Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas. The psychologist was convicted of four counts of healthcare fraud.

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Nursing Homes Fraud US Department of Health and Human Services Nurses 59

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. Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud. Update your policies as needed.

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COVID-19 Vaccine COVID-19 Fraud US Department of Health and Human Services 59

MedTrainer

JULY 28, 2023

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. That mean, maintaining compliance standards, efficient reporting, and conducting thorough internal audits are vital.

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Fraud Compliance Medicaid Medicaid 98

Healthcare IT Today

DECEMBER 21, 2023

The following is a guest article by Mitchell Perry, VP Compliance & Security at Access In the ever-evolving landscape of healthcare IT in US healthcare frameworks, integrating electronic health records (EHRs) has become a cornerstone for providers. If healthcare providers fail to comply, the consequences can be costly.

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Records Management Regulatory Compliance Compliance HIPAA 128

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. To become certified, please visit us at: American Medical Compliance (AMC).

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Fraud Medicare Medicare Compliance 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.

Fraud 59

Fraud US Department of Health and Human Services Medicare Medicare 59

Compliancy Group

FEBRUARY 28, 2024

Many industries have compliance rules and regulations to meet and follow, but few would argue that healthcare is one of the most stringent. Privacy and security – Compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient privacy and data security is crucial.

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Compliance US Department of Health and Human Services Fraud Medicare 52

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. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. Since then, the FCA has changed significantly.

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Fraud Medicaid Medicaid Medicare 52

HIPAA Journal

OCTOBER 21, 2022

A pharmaceutical sales rep has pleaded guilty to conspiring to commit healthcare fraud and wrongfully disclosing and obtaining patients’ protected health information in an elaborate healthcare fraud scheme involving criminal HIPAA violations. Alario pleaded guilty to his role in the healthcare fraud scheme earlier this month.

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Fraud HIPAA FDA Health Insurance 63

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

Healthcare Law Blog

NOVEMBER 9, 2023

In late April this year, the Office of Inspector General, Department of Health and Human Services (OIG) announced that it would make changes to its existing body of healthcare compliance program guidance (CPGs) as part of its current Modernization Initiative. [1] On November 6, 2023, OIG finally published the GCPG on its website [3].

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Compliance Compliance Officers Fraud Medicare 52

Compliancy Group

JULY 18, 2024

It’s becoming more well-known that billing is one of the most common compliance risk areas outlined by the Office of the Inspector General (OIG). The occurrence of these issues is consistent, and over time, they can result in thousands of dollars lost in compliance penalties.

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Medical Billing Compliance Fraud Compliance Officers 52

Healthcare Law Blog

MAY 11, 2023

The Department of Health and Human Services Office of Inspector General (OIG) recently announced changes to its process for informing healthcare industry stakeholders of new or updated Compliance Program Guidance (CPG). Historically, sector-specific CPG has been published in the Federal Register.

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Compliance Fraud Nurses Medicare 52

Med-Net Compliance

JULY 26, 2022

In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds. Discussion Points: Review policies and procedures regarding the use of telemedicine within the facility and related requirements for preventing fraud, waste, and abuse of government funds.

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Fraud Telemedicine Medicare Medicare 59

MedTrainer

APRIL 22, 2024

Creating and using a supplier compliance checklist ensures vendors meet regulatory requirements and are trusted partners in managing sensitive information. In this article, I’ll discuss why supplier compliance is as critical as legal and regulatory adherence for healthcare organization employees.

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Compliance HIPAA Licensing Fraud 52

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?

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Fraud US Department of Health and Human Services Medicaid Medicaid 52

AIHC

MAY 24, 2022

Once your suspicions have been reported to the Compliance Officer, were you asked to partake in evidence gathering during the investigation? Forensic investigations are specialized in nature, and the work requires detailed knowledge of fraud investigation techniques and the legal framework.

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Compliance Fraud Compliance Officers HIPAA 52

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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Fraud Medicaid Medicaid Nurses 52

Compliancy Group

OCTOBER 9, 2024

The primary place where healthcare organizations go wrong with their compliance efforts is that their compliance programs are reactive versus proactive. Workforce compliance in healthcare involves a comprehensive approach to establishing certain protocols and guidelines and helps maintain a continuously safe working environment.

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Compliance Compliance Officers HIPAA Fraud 52

Verisys

JUNE 8, 2023

Data Compliance: How to Identify and Close Data Risk Gaps Using Technology A three-part compliance series that focuses on using technology to help you achieve your compliance goals. Hiring a provider with red flags, even if in the past, can put your organization at risk for non-compliance. Fraud Data Gap The U.S.

Compliance 52

Compliance Fraud Licensing Medicare 52

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.

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Fraud Telemedicine COVID-19 Governance 52

Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. Donna Thiel, Chief Compliance Officer at ProviderTrust, said, “It’s an opportunity to promote partnership between HR and compliance.

