Compliance 52

Compliance Nursing Homes Nurses Fraud 52

HIPAA Journal

MARCH 20, 2025

You can view our H1, 2024 Report here.You can also receive a free copy of our HIPAA Compliance Checklist to understand your organization’s responsibilities under HIPAA. Check back regularly to get the latest healthcare data breach statistics and healthcare data breach trends. These figures are adjusted annually for inflation.

HIPAA 109

HIPAA Ransomware Compliance Hospitals 109

Healthcare IT Today

JUNE 29, 2023

Each ASC is responsible for ensuring that they are in compliance with the numerous statutes and regulations that are in place at both the state and federal levels. However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. ASCs must also meet Medicare’s Conditions for Coverage.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

Healthcare Compliance Blog

MAY 10, 2022

According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application. The provider is charged with one count of Medicaid fraud more than $50,000, a first-degree felony.

Medicaid 59

Medicaid Medicaid US Department of Health and Human Services Fraud 59

HIPAA Journal

JUNE 2, 2023

Rico Prunty, 41 years old, of Sierra Vista, Arizona, was previously employed at an Arizona medical facility where he unlawfully accessed the medical intake forms of patients between July 2014 and May 2017. His co-conspirators have already been sentenced for their roles in the identity theft scheme.

HIPAA 55

HIPAA Fraud Health Insurance Compliance 55

Med-Net Compliance

JUNE 24, 2022

A former Tennessee medical group director, 62, was sentenced to 18 months in federal prison for wire fraud. During her time there, she developed a fraud scheme that allowed her to steal hundreds of thousands of dollars from the organization.

Fraud 59

Fraud Hospitals 59

Hall Render

DECEMBER 11, 2024

OIGs new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community emphasizes the importance of staff screening and exclusion checks. Information about the LEIE may be found on the OIGs Exclusions page. Under 42 CFR Sec.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Healthcare IT Today

FEBRUARY 26, 2024

are estimated to go to administrative burdens, while another 25-30% are consumed by fraud, waste, and abuse. But the key element of generative AI, the transform or transformer , was first proposed in a 2017 paper and only recently has supplemented the more traditional convolutional neural networks (CNNs) and recurrent neural networks (RNNs).

Fraud 99

Fraud Doctors Nurses Compliance 99

Health Law RX

JANUARY 31, 2023

In such cases, a defendant is typically accused of falsely attesting to compliance with conditions of payment or other requirements under government programs. And some jurists are cynical about the impact of applying an objective standard to government fraud cases. In 2017, in United States ex rel. 3d 1148 (11th Cir.

Governance 52

Governance Fraud Compliance 52

Healthcare Compliance Blog

MARCH 31, 2022

The DOJ, in coordination with the Medicaid Fraud Control Unit of the Office of the New York State Attorney General, began an investigation after whistleblowers alleged that certain LHCSAs had knowingly defrauded the federal government and New York State by underpaying home health aides in violation of New York’s Wage Parity Act.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

AIHC

MARCH 2, 2023

Written by: Nancie Lee Cummins , CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This is part 2 in the Leadership essay series from members of the American Institute of Healthcare Compliance (AIHC). I remember actually defining my objectives in 2017 with one of the classes through AIHC.

Compliance Officers 52

Compliance Officers Compliance Fraud Medical Billing 52

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayment 52

Health Care Performance

AUGUST 16, 2022

When investigating a breach, the OCR also reviews the organization’s compliance with the HIPAA Security Rule. In a recent interview , Lisa Pino, HHS OCR Director stated: “We are a law enforcement agency and we have to instill that sense of accountability when obligations of the law are not in compliance.”

HIPAA 52

HIPAA Ransomware Fraud Compliance 52

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. His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription.

US Department of Health and Human Services 59

US Department of Health and Human Services Overpayment Overpayments Medicare 59

Health Law RX

AUGUST 10, 2021

The DOJ contended that Ancor caused false claims to be submitted to governmental healthcare programs for payment when it allowed the alleged conduct to continue during the period July 1, 2017 through January 1, 2020. In that way, the Board is ultimately responsible for ensuring the company’s compliance. Moreover, the U.S.

Due Diligence 40

Due Diligence Compliance Governance Fraud 40

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

AIHC

AUGUST 8, 2023

I am a Certified Internal Healthcare Fraud Auditor (CIFHA). More than likely some aspect involves a breach of compliance so compliance representatives must attend. In an October 12, 2017 article over Dr. Deming I find the best characterization of him and his importance to Quality. Sound familiar ?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

CMS.gov

NOVEMBER 16, 2018

Fraud, waste, & abuse. We are proud to announce that the Medicare Fee-for-Service (FFS) improper payment rate is at its lowest since 2010 and the decreased improper payment rate from 2017 to 2018 represents a $4.59 percent in 2017 to 8.12 billion decrease in estimated improper payments from 2017 to 2018. Jeremy.Booth@c….

