Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Fraud Medicare Medicare US Department of Health and Human Services 52

Compliancy Group

AUGUST 23, 2023

In a shocking turn of events, a dental office manager from Worcester has been sentenced for participating in a scheme to defraud the Massachusetts Medicaid program, MassHealth. He was sentenced to 18 months in prison and one year of supervised release on August 10, 2023. Senior District Court Judge Timothy S.

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Fraud Medicaid Medicaid Governance 52

Med-Net Compliance

SEPTEMBER 20, 2022

The defendant was also convicted for falsification of records designed to prevent detection of this fraud and aggravated identity theft for falsely corresponding with Medicare under the name of another physician. Million Healthcare Fraud Scheme appeared first on Med-Net. He is scheduled to be sentenced on Jan.

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Fraud US Department of Health and Human Services Medicare Medicare 59

HIPAA Journal

APRIL 27, 2023

The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.

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Medicare Medicare Medicaid Medicaid 106

MedTrainer

JANUARY 10, 2024

It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. The OIG is making major investments to systematically detect and prosecute fraud. It may seem a little early to do some spring cleaning, but not when it comes to compliance!

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Compliance Fraud HIPAA Compliance Officers 94

Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

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Fraud Medicare Medicare Compliance 52

HIPAA Journal

MARCH 6, 2023

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required the Centers for Medicare and Medicaid Services (CMS) to remove Social Security numbers from all Medicare cards as part of an effort to prevent fraud, combat identity theft, and safeguard taxpayer dollars and replace them with Medicare Beneficiary Identifiers.

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Healthcare Law Blog

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1]

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Medicaid Medicaid Compliance Overpayments 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. As Medicare Advantage continues to grow, the risk of provider-level fraud will also increase.

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Fraud Medicare Medicare US Department of Health and Human Services 52

HIPAA Journal

JUNE 28, 2023

Individuals that have suffered identity theft, medical fraud, tax fraud, other forms of fraud, and other actual misuses of their personal information, can submit claims for documented, unreimbursed extraordinary losses that are reasonably traceable to the data breach of up to a maximum of $5,000. A lawsuit – Young, et al.

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Hospitals Fraud Licensing HIPAA 87

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

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Fraud Medicare Medicare Compliance 52

HIPAA Journal

MARCH 21, 2023

During that time they exfiltrated files that contained sensitive patient data, including names, contact information, Social Security number, Medicare/Medicaid IDs, health information, and health insurance information.

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Fraud Health Insurance Medicaid Medicaid 113

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Moderated by David S.

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The Health Law Firm Blog

SEPTEMBER 20, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

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Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

AUGUST 24, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

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Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

JULY 19, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

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Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

JUNE 27, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

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Medicaid Medicaid Overpayment Overpayments 52

The Health Law Firm Blog

MAY 16, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.] Indest III, J.D.,

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Medicaid Medicaid Overpayment Overpayments 52

HIPAA Journal

JULY 4, 2023

Murfreesboro Medical Clinic & SurgiCenter (MMC) in Tennessee has recently confirmed that the protected health information of more than half a million patients was compromised in what it describes as “a series of attacks on our network and IT systems,” which were discovered on or around April 24, 2023.

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Medicaid Medicaid Health Insurance Licensing 81

Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes, which went into effect on January 1, 2023, are designed to ensure health plans are accurately reporting their costs and that they are not overcharging the government.

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Medicaid Medicaid Medicare Medicare 52

HIPAA Journal

JANUARY 23, 2024

Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors. Balwani was convicted of conspiracy to commit wire fraud against Theranos’s patients and investors and was sentenced to 12 years and 11 months in prison.

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Fraud FDA Medicaid Medicaid 82

Medisys Compliance

JANUARY 30, 2023

Medicare and Medicaid: Medicare and Medicaid are government-funded healthcare programs that provide coverage to millions of Americans. These can include additional privacy and security requirements, as well as laws related to medical billing and coding , fraud and abuse, and other issues.

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HIPAA Journal

APRIL 25, 2023

Santa Clara Family Health Plan Confirmed as Victim of Clop GoAnywhere Hack Santa Clara Family Health Plan has confirmed the 276,993-record data breach reported to the HHS’ Office for Civil Rights on March 30, 2023, was due to the hacking of Fortra’s GoAnywhere MFT solution by the Clop ransomware group.

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Health Insurance Public Health Ransomware Fraud 95

Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. To combat this fraud, waste, and abuse, the OIG introduced a three-part plan called the PRO framework to guide the oversight of nursing homes.

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Compliance Nursing Homes Nurses Fraud 52

C&M Health Law

SEPTEMBER 11, 2023

On September 1, 2023, the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (“CMS”) issued a much anticipated and contested proposed rule that seeks to establish minimum staffing level requirements for nursing homes. The 2001 recommendation of 4.1 HPRD consisted of 0.75 2] Id.

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Nursing Homes Nurses Medicaid Medicaid 98

Innovaare Compliance

OCTOBER 6, 2022

According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. And, in 2023, there will be more enrollees in MAPD than in original Medicare. Another highly anticipated change to begin on January 1, 2023 pursuant to the IRA is the $35 cap per month on out-of-pocket costs to Medicare beneficiaries.

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Medicare Medicare Compliance Public Health 52

Healthcare IT Today

MARCH 26, 2023

Malware attacks targeting cloud-based applications (as opposed to the web) increased from 38% of all attacks in March 2022 to 42% in February 2023 – albeit down from a high of 50% in November – according to the latest Netskope Threat Labs Report. Among all physicians, pay actually decreased 2.4% from 2021 to 2022.

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Doctors Fraud Medicaid Medicaid 81

HIPAA Journal

JANUARY 30, 2023

This will be followed by the preconference basic training day on March 2, 2023. Advance registration is required and there are Early Bird Discounts available to HIPAA Journal readers who are able to register for the event before February 3, 2023.

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US Department of Health and Human Services HIPAA Compliance Medicaid 85

The Health Law Firm Blog

FEBRUARY 8, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

The Health Law Firm Blog

JANUARY 18, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

The Health Law Firm Blog

DECEMBER 28, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] By George F. Indest III, J.D.,

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Medicare Medicare Fraud Governance 52

The Health Law Firm Blog

JANUARY 4, 2024

On November 6, 2023, the U.S. By Michelle E. Missigman, J.D. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), released 91 pages of "General Compliance Program Guidance" (GCPG) on its website. This is the first compliance program guidance the OIG has released since 2008.

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Compliance Fraud Medicaid Medicaid 52

Healthcare Law Blog

FEBRUARY 1, 2023

As we approach the middle of the first quarter of 2023, private equity firms have continued to demonstrate their interest in investing in digital health. The following serves as a broad overview of recent policy updates and areas of opportunity in 2023. from 2023 to 2030.

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Electronic Medical Records Medicare Medicare COVID-19 52

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. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

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. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

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Fraud Compliance Health Insurance Medicaid 52

Health Law Advisor

APRIL 13, 2023

On March 22, 2023, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) updated its Frequently Asked Questions (“FAQs”), drafting 13 FAQs aimed at easing the transition from COVID-era flexibilities to the end of the Public Health Emergency (“PHE”) on May 11, 2023.

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