The Health Law Firm

OCTOBER 31, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019.

Fraud 40

Fraud Medicare Medicare Doctors 40

The Health Law Firm

SEPTEMBER 25, 2018

Board Certified by The Florida Bar in Health Law On August 22, 2018, a doctor received a sentence of one year and a day in prison from a New York federal court for his part in a $30 million scheme to defraud Medicare and the state Medicaid program. Indest III, J.D., Lies and Cover-ups.

Fraud 40

Fraud Doctors Medicaid Medicaid 40

The Health Law Firm

OCTOBER 3, 2019

Board Certified by The Florida Bar in Health Law On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019.

Fraud 40

Fraud Doctors Medicare Medicare 40

HIPAA Journal

JANUARY 23, 2024

Theranos and Homes denied the allegations and threatened to sue Carreyrou; however, in 2018, Homes stepped down from her position as CEO, and following an FBI investigation the company was shut down. HHS-OIG Issues Notice of Exclusion HHS-OIG Inspector General Christi A.

Fraud 89

Fraud FDA Medicaid Medicaid 89

Healthcare Compliance Blog

MAY 11, 2022

The South Carolina Attorney General announced that his office’s Medicaid Fraud Control Unit (SCMFCU) had arrested a 57-year-old woman on two counts of Exploitation of a Vulnerable Adult and two counts of Breach of Trust with Fraudulent Intent, value of $10,000 or more.

Fraud 59

Fraud Nursing Homes Medicaid Medicaid 59

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Tue, 10/02/2018 - 15:36. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Jeremy.Booth@c…. Seema Verma.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

HIPAA Journal

MARCH 20, 2025

2023, OCR reported a 239% increase in hacking-related data breaches between January 1, 2018, and September 30, 2023, and a 278% increase in ransomware attacks over the same period. PA Business Associate 2,675,934 Hacking/IT Incident 45 2018 AccuDoc Solutions, Inc. In 2019, hacking accounted for 49% of all reported breaches.

HIPAA 109

HIPAA Ransomware Compliance Hospitals 109

Healthcare IT Today

AUGUST 14, 2024

It ensures timely patient access to care, automatic claim processing, network management, compliance, fraud detection, physician recruitment and more. The Centers for Medicare and Medicaid Services reported more than 45% of provider office locations listed in online directories contained at least one error.

Fraud 75

Fraud Hospitals Medicaid Medicaid 75

Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. Under the Wage Parity Law, which is funded by Medicaid, aides are to be paid a minimum amount in total compensation.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

Pharmacy Law Blog

MARCH 13, 2018

She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. fraud suit – judge.” Copyright © 2018 The Health Law Firm. The Relator’s FCA Suit. The relator McKenzie Stepe, a former RS sales representative, originally filed her complaint in December 2013.

Fraud 52

Fraud Governance Licensing FDA 52

AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. Prior to appealing a Medicare, Medicaid, TriCare or other Federal Program claim, you should verify that your organization is compliant in this area ( click here ).

Fraud 52

Fraud Medicare Medicare Compliance 52

HIPAA Journal

JULY 24, 2023

The team’s roles are to investigate and audit the Department’s operations to prevent fraud, waste, and abuse within the Department, and also to audit and investigate potential crimes against the Department. In addition to HHS OIG enforcement actions, Medicare Fraud Control Units (MFCUs) operate in every state and territory.

Fraud 52

Fraud Medicare Medicare Medicaid 52

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Administrator, Centers for Medicare & Medicaid Services. Fraud, waste, & abuse. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2018. percent in 2018. Leadership.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

McGuire Wood

OCTOBER 2, 2023

According to the DOJ press release, from January 2013 to July 2018, Oliver Street, doing business as U.S. If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure. DOJ Voluntary Self-Disclosure.

Fraud 52

Fraud Governance Compliance Medicare 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. Parts 417, 422, 423, 455, and 460.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Provider Trust

MAY 18, 2022

In addition, the suit involved alleged submission of false claims for reimbursement to the Massachusetts Medicaid Agency. The Massachusetts Attorney General had already fined South Bay $4M in February 2018. The defendants settled and paid $19.95 MM in reimbursements and fines, as well as $5.05 Get Daily Vendor Monitoring.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Inovaare’s A&G software optimizes your processes so you can handle large volumes of data, reduce costs and ensure transparency to prevent fraud at every step. References.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Florida Health Care Law Firm

FEBRUARY 22, 2022

He has also had assets forfeited since these assets were acquired with money from his ill-gotten fraud scheme. From January 2018 to 2019, this scheme of greed resulted in approximately $12 million in payment to Truglia and his co-conspirators. In total, Mr. Truglia and his co-conspirators collected approximately $18.5

Telemedicine 40

Telemedicine Medicare Medicare Fraud 40

CMS.gov

JUNE 20, 2018

Wed, 06/20/2018 - 16:17. Fraud, waste, & abuse. Over the past year, the Centers for Medicare & Medicaid Services (CMS) has engaged with the provider community in a discussion about regulatory burden issues. Working Together for Value. lisa.sokol@cms…. Seema Verma. Administrator, CMS. Billing & payments. Leadership. Legislation.

