Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. During the fiscal year 2021, the report states that the federal government won or negotiated over $5 billion in healthcare fraud judgments and settlements. Monetary Penalties.

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Fraud Medicaid Medicaid Medicare 52

Compliancy Group

JANUARY 25, 2022

With at least six weeks before final numbers are in, the Department of Health and Human Services HIPAA Breach Reporting Tool website is reporting 713 major healthcare data breaches in 2021, an increase of more than 7.5 By the Numbers: Major Healthcare Data Breaches Increase in 2021. million records in 2021.

HIPAA 98

HIPAA Ransomware Governance Fraud 98

Med-Net Compliance

JUNE 22, 2022

A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Her theft of the cards began at least as early as May 2021 and continued through September 2021. Participating in the fraud can result in the person(s) being prosecuted.

COVID-19 Vaccine 59

COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

HIT Consultant

DECEMBER 10, 2021

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. Telehealth Spend.

Fraud 98

Fraud COVID-19 Nurses Licensing 98

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.

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Fraud Medicare Medicare Overpayments 63

Health Law Advisor

FEBRUARY 3, 2022

Department of Justice (DOJ) released its annual False Claims Act (FCA) enforcement statistics for fiscal year (FY) 2021. [1]. billion, FY 2021 marks DOJ’s largest annual total FCA recovery since FY 2014, and more than twice the $2.3 Marking another record, DOJ’s health care recoveries in FY 2021 in non- qui tam actions ($3.6

Fraud 52

Fraud COVID-19 Governance Medicare 52

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

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Fraud Medicare Medicare US Department of Health and Human Services 52

Health Care Law Brief

JULY 21, 2022

On July 20, 2022, the Office of Inspector General for the Department of Health and Human Services (“ OIG ”) issued a special fraud alert (“ Alert ”) advising “practitioners to exercise caution when entering into arrangements with purported telemedicine companies.” OIG Flags Seven Characteristics of Telehealth Fraud.

Fraud 52

Fraud Telemedicine COVID-19 Governance 52

Med-Net Compliance

AUGUST 16, 2022

Five individuals and two for-profit skilled nursing facilities (SNFs) in Pennsylvania were indicted on charges of conspiracy to defraud the United States and related healthcare fraud charges. The post Five Individuals and Two Nursing Facilities Indicted on Healthcare Fraud Charges appeared first on Med-Net.

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Fraud Nurses Medicaid Medicaid 59

Hall Render

FEBRUARY 4, 2022

billion from False Claims Act (“FCA”) cases in the federal fiscal year 2021, “the second largest annual total in False Claims Act history” and more than doubling the FCA recoveries for the DOJ from fiscal year 2020. Whistleblowers themselves received $237 million in 2021. Health Care Fraud Actions.

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Fraud Governance Medicare Medicare 40

Florida Health Care Law Firm

APRIL 18, 2022

Fraud in these cases is generally easy to prove. Simply verifying inventory, orders and dispensing records yields incredible data that when combined with comparative data from peer pharmacies can be used by law enforcement to establish that fraud has been committed. Latest Enforcement Activity. On April 13, 2022, the U.S.

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Fraud Medicaid Medicaid Medicare 52

Florida Health Care Law Firm

DECEMBER 7, 2021

Telemedicine pharmacy arrangements continue to be of significant interest to fraud enforcement. The federal jury trial in the billion-dollar telehealth pharmacy fraud scheme resulted in conviction on 22 counts of mail fraud, conspiracy to commit health care fraud and introduction of misbranded drugs into interstate commerce.

Fraud 40

Fraud Telemedicine Governance Compliance 40

Healthcare IT News - Telehealth

SEPTEMBER 12, 2024

Queensland to pilot telestroke service at Hervey Bay Hospital The Queensland government has designated Hervey Bay Hospital as the pilot site for the upcoming statewide telestroke service. The state government has committed A$5.8 The software pilot fulfils one of the reform recommendations of the Royal Commission in 2021.

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Doctors Governance Fraud Hospitals 121

The Health Law Firm

AUGUST 20, 2021

is Board Certified by The Florida Bar in Health Law On August 6, 2021, federal prosecutors pushed back on claims that government agents tricked a Harvard University professor into making incriminating statements during his interrogation by federal agents. Indest III, J.D.,

Fraud 45

Fraud Governance 45

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

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). 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 Compliance Officers 52

Healthcare IT News - Telehealth

JANUARY 30, 2023

FINDINGS Based on the state audit , the department fell short in governance, risk management, and evaluation of the telehealth expansion. It also did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, before implementing the temporary and permanent MBS telehealth items.

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COVID-19 Governance Medicare Medicare 151

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 111

Fraud Health Insurance Ransomware HIPAA 111

HIPAA Journal

OCTOBER 6, 2022

Sebastien Vachon-Desjardins, 34, from Quebec, a former IT consultant who worked for the Public Works and Government Services in Canada, was arrested in Canada in January 2021 on suspicious of conducting ransomware attacks as part of a law enforcement crackdown on the Netwalker ransomware gang. A ransom of $1.14

Ransomware 114

Ransomware Fraud COVID-19 HIPAA 114

Healthcare Compliance Blog

FEBRUARY 7, 2022

A Michigan woman has pled guilty to stealing government funds that were designated to aid medical providers in the treatment of patients suffering from COVID-19 and acknowledged using the money for her own personal use. Issue: Misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds.

