This site uses cookies to improve your experience. To help us insure we adhere to various privacy regulations, please select your country/region of residence. If you do not select a country, we will assume you are from the United States. Select your Cookie Settings or view our Privacy Policy and Terms of Use.
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Used for the proper function of the website
Used for monitoring website traffic and interactions
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Strictly Necessary: Used for the proper function of the website
Performance/Analytics: Used for monitoring website traffic and interactions
Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. This disparity highlights the difficulty in accurately assessing the risks and potential penalties associated with health care fraud violations.
Healthcare fraud, waste, and abuse is a costly problem for both public and private payers. The National Health Care Anti-Fraud Association estimates financial losses due to healthcare fraud could be as much as $300 billion annually. Keep in mind that these are just examples of provider fraud!
Mendez, who was a physician assistant at CCI Therapy Counseling Centers International, was working with a suspended medical license. However, despite his suspended medical license, Mendez continued to treat patients at various mental health clinics in Brownsville, Harlingen, and Pharr, TX. How Often Should You Verify Employee Licenses?
Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.]
Healthcare Fraud Crackdown! With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys.
Licensure actions Disciplinary actions from state medical boards, like suspensions or revoked licenses. Criminal convictions related to healthcare Felonies or misdemeanors involving fraud, patient abuse, or drug-related offenses. Other adverse actions Things like voluntarily giving up a license while under investigation.
Credentialing services perform this verification by contacting primary sources, such as medical schools and licensing boards, to confirm the physician’s education and qualifications. Physician credentialing is required not only for initial hiring but also for obtaining admitting privileges at hospitals or joining a medical practice.
Organizations across the healthcare continuum have experienced several workforce trends that are creating gaps in license monitoring and verifications. In this post, we’ll explore three current challenges impacting the healthcare license and credential verification process. See our Telehealth Credentialing Guide for more information.
Healthcare Fraud Crackdown! Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc. Here is a round up of bad actors: Entity Fraud Cardiac imaging company and founder to pay historic $85M settlement Full Story Genomic Health Inc.
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.
However, this solution comes with its share of compliance risks, especially if interstate licenses are involved. A travel nurse could be hired to work at a hospital located in a state where they are not licensed to practice. For starters, each state has its own process, rules, and regulations for monitoring licensed nurses.
Identifying Compliance Risks in Real Time AI-powered surveillance tools work around the clock, scanning data to catch red flags or suspicious patterns that indicate: Fraud Security threats Regulatory violations Credential discrepancies Take electronic health records (EHRs), for example.
A professional career can take a provider across state lines, and through an evolution of various license types. In order to see the full picture of an individual, the comprehensive whole of each state licensing board across all license types must be searched. Take the process back another step.
Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.].
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.
Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. But what exactly is considered fraud, waste, and abuse? These complaints can trigger an audit. Data Analysis and Trends.
State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment. In Delaware, 26 nursing licenses were revoked when the nurses’ credentials were tied to the scheme. ProviderTrust recommends conducting license verification monthly.
Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,
Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,
Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,
Board Certified by The Florida Bar in Health Law On June 15, 2023, a United States District Judge sentenced a Florida man to 15 years in prison for his role in an HIV prescription drug fraud scheme that amassed more than $230 million in two years. Indest III, J.D.,
The Office of Inspector General (OIG) Monitors and enforces compliance with regulations that prevent fraud, waste, and abuse in healthcare programs. Loss of Licenses or Certifications Depending on their specialties and staff, healthcare organizations must maintain specific licenses and certifications to operate legally.
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?
The NPI does not replace other identification numbers such as a provider’s taxpayer identification number (TIN), Drug Enforcement Administration registration, license number, or Social Security number. Tracking actions to a standardized identifier provides transparency that can identify and impede fraud.
Mandatory exclusions result from serious convictions, including Medicare fraud, patient abuse, and felony healthcare fraud. Permissive exclusions stem from less severe violations, such as defaulting on student loans or losing a healthcare license.
Original source data is more difficult to access, there are more licensed professionals, and verification timelines are getting tighter. In this blog post, Ill lay out the new standard and explain in detail the challenges and trends that are forcing the change. Its forcing a new standard of PSV credentialing.
Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On October 18, 2023, an ex-Navy officer was sentenced to 30 months in prison after he pleaded guilty to conspiracy to commit wire fraud for his role in an [.] Indest III, J.D.,
To learn about a similar case involving a Florida compounding pharmacy, click here to read one of my prior blogs. The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits.
In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.
With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Here is a round up of bad actors: Doctor sentenced to 10 years in prison for unlawfully dispensing controlled substances ( Full Story ) Doctor Convicted for $5.4M
With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Here is a round up of bad actors: Doctor sentenced to 10 years in prison for unlawfully dispensing controlled substances ( Full Story ) Doctor Convicted for $5.4M
Complaints of resident abuse in a Michigan nursing home led to an investigation by the Michigan Office of Attorney General’s Health Care Fraud Division, working with the Michigan Sentinel Project. The investigation determined that a nurse was working at the nursing home while her license was suspended, which is a felony.
Verisys is a trusted partner that ensures the safety of your business from potential risks and guarantees the validation of identities, licenses, and absence of sanctions, exclusions, or debarments within your business network, enabling you to secure your path to success. The post July 2024 Bad Actors Roundup appeared first on Verisys.
Verisys is a trusted partner that ensures the safety of your business from potential risks and guarantees the validation of identities, licenses, and absence of sanctions, exclusions, or debarments within your business network, enabling you to secure your path to success. The post July 2024 Bad Actors Roundup appeared first on Verisys.
Verisys is a trusted partner that ensures the safety of your business from potential risks and guarantees the validation of identities, licenses, and absence of sanctions, exclusions, or debarments within your business network, enabling you to secure your path to success. The post July 2024 Bad Actors Roundup appeared first on Verisys.
Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3 Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Secure your success by choosing Verisys.
Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3 Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Secure your success by choosing Verisys.
Verisys is a trusted partner that ensures the safety of your business from potential risks and guarantees the validation of identities, licenses, and absence of sanctions, exclusions, or debarments within your business network, enabling you to secure your path to success. Attorney Announces $2.5 Attorney Announces $2.5
Verisys is a trusted partner that ensures the safety of your business from potential risks and guarantees the validation of identities, licenses, and absence of sanctions, exclusions, or debarments within your business network, enabling you to secure your path to success. Attorney Announces $2.5 Attorney Announces $2.5
With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Secure your success by choosing Verisys.
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. According to the U.S.
Here is a round up of bad actors: National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 Here is a round up of bad actors: National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 The post June 2024 Bad Actors Roundup appeared first on Verisys.
Here is a round up of bad actors: National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 Here is a round up of bad actors: National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 The post June 2024 Bad Actors Roundup appeared first on Verisys.
Here is a round up of bad actors: National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 Here is a round up of bad actors: National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 The post June 2024 Bad Actors Roundup appeared first on Verisys.
We organize all of the trending information in your field so you don't have to. Join 26,000+ users and stay up to date on the latest articles your peers are reading.
You know about us, now we want to get to know you!
Let's personalize your content
Let's get even more personalized
We recognize your account from another site in our network, please click 'Send Email' below to continue with verifying your account and setting a password.
Let's personalize your content