Medicare 30

Medicare Medicare Fraud Medicaid 30

Pharmacy Law Blog

MARCH 8, 2018

They face maximum sentences of 10 years in prison on the health care fraud counts. Copyright © 2018 The Health Law Firm. If convicted, each defendant faces a maximum sentence of 20 years in prison on the drug conspiracy and distribution counts. To read the indictment in full, click here. According to the U.S. Indest III, P.A.

Nurses 40

Nurses Doctors Licensing Medical Personnel 40

Florida Health Care Law Firm

DECEMBER 9, 2021

The Rule does not apply to people with coverage through Medicare, Medicaid, Indian Health Services, Veteran Affairs Health Care or TRICARE as these programs already contain protections against high medical bills. Bans balance billing for emergency services.

Medical Billing 40

Medical Billing Medicare Medicare Compliance 40

Hall Render

JULY 12, 2023

CMS has seen hundreds of hospice ownership changes since 2018, for which CMS may not know whether the facility under its new ownership and leadership is compliant with the hospice regulatory requirements for participation. CMS believes that additional provider enrollment measures are necessary to help address these concerns.

Medicare 40

Medicare Medicare Nursing Homes Fraud 40

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. 7,872 2018 5,851 77.1% 7,589 2019 5,871 79.3%

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Med Law Blog

MAY 1, 2023

Tenet went through its own bankruptcy difficulties and, in 2018, sold its remaining Philadelphia assets, i.e. Hahnemann Hospital and St. Hahnemann was acquired by AHERF, the forerunner of Allegheny Health Network, in 1993. Tenet Healthcare bought Hahnemann out of the AHERF bankruptcy in 1998.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

AIHC

FEBRUARY 16, 2024

Because aspiration pneumonia is excluded from Centers for Medical & Medicaid Services (CMS) pneumonia mortality scores, the implicit conclusion is that a hospital can improve its public rating by coding its oldest and sickest patients with pneumonia as having aspiration pneumonia. First, we need to look at exactly what happened.

Compliance 52

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

AIHC

FEBRUARY 16, 2024

Because aspiration pneumonia is excluded from Centers for Medical & Medicaid Services (CMS) pneumonia mortality scores, the implicit conclusion is that a hospital can improve its public rating by coding its oldest and sickest patients with pneumonia as having aspiration pneumonia. First, we need to look at exactly what happened.

Compliance 52

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

CMS.gov

NOVEMBER 2, 2018

Fri, 11/02/2018 - 21:32. Seema Verma, Administrator, Centers for Medicare & Medicaid Services . November 2, 2018. Medicare has a plethora of misaligned financial incentives that work to increase costs for taxpayers and beneficiaries, and create challenges related to fraud and abuse. CMS BLOG: Medicare for All?

Governance 55

Governance Medicare Medicare ACA 55

CMS.gov

DECEMBER 21, 2018

Fri, 12/21/2018 - 13:09. Administrator, Centers for Medicare & Medicaid Services. CMS issues waivers to ACOs of specific fraud and abuse laws in order to provide the regulatory relief needed to innovate, including waivers of provisions of the Stark Law and the Federal Anti-Kickback Statute. Jeremy.Booth@c…. Seema Verma.

Medicare 41

Medicare Medicare Payment Systems Fraud 41

New Jersey Healthcare Blog

JULY 22, 2022

The chapter describes the policies and procedures of the New Jersey Medicaid/NJ FamilyCare program regarding transportation services. On April 4, 2022, at 54 N.J.R. 620(b), the Department of Human Services, Division of Medical Assistance and Health Services adopted amendments to Transportation Services Rules. See N.J.A.C. 191 (N.J.S.A.

COVID-19 Vaccine 40

COVID-19 Vaccine Licensing COVID-19 Public Health 40

Hall Render

JULY 14, 2023

Vernon receives award to improve stroke care Health system to expand Illinois hospital after $23.5M renovation Reid Health details restructuring effort to reduce costs Cameron Hospital, Trine break ground on $10M nursing education center IOWA 26 Nursing Homes Close in the Past Year Across Iowa Groundbreaking set for new UnityPoint – St.

US Department of Health and Human Services 40

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

Hall Render

MARCH 17, 2023

‘Not what we were looking for,’ CEO says Fired CEO files slander, defamation suit against Scotland County Hospital Missouri health system appoints strategy chief Missouri physician pleads guilty to $537K Medicare fraud scheme New Behavioral Health Crisis Center Open in Cape Girardeau St. in Indiana aging-in-place work.

US Department of Health and Human Services 40

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

Hall Render

JUNE 9, 2023

million from Miracle Day Arkansas Hospice Takes Over LifeTouch Hospice Arkansas hospitals say they are struggling; report questions those claims Arkansas law allows physician assistants to be rendering providers for Medicaid Arkansas rural hospitals work to keep their doors open Panda Express Pledges $1.2M

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

APRIL 28, 2023

on EHR upgrade New SSM Health children’s developmental center opening today Illinois Capitol bills would give more money to community health centers Illinois physician selected for year-long NASA Mars simulation HSHS St.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

FEBRUARY 7, 2025

fraud scheme Banner names Seattle physician-scientist to C-suite role Bill would require Arizona hospitals to ask about immigration status Phoenix Children’s receives $2.25 Alaska Mental Health Trust Authority chooses new chief executive ARIZONA Arizona couple pleads guilty to $1.2B The university says no. area clinics, eyes more D.C.

Nurses 40

Nurses Nursing Homes Hospitals Medicaid 40