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Fraud US Department of Health and Human Services Licensing Nurses 52

HIT Consultant

JULY 25, 2024

Presently, many healthcare organizations remain in limbo after the attack, which exposed 6 terabytes of sensitive patient data, without access to important services such as claim processing for prescriptions, and daily workflows around auditing and reporting. With expertise in leading teams and ensuring successful project execution.

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Compliance HIPAA Regulatory Compliance Ransomware 111

Healthicity

SEPTEMBER 30, 2022

The explosion of telehealth since 2020 means auditors, compliance managers, and regulators are scrambling.

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Compliance Fraud Telemedicine 52

Compliancy Group

DECEMBER 11, 2024

Unfortunately, such incidents of fraud happen, which is the reason for the False Claims Act in Healthcare. In civil cases, knowing implies having accurate knowledge and acting with careless indifference or deliberate ignorance when presenting false information. In light of constant cyber threats, the U.S.

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Fraud Medicare Medicare Compliance 52

HIPAA Journal

JANUARY 10, 2023

An external investigation into credit card fraud pointed to Captify Health as the source of a data breach. As an online retailer, Captify Health collects customer information and processes debit/credit card payments through the website.

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HIPAA Doctors Fraud Compliance 112

MedTrainer

SEPTEMBER 20, 2023

Watch this one-demand webinar for insider tips straight from seasoned compliance surveyors. The Joint Commission (TJC) is another national accreditation organization, whereby a healthcare facility that has met Medicare’s requirements and passed a survey can achieve “deemed status.” Compliance. What Is the Scope of a CMS Inspection?

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Medicaid Medicaid Medicare Medicare 97

MedTrainer

SEPTEMBER 5, 2024

In an effort to prevent fraud, the Drug Enforcement Agency (DEA) implemented additional security for their Registrant Validation Toolset. The post DEA Verification Change Resulting in Non-Compliance appeared first on MedTrainer. See how it works in this one-minute video. And then, reach out to MedTrainer to learn more.

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Compliance Fraud Licensing 52

Hall Render

SEPTEMBER 12, 2022

Healthsouth of Sarasota Limited Partnership, et al , the Eleventh Circuit held that for a plaintiff to qualify as engaging in “protected activity,” the plaintiff must demonstrate that they had both a subjectively reasonable belief of fraud and an objectively reasonable belief of fraud. Background. Practical Takeaways.

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Fraud Governance Compliance 40

Verisys

NOVEMBER 20, 2022

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. If you are looking for something to read prior to turkey or afterwards, here is a round up of bad actors: Pharma Fraud: . Pharma Fraud. Pharma Fraud . Pharma Fraud. Fraud Scheme. Fraud Scheme. Fraud Scheme .

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Fraud Medicaid Medicaid Nursing Homes 52

Med-Net Compliance

JULY 13, 2022

Employees and applicants of healthcare facilities must provide truthful information regarding their vaccination status and understand the penalties for engaging in fraud. Participating in the fraud can result in the person(s) being prosecuted.?. Update your policies as needed.

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COVID-19 Vaccine US Department of Health and Human Services COVID-19 Fraud 59

HIPAA Journal

JANUARY 12, 2023

Despite the challenges of compliance and the gaps in HIPAA , the legislation has provided many benefits for healthcare organizations, healthcare professionals, patients, and health plan members. Before the introduction of HIPAA, healthcare fraud was rife and was costing the healthcare industry around $7 billion a year.

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HIPAA Compliance Fraud COVID-19 97

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. OIG may exclude the provider if certain circumstances regarding the ownership are present. However, healthcare receives federal funding, and thus OFAC is an additional sanction list that you should add to your vendor compliance plan/program. Case Study: S. Martino-Fleming v.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Hall Render

NOVEMBER 25, 2024

Department of Health and Human Services (“HHS”) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (“Nursing Facility ICPG”) for nursing home members of the health care compliance community. On November 20, 2024, the Office of Inspector General (“OIG”) for the U.S.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. The risk categories are described as follows: Highest Risk—Exclusion: Parties that the OIG determines present the highest risk of fraud will be excluded from Federal healthcare programs to protect those programs and their beneficiaries.

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Fraud Compliance Medicare Medicare 59

Compliancy Group

JUNE 3, 2024

Not only will a well-structured incident tracking and reporting system help your organization remain in compliance with Occupational Safety and Health Administration (OSHA) regulations , but it will also help you reach resolutions more quickly. The way to enhance your success with compliance changes is the way you host your policies.

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Compliance Compliance Officers HIPAA Fraud 59

Hall Render

SEPTEMBER 15, 2022

This study comes on the heels of a recent Press Release issued July 20, 2022 (“Press Release”), in which the Department of Justice (“DOJ”) announced criminal charges against 36 defendants in 13 federal districts across the United States largely alleging fraud in the telemedicine space. Inspector General Christi A.

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Telemedicine Fraud Medicare Medicare 40