HIPAA Journal

JUNE 9, 2023

In 2019, David Dubin was sentenced to one year in jail for submitting inflated bills and 2 years for aggravated identity theft, with the sentences to run consecutively. Under the letter of the law, small-scale fraud and large-scale fraud carry the same sentence for aggravated identity theft.

Fraud 106

Fraud Medicaid Medicaid Doctors 106

Health Populi

MARCH 29, 2019

Welcome to health politics in America as of March 2019, according to The Public and High U.S. A similar percentage overall blames waste, fraud and administrative costs in the system for high health care spending in America. But one issue that brings U.S. Health Care Costs , a poll conducted by POLITICO and the Harvard T.H.

Hospitals 105

Hospitals Medicare Medicare Governance 105

The Health Law Firm

JANUARY 23, 2019

On January 23, 2019, a Miami woman pled guilty to conspiring to defraud the government and paying and receiving kickbacks as part of a $1 billion health care fraud scheme. Largest Health Care Fraud Case. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Governance Hospitals 40

HIT Consultant

DECEMBER 10, 2021

Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know. What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Report Background.

COVID-19 98

COVID-19 Fraud Nurses Licensing 98

Hall Render

SEPTEMBER 15, 2022

This study comes on the heels of a recent Press Release issued July 20, 2022 (“Press Release”), in which the Department of Justice (“DOJ”) announced criminal charges against 36 defendants in 13 federal districts across the United States largely alleging fraud in the telemedicine space. Inspector General Christi A.

Telemedicine 40

Telemedicine Fraud Medicare Medicare 40

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

Health Law Gurus

MAY 16, 2019

rel Hunt (decided on May 13, 2019), that qui tam whistleblowers can invoke the ‘”government knowledge” three-year tolling provision in the False Claims Act (the “FCA”) suits. government, and continue proliferation of fraud recovery actions. alleging that they defrauded the U.S.

Fraud 52

Fraud Governance 52

Healthcare IT Today

DECEMBER 26, 2024

Recent incidents involving fake video calls and voice cloning demonstrate the technology’s potential for sophisticated fraud. Instead, what McKinsey dubbed a risk-based model for security back in 2019 will be more crucial in 2025 than ever.

US Department of Health and Human Services 90

US Department of Health and Human Services Ransomware Compliance Hospitals 90

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 IT Today

NOVEMBER 4, 2022

EHR vendor Modernizing Medicine has agreed to pay $45 million to the federal government to settle a whistleblower suit alleging that the vendor engaged in varied kickback schemes as well as causing its provider customers to submit false claims. Miraca (now known as Inform Diagnostics) agreed in January 2019 to pay the DOJ $63.5

Governance 67

Governance Fraud 67

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. The DOJ’s Civil Division updated its guidelines in 2019.

Compliance 52

Compliance Due Diligence Fraud Governance 52

Med-Net Compliance

SEPTEMBER 9, 2022

From January 13, 2013, through April 12, 2019, the ophthalmologist routinely administered vascular endothelial growth factor inhibitor injections into the eyes of patients to treat purported wet age-related macular degeneration (Wet-AMD) or other ophthalmological conditions for which treatment with such injections is indicated.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare Law Today

JANUARY 11, 2023

The government alleged that, between April 2014 and April 2019, Jet Medical introduced devices into interstate commerce that were misbranded under the Federal Food, Drug and Cosmetic Act (FDCA) because Jet Medical did not obtain approval or clearance from the U.S. Food and Drug Administration (FDA) prior to distribution.

FDA 59

FDA Governance Medicare Medicare 59

Healthcare Law Today

DECEMBER 16, 2022

Sentencing in federal fraud cases is driven by loss amounts. To seek a higher sentencing guidelines range, the government often relies on a defendant’s “intended” loss,” rather than the “actual” loss. 2400 (2019) narrowing Auer deference applied to the Sentencing Commission’s commentary.

Fraud 52

Fraud Governance Medicaid Medicaid 52

Healthcare Compliance Blog

APRIL 13, 2022

The two men, both 51, were convicted of criminal healthcare fraud and conspiracy charges in 2019. The owner and administrator of Texas-based hospice and home health entities have been named in a multimillion-dollar whistleblower lawsuit.

Fraud 59

Fraud Medicare Medicare Compliance 59

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Situation One: Before the Pandemic   In April 2019, government officials announced Operation Brace Yourself: a fraud takedown related to telemedicine and durable medical equipment (DME).

Fraud 52

Fraud COVID-19 Medicare Medicare 52

Healthcare Compliance Blog

MAY 19, 2022

The voluntary disclosure and investigation revealed that from June 1, 2013, through May 31, 2019, the hospital submitted claims to Medicare for Intensive Cardiac Rehabilitation (ICR) services provided to Medicare beneficiaries.?Before Throughout the investigation, the hospital cooperated with the above entities. to resolve the claims.

US Department of Health and Human Services 59

US Department of Health and Human Services Hospitals Medicare Medicare 59

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. Operation Brace Yourself was one of the largest healthcare fraud schemes investigated and prosecuted by enforcement agencies. The $73 million fraud scheme was discovered and busted. 

