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.

Fraud 67

Fraud Medicare Medicare Overpayments 67

Health Law RX

AUGUST 1, 2022

To facilitate the provision of care during the pandemic, the federal government and many state governments enacted changes that encouraged physicians and other nonphysician practitioners (collectively, Practitioners) to use telehealth services. On July 20, 2022, the U.S. Insufficient Physician-Patient Contact.

Fraud 59

Fraud Telemedicine Nurses Governance 59

Compliancy Group

AUGUST 31, 2022

A pair of government contractors recently agreed to settlements of alleged violations of the False Claims Act (FCA) for nearly $10 million as part of the U.S. Department of Justice’s (DOJ) Civil Cyber Fraud Initiative (CCFI). Details of DOJ Cyber Fraud Initiative Settlements. DOJ Cyber Fraud Initiative and the HIPAA Connection.

Fraud 52

Fraud HIPAA Electronic Medical Records Governance 52

HIPAA Journal

OCTOBER 18, 2022

According to the breach report sent to the HHS on October 3, 2022, unauthorized individuals gained access to its email environment which contained patient information. Suspicious email account activity was detected on June 1, 2022, and immediate action was taken to secure the account. Eventus WholeHealth Announces Email Account Breach.

Fraud 114

Fraud HIPAA Health Insurance Governance 114

The Health Law Firm

DECEMBER 4, 2023

At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. Indest III, J.D., He was ordered to pay $187 million in restitution.

Fraud 52

Fraud Medicare Medicare Governance 52

The Health Law Firm

DECEMBER 4, 2023

At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. Indest III, J.D., He was ordered to pay $187 million in restitution.

Fraud 52

Fraud Medicare Medicare Governance 52

AIHC

JUNE 14, 2024

Understanding Elder Abuse and Financial Exploitation Statutes The federal government, states, commonwealths, territories and the District of Columbia all have laws designed to protect older adults from elder abuse and guide the practice of adult protective services agencies, law enforcement agencies, and others.

Fraud 52

Fraud Elder Abuse Governance Compliance 52

The Health Law Firm

AUGUST 18, 2022

Board Certified by The Florida Bar in Health Law On August 12, 2022, a doctor acquitted in a $85 million Medicare fraud scheme filed a motion in the US District Court for the Eastern District of New York requesting prosecutors cover the legal fees and expenses she incurred. Indest III, J.D.,

Fraud 52

Fraud Doctors Medicare Medicare 52

HIPAA Journal

MARCH 30, 2023

The report, a collaboration between Health-ISAC and Booz Allen Hamilton Cyber Threat Intelligence (CTI), identified the key threats to the healthcare sector and is based on responses to a November 2022 survey of executives across Health-ISAC, CHIME, and the Health Sector Coordinating Council.

Ransomware 109

Ransomware Fraud Governance Medical Billing 109

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

Healthcare IT Today

FEBRUARY 9, 2024

A 2022 Deloitte survey of U.S. government and leading medical associations call upon stakeholders to do their part. Yet due to their complex nature, health payers, third-party administrators, government agencies, and pharmacy benefits managers focus most of their constrained resources on auditing professional claims.

Fraud 124

Fraud Governance Hospitals Licensing 124

Compliancy Group

MARCH 30, 2023

The 2022 Internet Crime Report has revealed alarming statistics about the rampant rise in cybercrime, making it more critical than ever to be aware of the dangers and take necessary precautions. 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

Ransomware 52

Ransomware Fraud HIPAA Compliance 52

HIPAA Journal

JUNE 8, 2023

Alvaria explained that the ransomware attack occurred on November 28, 2022, and steps were immediately taken to contain the attack and prevent further unauthorized access to its network. The post Alvaria Confirms November 2022 Hive Ransomware Attack appeared first on HIPAA Journal.

Ransomware 52

Ransomware Fraud HIPAA Health Insurance 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

HIPAA Journal

MARCH 24, 2022

The Conti gang favored targets in critical manufacturing, commercial facilities, and the food and agriculture sectors, LockBit most frequently attacked healthcare and public health, government facilities, and financial services, and REvil targeted healthcare and public health, financial services, and the information technology sectors.

Ransomware 137

Ransomware Public Health Fraud HIPAA 137

Med-Net Compliance

OCTOBER 21, 2022

The Office of Inspector General (OIG) has recently posted the False Claims Act (FCA) settlements for FY 2022 Q1–Q4 on the risk spectrum. The government’s primary civil tool for addressing healthcare fraud is the FCA.

Fraud 59

Fraud Compliance Medicare Medicare 59

HIPAA Journal

AUGUST 2, 2023

Notification letters will be sent to the affected individuals in the coming weeks and credit monitoring, fraud consultation, and identity theft restoration services will be offered. A third-party data review company was provided with the files on December 22, 2022, and provided the results of the analysis to SHS on May 16, 2023.

Licensing 95

Licensing Electronic Medical Records Ransomware Health Insurance 95

Kaiser Health News

APRIL 16, 2024

District Court for the Southern District of Florida, two such call centers paid tens of thousands of dollars a day to buy names of people who responded to misleading advertisements touting free government “subsidies” and other rewards.

ACA 140

ACA Health Insurance Governance Medical Billing 140

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. On April 13, 2022, the U.S. Latest Enforcement Activity.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

HIPAA Journal

DECEMBER 7, 2022

In October 2022, Urology of Greater Atlanta in Georgia reported a data breach to the HHS’ Office for Civil Rights that had affected 79,795 patients. The intrusion was detected on September 5, 2022, and third-party computer specialists were engaged to investigate the nature and scope of the breach.