COVID-19 59

COVID-19 Fraud Governance Compliance 59

Med-Net Compliance

JULY 13, 2022

Two California brothers were both sentenced to 36 months of probation and ordered to pay $500 dollars in restitution after pleading guilty to misdemeanor conspiracy to steal or convert government property charges stemming from the theft of Centers for Disease Control (CDC) COVID-19 Vaccination Record Cards.

COVID-19 Vaccine 59

COVID-19 Vaccine US Department of Health and Human Services COVID-19 Fraud 59

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 79

Fraud Health Insurance Ransomware HIPAA 79

The Health Law Firm

MARCH 10, 2021

Board Certified by The Florida Bar in Health Law On February 3, 2021, a former University of Florida professor was indicted on allegations of fraudulently obtaining a federal grant from the US by concealing his ties with the Chinese government. Indest III, J.D., He is accused of fraudulently obtaining $1.75

Fraud 40

Fraud Governance 40

HIPAA Journal

MARCH 15, 2023

The contract was renewed by FHKC through 2020, with the federal government covering 86% of the payments to Jelly Bean Communications Design. Attorney’s Office for the Middle District of Florida, with assistance provided by HHS-OIG.

Health Insurance 84

Health Insurance HIPAA Fraud Due Diligence 84

Healthcare Law Blog

APRIL 3, 2023

While government enforcement has traditionally been an indirect concern for private equity (“PE”) investors, such as looking at whether a target entity has been sanctioned or could be sanctioned in the future, the current trend in government enforcement has been to target PE firms directly. On March 25, 2021, the U.S.

Due Diligence 52

Due Diligence Fraud Governance Compliance 52

Health Law RX

JUNE 17, 2022

The FCA imposes civil liability on any person requesting government funds or property who “knowingly presents. A pleading, “alleging fraud or mistake. must state with particularity the circumstances constituting fraud or mistake.” government. 2021) (noting a case does not have to be proven in the complaint).

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Fraud Governance 52

Health Law Attorney

NOVEMBER 12, 2021

On November 8, 2021, the Office of Inspector General (“ OIG ”) issued multiple updates to the Health Care Fraud Self-Disclosure Protocol (“ SDP ”), incorporating legal changes made since the previous SDP revision in 2013. The OIG’s updated SDP may be accessed here. Below is an overview of the updates.

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Fraud Governance 40

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

Healthcare Compliance Blog

MARCH 2, 2022

An indictment was filed on February 25, 2022, against ten persons in Florida for their alleged roles in a $67 million healthcare fraud, wire fraud kickback, and money laundering scheme. Healthcare fraud and anti-kickback violations are each punishable by a maximum penalty of 10 years in prison.

Medicare 45

Medicare Medicare Fraud Compliance 45

Innovaare Compliance

FEBRUARY 9, 2021

The higher the ratings, the larger the bonus payments health plans receive from the government. New CMS star ratings criteria 2021. With the CMS release of the Final Rule for Contract Year 2021 on May 22, 2020, Medicare Advantage (MA) plans now have some near-term clarity regarding the many star-rating proposals made earlier this year.

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Medicare Medicare Medicaid Medicaid 40

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. Health care fraud cases are a prime example. In United States v. Banks Decision.

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Fraud Governance Medicaid Medicaid 52

Health Law RX

JUNE 27, 2023

the Court held that, despite declining to intervene at the outset of a case, the Government retains the authority to intervene later, including for the purposes of seeking dismissal pursuant to and consistent with Federal Rule 41(a) ( U.S. Circuit found the Government’s dismissal authority to be “unfettered” ( Swift v. SuperValu Inc.,

Governance 52

Governance Fraud Compliance 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

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

AIHC

MAY 17, 2023

This article addresses various forms of fraud and how criminals’ prey on compromised citizens. There are many factors which can influence our health, and in turn, there are just as many schemes which are actually considered health care fraud. SNAP Fraud Food assistance is generally referred to as SNAP or food stamps.

Health Outcomes 52

Health Outcomes Fraud Compliance Governance 52

Compliancy Group

MARCH 30, 2023

According to the report, there were 847,376 complaints of suspected internet crime in 2021, representing a 7% increase compared to the previous year. In 2022 there were a total of 800,944 complaints, which shows a 5% decrease from 2021, but the potential total loss has increased from $6.9 billion to more than $10.2

Ransomware 52

Ransomware Fraud HIPAA Compliance 52

HIPAA Journal

NOVEMBER 21, 2022

According to the FBI, more than $43 billion was lost to these scams between June 2016 and December 2021, and in 2021 alone, the FBI Internet Crime Complaint Center received reports of losses of $2,395,953,296 to BEC scams. million in losses were caused to federal government agencies, private companies, and individuals.

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Medicaid Medicaid Medicare Medicare 88