Fraud 52

Fraud COVID-19 Compliance Medicare 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

Healthcare Compliance Blog

FEBRUARY 8, 2022

From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta. Routine audits should be conducted, and the results of the audits should be reported at the compliance and ethics committee meetings and in reports to the governing body.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

NY Health Law

JUNE 25, 2019

Progressive Insurance Company , 2019 NY Slip Op 04643, decided that an insurer may withhold payment for services provided by a medical services corporation improperly controlled by non-physicians whether or not the medical services corporation acted fraudulently or with fraudulent intent.

Fraud 52

Fraud Licensing Governance Health Insurance 52

Health Law RX

AUGUST 10, 2023

et al , the government contends that Teva funded the copays of Medicare patients using Copaxone, a multiple sclerosis drug, through donations to nonprofits running patient assistance programs. Teva in turn allegedly benefited from these donations by increasing the cost of Copaxone to the government. Teva Pharmaceuticals USA, Inc.

Governance 52

Governance Medicare Medicare Fraud 52

Health Care Law Brief

JULY 19, 2023

Executive Health Resources affirmed the federal government’s power to dismiss a False Claims Act (“FCA”) action brought under the qui tam provisions whenever it chooses to intervene. By 2019, however, DOJ determined that the case’s burdens outweighed its potential value and, thus, moved to dismiss the case under 31 U.S.C.

Governance 52

Governance Medicare Medicare Fraud 52

Hall Render

JUNE 1, 2022

Ritu also serves as the Chair of the Hospitals and Health Systems Practice Group and has been a member of the Editorial Board for the Health Care Compliance Professionals Manual since 2019. Ritu is a shareholder in Hall Render’s health section and serves as a co-leader of the firm’s compliance service line.

Compliance 40

Compliance Fraud Governance Hospitals 40

Hall Render

APRIL 11, 2022

These relators filed an amended complaint in January of 2019. 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. This original lawsuit reached settlement in August of 2020. Practical Takeaways.

Governance 40

Governance Fraud 40

Hall Render

DECEMBER 11, 2024

The Proposed Rule would codify changes made by the Medicaid Services Investment and Accountability Act of 2019 (MSIAA), that added exclusion authorities related to misclassification and false information about outpatient drugs.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Healthcare Law Blog

FEBRUARY 9, 2024

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. Million To Resolve Health Care Fraud Allegations | United States Department of Justice [3] See Defs.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayment 52

AIHC

MARCH 28, 2022

Government Accountability Office (GAO), improper payments have been estimated to total almost $1.7 trillion government-wide from fiscal years 2003 through 2019. Auditing and denying claims after the claims have been paid is “big money” for the government. According to the U.S.

Medicare 52

Medicare Medicare Compliance Governance 52

Health Blawg

JANUARY 16, 2019

Remember, this is the federal government, so getting almost halfway through the throat-clearing phase of fleshing out an idea in about six months or so really is a sprint.) Comments are due February 12, 2019.) Comments are due February 12, 2019.) Hey, coordinated care is a good idea. We can all agree on that.

HIPAA 60

HIPAA Fraud Governance Payment Systems 60

Health Blawg

JANUARY 16, 2019

Remember, this is the federal government, so getting almost halfway through the throat-clearing phase of fleshing out an idea in about six months or so really is a sprint.) Comments are due February 12, 2019.) Comments are due February 12, 2019.) Hey, coordinated care is a good idea. We can all agree on that.

HIPAA 60

HIPAA Fraud Governance Payment Systems 60

AIHC

SEPTEMBER 5, 2023

Higher rates of use of telehealth are now standard in many practices since the coronavirus disease 2019 (COVID-19) pandemic. This requirement can sometimes apply to specific types of professionals when located in law or regulations governing their profession. This includes understanding various fraud and abuse laws.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

Innovaare Compliance

FEBRUARY 9, 2021

The higher the ratings, the larger the bonus payments health plans receive from the government. So it should come as no surprise that it’s even harder to achieve a five-star rating; in 2019, only 21 plans received a five-star rating whereas 24 healthcare payers received the top rating in 2018. New CMS star ratings criteria 2021.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Health Law Advisor

MARCH 7, 2023

In 2018, Congress passed requirements under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, requiring DEA to create a special registration for opioid addiction treatment via telehealth by October 2019. Impact on Pharmacies.

Telemedicine 52

Telemedicine COVID-19 FDA Compliance 52

Compliancy Group

JANUARY 25, 2022

This is the second-largest number of records reported breached on the government site since 2015. Besides the start of the global pandemic, the year 2019 marked the beginning of a precipitous jump in major healthcare data breaches reported on the “Wall of Shame.” million individuals. million patient records. .

HIPAA 98

HIPAA Ransomware Governance Fraud 98

Kaiser Health News

APRIL 8, 2022

Prescription drug costs for California’s massive Medicaid program were draining the state budget, so in 2019 Gov. 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. SACRAMENTO, Calif.

Medicaid 103

Medicaid Medicaid Health Insurance COVID-19 103

Med Law Blog

MAY 1, 2023

Christopher’s Hospital, to American Academic Health System, which then closed Hahnemann Hospital in June of 2019. Tenet went through its own bankruptcy difficulties and, in 2018, sold its remaining Philadelphia assets, i.e. Hahnemann Hospital and St. in United States ex rel. Cho and Baker v. Surgery Partners, Inc.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52