COVID-19 Vaccine 101

COVID-19 Vaccine COVID-19 Department of Veterans Affairs Licensing 101

Hall Render

SEPTEMBER 15, 2022

On September 2, 2022, the Office of the Inspector General (“OIG”) published a study assessing potential Medicare program integrity risks related to the proliferation of telehealth services during the first year of the COVID-19 pandemic. Government Continues National Crackdown on Telemedicine-Related Fraud. Grimm of the U.S.

Telemedicine 40

Telemedicine Fraud Medicare Medicare 40

Healthcare IT Today

APRIL 25, 2024

For a healthcare entity, the data and information are viewed as extremely valuable as it includes PII as well as other health information that can be used for insurance fraud and identity theft. A large-scale cyberattack, like the Change Healthcare attack, could cost an organization 10 times more than average.

Ransomware 122

Ransomware Compliance Fraud Governance 122

Healthcare Law Blog

FEBRUARY 1, 2022

In the attached article , we highlight some of the key legal considerations that the digital health industry can expect in the coming year from the perspective of: (1) telehealth related laws and regulations, (2) FDA, (3) privacy and cybersecurity, (4) fraud and abuse, and (5) antitrust issues.

Fraud 52

Fraud FDA Governance HIPAA 52

HIPAA Journal

NOVEMBER 21, 2022

million in losses were caused to federal government agencies, private companies, and individuals. He was sentenced to 4 years in jail on September 15, 2022. This coordinated action is a prime example of the commitment that HHS-OIG and our law enforcement partners have to defending the federal health care system against fraud.”.

Medicaid 99

Medicaid Medicaid Medicare Medicare 99

Health Law Checkup

JANUARY 27, 2022

Medicare Advantage plans and providers need to be aware of the recent increase in government enforcement of risk adjustment coding issues. See below for an overview of risk adjustment coding, recent enforcement examples, and five tips for providers to help ensure accurate coding.

Fraud 52

Fraud Compliance Medicare Medicare 52

NY Health Law

JUNE 28, 2024

In a complaint filed on June 13, the government sued LabQ Clinical Diagnostics, Dart Medical Laboratory, Community Mobile Testing, and their CEO, Moshe Landau. In response to the COVID pandemic, Congress mandated that private health insurers cover COVID-19 testing and required government health care programs to also cover such testing.

COVID-19 52

COVID-19 Governance Fraud Health Insurance 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

Health Law Advisor

FEBRUARY 3, 2022

On February 1, 2022, the U.S. FY 2021 was also a record-shattering year for DOJ as it relates to health care fraud enforcement; over $5 billion (90% of the total) was obtained from cases pursued against individuals and entities in the health care and life sciences industries. With collections amounting to $5.6

Fraud 52

Fraud COVID-19 Governance Medicare 52

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. The lawsuit was filed in 2017 by law firms Phillips and Cohen LLP and Downs Rachlin Martin PLLC.

Governance 67

Governance Fraud 67

AIHC

APRIL 5, 2022

Read Part 1 entitled “ Managing Denials Is Important to Good A/R Hygiene ” posted March 22, 2022, and Part 2 entitled “ Understanding How Payers Deny Claims. Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time.

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare Law Blog

DECEMBER 12, 2022

Now, almost three years later, governmental entities have focused their attention on telehealth services and the potential for fraud and abuse. On October 13, 2022 , Health and Human Services (“HHS”) Secretary Xavier Becerra renewed the COVID-19 PHE and the PHE is now set to expire on January 11, 2023. Notable Updates. Looking Forward.

COVID-19 52

COVID-19 Fraud Telemedicine Public Health 52

Healthcare IT Today

JANUARY 2, 2023

Healthcare is the number one type of data hackers set their sites on, and healthcare identity fraud is prevalent. In 2022, convenience is now a patient demand, hackers understand how to take advantage of such virtual practices, and the industry has yet to widely implement the security measures needed to combat these growing threats.

Ransomware 108

Ransomware Fraud Compliance Telemedicine 108

Healthcare IT Today

JANUARY 3, 2023

Judy Jiao, Chief Information Officer at National Government Services. Frauds are detected through analyzing patterns and predicting future behaviors. Reducing fraud? Therefore, data governance and management is essential for data strategy. Is it increasing sales efficiency? Replacing tedious, manual steps?

Governance 100

Governance Fraud Medical Personnel COVID-19 100

Hall Render

FEBRUARY 25, 2022

On February 4, 2022, the Department of Health & Human Services Office of Inspector General (“OIG”) issued Advisory Opinion 22-02 protecting a children’s hospital’s donor-funded charity program (“Proposed Arrangement”). Finally, the Children’s Hospital would use money from the Fund to pay any balance remaining on the bill.

Fraud 40

Fraud Hospitals Medicare Medicare 40

Healthcare Compliance Blog

APRIL 27, 2022

The hearing is scheduled for May 2, 2022. Under the False Claims Act, the government is entitled to three times damages and civil penalties ranging from $5,500 and $11,000 for each identifiable claim submitted between Nov. The court has ordered the parties involved to appear within 30 days for a hearing on the issue of damages.

Medicaid 59

Medicaid Medicaid Compliance Governance 59

Healthcare Compliance Blog

APRIL 13, 2022

The two men, both 51, were convicted of criminal healthcare fraud and conspiracy charges in 2019. On April 7, 2022, a civil complaint was filed against the two men, which alleges that they conspired to violate the False Claims Act by submitting false and fraudulent claims to Medicare for medically unnecessary hospice and home health services.

Fraud 59

Fraud Medicare Medicare Compliance 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. HHS estimated that over 15% of payments in FY 2022 were improper.

Fraud 52

Fraud Medicaid Medicaid Medicare 52