Healthcare IT News - Telehealth

MAY 13, 2022

The owners of a national telehealth company pleaded guilty this week to charges of conspiracy to violate the federal Anti-Kickback Statute and to commit healthcare fraud. Law enforcement agencies have ramped up the pressure on telehealth fraud, particularly amid the COVID-19 pandemic. According to a statement released by the U.S.

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HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. 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, and $6.4

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Healthcare IT News - Telehealth

DECEMBER 13, 2021

The bill, the Telehealth Extension Act , would also end geographic and site restrictions on approved telemedicine services for Medicare beneficiaries. Despite being broadly popular on both sides of the aisle , the geographic- and site-related Medicare provisions the new bill would establish have yet to be enshrined by Congress.

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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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The Health Law Firm Blog

JUNE 10, 2023

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D., The doctor argued that the [.]

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The Health Law Firm Blog

MARCH 16, 2022

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D., The doctor argued that the.

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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. This year, 50% of Medicare enrollees are expected to sign up for Medicare Advantage.

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Innovaare Compliance

JULY 19, 2024

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

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The Health Law Firm

FEBRUARY 14, 2022

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D.,

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Hall Render

MARCH 12, 2025

Background of the Case Relator Rosales filed a qui tam action in June 2020 against a hospice care provider and its subsidiaries, alleging fraudulent conduct aimed at securing payments from Medicare and Medicaid. Instead, courts must review all properly filed claims and assess each claim individually.

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Healthcare Compliance Blog

FEBRUARY 15, 2022

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. Whistleblowers filed 598 qui tam suits in fiscal year 2021, which resulted in $1.6 More than $5.6 Total recovery now totals more than $70 billion.

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Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

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Healthcare IT News - Telehealth

JANUARY 30, 2023

While it made "significant" changes to the Medicare Benefits Schedule (MBS), the expanded telehealth services were "only partly supported by sound implementation arrangements." In late 2021, the Health Ministry announced that the government has set aside funding to make the subsidised telehealth items permanent.

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HIPAA Journal

MARCH 30, 2022

Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. the Transactions and Code Sets Rule) and address abuse and fraud in the health care industry to reduce costs to health insurance providers. 7 Billion Lost Each Year to Fraud.

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Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. This year’s 129-page report also includes information about the amounts deposited and appropriated to the Medicare Trust Fund, as well as the source of such deposits. Monetary Penalties. Of this $1.9

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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.

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Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. Over $5 billion of the total amount recovered in 2021 was related to the healthcare industry. government or a government contractor.

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HIPAA Journal

SEPTEMBER 29, 2022

Humana has recently announced that the protected health information of 22,767 individuals has potentially been compromised in a security incident and data breach at one of its business associates – Choice Health – which Human used to sell Medicare products on its behalf.

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Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. In October 2021, the California Department of Justice’s?Division

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HIPAA Journal

MARCH 25, 2022

The forensic investigation revealed the email accounts were accessed by unauthorized individuals between April 7, 2021, and June 2, 2021. AHA provided notice about the attack on January 6, 2021. UMC was a victim of a REvil ransomware attack in June 2021 that resulted in the theft of the protected health information of 1.3

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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. Billing Medicare or Medicaid for services that were not provided is fraudulent activity that is often punishable by fines and imprisonment.

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Healthcare IT News - Telehealth

APRIL 18, 2022

PPOA is also accused of allegedly submitting or causing the submission of false claims to Medicare by billing for qualitative and quantitative urine drug testing in violation of the physician self-referral law. Concerns of fraud have dogged conversations around telehealth expansion beyond the public health emergency.

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Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

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Compliancy Group

DECEMBER 20, 2024

Read the Fine(s) Print: On August 25, 2021, OCR submitted a data request providing an opportunity for PMI to adequately demonstrate that it had recognized security practices in place. PMI responded to OCRs data request on October 6, 2021. In late November of 2021, a ransomware infection began to encrypt files on BCAAs network.

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The Health Law Firm

APRIL 11, 2022

Board Certified by The Florida Bar in Health Law On February 28, 2022, ten (10) Florida residents were charged in an indictment in the US District Court for the Southern District of Florida for their alleged roles in a $67 million health care fraud, wire fraud, kickback, and money laundering scheme. Indest III, J.D.,

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Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). This year’s report also shows greater participation from managed care organizations (MCOs) as a key trend.

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HIPAA Journal

OCTOBER 6, 2022

Mon Health is facing a class action lawsuit over a hacking incident that allowed unauthorized individuals to gain access to its network for an 11-day period in December 2021. Mon Health said it detected the breach on December 30, 2021, with the forensic investigation determining hackers accessed its network between December 9 and December 19.

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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

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The Health Law Firm Blog

JUNE 1, 2023

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. By George F. Indest III, J.D.,

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The Health Law Firm Blog

MARCH 7, 2022

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. By George F. Indest III, J.D.,

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The Health Law Firm Blog

JANUARY 24, 2022

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. By George F. Indest III, J.D.,

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Health Care Performance

JULY 20, 2022

A New York ENT physician was convicted of filing false claims with Medicare and Medicaid. The physician submitted claims totaling about $585,000 to Medicare and Medicaid and was paid roughly $191,000. Mole billing fraud scheme totals $4.1 million in fraudulent payments between 2015 and 2021. That is how you collect $4.1

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Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors? Department of Justice (DOJ), the U.S.

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The Health Law Firm Blog

FEBRUARY 10, 2023

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] By George F. Indest III, J.D.,

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Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

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HIPAA Journal

DECEMBER 30, 2022

Fertility Centers of Illinois has proposed a $450,000 settlement to resolve a lawsuit filed on behalf of patients and employees who were affected by its February 2021 data breach. The investigation of the breach took six months, but it then took a further four months for affected individuals to be notified.

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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.

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