Medicare 20

Medicare Medicare Overpayment Overpayments 20

Healthcare Law Blog

MAY 16, 2022

At the beginning of the applicable contract year, the credit and the use of LOIs will no longer apply and, if the application is approved, the MAO must be in full compliance with network adequacy, including having signed provider and facility contracts. A warning letter = 3 points. A notice of noncompliance = 1 point.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

NOVEMBER 28, 2023

Year Positive Margin Cost Reports Negative Margin Cost Reports Total Number Percent Number Percent Number 2017 6,024 76.5% CMS recounts one specific, egregious hospice fraud case in the 2024 Final Rule to reinforce its concern. Hospices need to be much more vigilant about compliance. 7,872 2018 5,851 77.1% 7,589 2019 5,871 79.3%

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. This plan, whatever it was set up the perverse incentives by not looking at critical elements to ensure compliance.

Compliance 52

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

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. This plan, whatever it was set up the perverse incentives by not looking at critical elements to ensure compliance.

Compliance 52

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

Healthcare Compliance Blog

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. The woman, 45, pleaded guilty to an amended charge of Reckless Conduct (Class A Misdemeanor).

Nurses 59

Nurses Nursing Homes Licensing Fraud 59

AIHC

JUNE 3, 2024

Overall firearm-specific older adult homicide rates increased between 2014 and 2017. The article states that Americans over 60 years of age fell victim to so-called elder fraud crimes more frequently last year than during any other year and accounted for an estimated $3.4 Of the 6,188 victims, 62% were male.

Elder Abuse 52

Elder Abuse Compliance Nursing Homes Compliance Officers 52

Verisys

MARCH 24, 2022

We’ll explore what the OFAC Sanctions List means for healthcare organizations, how maintaining compliance with OFAC rules reduces reputational, financial, and patient risk, and the steps individual providers and entities can take to be removed from the OFAC list. businesses and individuals. However, the U.S. 107,691).

ACA 52

ACA Compliance Governance Medicaid 52

New Jersey Healthcare Blog

JULY 22, 2022

Following a thorough review in compliance with Executive Order No. These include the purpose and scope, definitions, standard of care, licensee-patient relationship, provision of health care services through telemedicine or telehealth, records, prevention of fraud and abuse, and privacy and notice to patients. 13:44F with amendments.

COVID-19 Vaccine 40

COVID-19 Vaccine Licensing COVID-19 Public Health 40

Hall Render

FEBRUARY 24, 2023

NATIONAL Addressing Staff Burnout In Healthcare Design Amazon completes $3.9B Can Hospitals Change in Time to Keep Them? Staff shortages could spur next public health crisis, Baystate Health CEO warns CommonSpirit, Mass General, Moffitt execs to judge telehealth challenge Brigham and Women’s, AI company get $2.5M

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

JANUARY 28, 2022

Where Hospital Price Transparency Compliance Is Lagging. Federal officials arrest nursing home owner charged with more than $3M in Arkansas Medicaid fraud. More Civil, Criminal Charges for Former Skyline CEO Accused of Tax and Medicaid Fraud. Iowa surgical group pays $612K to resolve fraud allegations. MISSISSIPPI.

COVID-19 40

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

Drug & Device Law

MARCH 19, 2024

Plaintiff was missing any “indicia of fraud, wrongdoing, domination, misuse, or subversion of corporate formalities. And while the court agreed that placing a product into the stream of commerce is not enough to be “purposeful availment,” the manufacturer here did more.

FDA 52

FDA Fraud Doctors Governance 52

Drug & Device Law

FEBRUARY 15, 2024

2022) (recognizing the following product defect liability theories: “(1) negligent design of the product; (2) negligent manufacture of the product; (3) negligent failure to warn about some aspect of the product; (4) breach of express or implied warranty; or (5) misrepresentation or fraud”). Cartridge Co. , FCA US, LLC , 579 B.R.

FDA 52

FDA Fraud Compliance Hospitals 52

Drug & Device Law

DECEMBER 29, 2023

2023) ( Buckman preemption barred MDL asserting fraud on EPA), cert. Negligence requires an evaluation of a defendant’s reasonableness, and all relevant NC authority includes relevant regulatory compliance in that mix. Plaintiffs’ own litigation strategy thus opened the door to compliance evidence. Hrymoc was tried in late 2017.

FDA 105

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

Drug & Device Law

MAY 5, 2022

Stated differently, the rebuttal provision makes allegations and evidence of fraud on the FDA a prerequisite to state-law liability. But state-law claims that rest on alleged fraud on the FDA are contrary to Buckman Co. 2022 WL 1261318, at *1 (quoting N.J. quoting Cornett v. Johnson & Johnson , 48 A.3d 3d 1041, 1056 (N.J.

Compliance 52

Compliance FDA Fraud 52