The Health Law Firm Blog

JUNE 10, 2023

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Indest III, J.D., 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 The doctor argued that the [.]

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The Health Law Firm Blog

NOVEMBER 29, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

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The Health Law Firm Blog

DECEMBER 19, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

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The Health Law Firm Blog

OCTOBER 14, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

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Fraud Medicaid Medicaid Overpayments 52

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 [.] Indest III, J.D.,

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Fraud Health Insurance Overpayments Overpayment 52

The Health Law Firm Blog

NOVEMBER 7, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

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Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

MARCH 16, 2022

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Indest III, J.D., 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 The doctor argued that the.

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Fraud Medicare Medicare Doctors 52

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. Gandle, for her contribution to this blog post. Ensure Ongoing Compliance. 1] The authors would like to thank their former colleague, Lauren F.

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Compliance Due Diligence Fraud Governance 52

Health Care Law Brief

APRIL 12, 2023

405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. Notable Omissions from Proposed Rule CMS declined to adopt previously proposed amendments to the standard for “identified overpayments” under Medicare Parts A, B, C, and D. 3729(b)(1)(A) of the False Claims Act (“FCA”). See Proposed Rule at 79559.

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Medicare Medicare Overpayments Overpayment 52

Provider Trust

JUNE 30, 2023

Maintaining the highest payment integrity standards helps payers avoid unnecessary payments, recover overpayments, and prevent fraud, waste, and abuse (FWA) in healthcare billing. This means payers must rely on post-payment reviews and audits to identify those errors, overpayments, and fraudulent claims.

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Overpayments Overpayment Fraud Compliance 52

Healthcare Law Blog

FEBRUARY 3, 2023

In addition, each MMCO must develop a fraud, waste and abuse prevention plan and submit it to OMIG within 90 days of the effective date of the new rules or upon signing a new contract with the New York State Department of Health to begin participation as an MMCO.

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Medicaid Medicaid Compliance Overpayments 52

The Health Law Firm Blog

JANUARY 8, 2024

This agency investigates allegations of fraud, waste, and abuse of Medicare, Medicaid, and other federally funded healthcare programs. [.] Indest III, J.D., Board Certified by The Florida Bar in Health Law The U.S. Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG).

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YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse. Fraud – Billing for supplies or services that were not given or provided to the patient.

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Health Law Blog

MAY 22, 2018

Substance Abuse Treatment Center Fraud Scheme Results in Guilty Plea. The Department of Justice recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.”

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Fraud Overpayments Overpayment Licensing 52

The Health Law Firm Blog

OCTOBER 14, 2022

This agency investigates allegations of fraud, waste, and abuse of Medicare, Medicaid, and other federally funded healthcare programs. [.]. Indest III, J.D., Board Certified by The Florida Bar in Health Law The U.S. Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG).

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Fraud Medicaid Medicaid Medicare 52

Healthcare Compliance Blog

JUNE 9, 2022

In March of 2022, in a related matter, the man pleaded guilty to Healthcare Fraud, Money Laundering, and Theft of Public Money for defrauding Medicare, Medicaid, and the US Department of Health and Human Services between 2016 and 2020. He is awaiting sentencing on those charges.

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US Department of Health and Human Services Overpayments Overpayment Medicare 59

Healthcare Law Blog

FEBRUARY 9, 2024

Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance. Million To Resolve Health Care Fraud Allegations | United States Department of Justice [3] See Defs.

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Hospitals Compliance Officers Compliance Overpayments 52

Hall Render

DECEMBER 6, 2022

These waivers exempt providers from sanctions for noncompliance with the Stark Law in relation to various types of arrangements (absent the government’s determination of fraud or abuse), including remuneration that exceeds the current non-monetary compensation limit and medical staff incidental benefits amount.

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COVID-19 Hospitals Overpayments Overpayment 40

The Health Law Firm Blog

SEPTEMBER 5, 2023

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The federal Anti-Kickback Statute prohibits remuneration in relation to the provision of a “good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program.” 42 U.S.C. § [.]

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Overpayments Overpayment Fraud Medicaid 52

The Health Law Firm Blog

NOVEMBER 18, 2023

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), and Bureau of Medicaid Program Integrity is the Florida agency responsible for routine Medicaid audits The agency ensures that the Medicaid program was billed correctly for [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

SEPTEMBER 20, 2023

By George F. Indest III, J.D., 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 [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

AUGUST 24, 2023

By George F. Indest III, J.D., 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 [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

APRIL 19, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]

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Malpractice Overpayments Overpayment Licensing 52

The Health Law Firm Blog

JULY 19, 2023

By George F. Indest III, J.D., 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 [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

JUNE 27, 2023

By George F. Indest III, J.D., 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 [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

MAY 16, 2023

By George F. Indest III, J.D., 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 [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

AUGUST 24, 2022

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), and Bureau of Medicaid Program Integrity is the Florida agency responsible for routine Medicaid audits The agency ensures that the Medicaid program was billed correctly for [.].

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

APRIL 21, 2023

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On September 7, 2021, federal prosecutors announced the arrest of a Florida surgeon and owner of device company SpineFrontier Inc on charges of bribing surgeons to use products by paying sham consulting fees. Accused in an indictment in [.]

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Overpayments Overpayment Fraud Medicaid 40

The Health Law Firm Blog

JANUARY 24, 2023

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]

Malpractice 52

Malpractice Overpayments Overpayment Licensing 52

The Health Law Firm Blog

JANUARY 24, 2022

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On September 7, 2021, federal prosecutors announced the arrest of a Florida surgeon and owner of device company SpineFrontier Inc on charges of bribing surgeons to use products by paying sham consulting fees. Accused in an indictment in.

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Overpayments Overpayment Fraud Medicaid 40

Drug & Device Law

AUGUST 24, 2022

If we advertised our blog as being non-drowsy, would that be false advertising? He filed a putative class action based on various state consumer fraud laws, breach of contract, breach of warranty, etc., But the plaintiff had alleged an economic injury of overpayment, so he had standing as far as that goes. We hope not. .

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Fraud Overpayments Overpayment FDA 119