Hall Render

MARCH 24, 2025

government for false or fraudulent claims submitted for federal reimbursement. Under federal law, the public disclosure bar prohibits a relator from bringing an FCA lawsuit based on fraud that has already been disclosed through certain public channels. The government investigated the allegations and declined to intervene in the suit.

Fraud 52

Fraud Governance 52

Healthcare IT News - Telehealth

JANUARY 27, 2021

Department of Justice announced Monday that four people and one company have recently pleaded guilty in a telemedicine pharmacy healthcare-fraud conspiracy that allegedly lasted for years. "Telemarketing fraud is a major threat to the integrity of government and commercial insurance programs," said Derrick L.

Fraud 176

Fraud Telemedicine Ransomware COVID-19 176

Healthcare IT News - Telehealth

APRIL 10, 2019

Hundreds of thousands patients were lured into worldwide criminal healthcare fraud schemes involving telemedicine and durable medical equipment (DME) executives, according to the FBI and Department of Justice. WHY IT MATTERS. billion in losses. ON THE RECORD.

Fraud 167

Fraud Telemedicine Medicare Medicare 167

American Medical Compliance

MARCH 6, 2025

Fraud, Waste, and Abuse (FWA) remain critical challenges in the healthcare industry, impacting patient care, financial integrity, and regulatory compliance. What you’ll learn Common types of fraudulent activities Applicable laws governing FWA Details Course length: 35 minutes, CME: 0.5.

Fraud 52

Fraud Medicare Medicare Compliance 52

AIHC

FEBRUARY 17, 2025

When Audit Managers Knowingly Skew Audit Results Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. on fraud detection and prevention in healthcare. median loss.

Fraud 52

Fraud Compliance Overpayments Overpayment 52

Compliancy Group

JANUARY 23, 2025

The federal False Claims Act prohibits someone from knowingly presenting or causing a false claim for payment if the federal government will pay for that claim. A classic example is Medicare fraud. The DOJ has focused much of its anti-fraud efforts on pursuing these cases, litigating several of them in 2024. While the $1.67

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

Fierce Healthcare

FEBRUARY 15, 2024

Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months. ACOs could face lasting financial difficulties because of a recent, alleged $2 billion Medicare catheter fraud scheme.

Fraud 126

Fraud Medicare Medicare Governance 126

HIT Consultant

JUNE 6, 2024

Healthcare fraud is a significant issue in the U.S. the cost of healthcare fraud in the country is close to $100 billion a year. Recent advances in technology are now enabling government agencies to be more effective in their efforts to detect and prevent healthcare fraud. According to the U.S.

Fraud 94

Fraud Medicare Medicare Governance 94

HIPAA Journal

MARCH 16, 2022

This is the first settlement to be reached under the DOJ Civil Cyber Fraud Initiative, which was launched in 2021. We will continue to ensure that those who do business with the government comply with their contractual obligations, including those requiring the protection of sensitive government information.”. “We

Fraud 123

Fraud Electronic Medical Records Governance HIPAA 123

Healthcare IT Today

JUNE 2, 2023

With those competing priorities, fraud prevention does not always make its way to the top of the list of considerations, even when it should. According to the National Health Care Anti-Fraud Association, fraud costs the U.S. healthcare industry more than $50 billion each year. What Exactly is KYP?

Fraud 111

Fraud Ransomware Licensing Governance 111

HIT Consultant

OCTOBER 18, 2021

Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud. The second type, indirect fraud, involves several bad actors that coordinate their efforts.

Fraud 98

Fraud COVID-19 Public Health Medicare 98

Fierce Healthcare

SEPTEMBER 19, 2024

Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower | A newly unsealed lawsuit alleges major health insurers and health systems defrauded Indiana Medicaid by hundreds of millions of dollars, with the government (..)

Medicaid 136

Medicaid Medicaid Fraud Hospitals 136

HIT Consultant

JANUARY 5, 2025

government alleged that between January 2017 and November 2022, Meditelecare submitted claims to Medicare for telehealth psychotherapy sessions that did not meet the minimum time requirements for reimbursement. The settlement was announced today by U.S. Attorney Michael A. Bennett of the Western District of Kentucky. – The U.S.

Medicare 52

Medicare Medicare Fraud Governance 52

Fierce Healthcare

AUGUST 27, 2024

A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars—only to abruptly back off amid an “uproar” fr | Filings and testimonies in a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group outline industry pressure that led the (..)

Medicare 131

Medicare Medicare Fraud Governance 131

HIT Consultant

DECEMBER 10, 2021

What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Report Background.

Fraud 98

Fraud COVID-19 Nurses Licensing 98

Healthcare Dive

JUNE 10, 2024

From 2020 to 2022, CityMD falsely documented insured patients as uninsured before fraudulently billing the federal government for their COVID-19 care, according to regulators. CityMD denies the allegations.

COVID-19 110

COVID-19 Fraud Governance 110

Healthcare IT News - Telehealth

JANUARY 30, 2023

FINDINGS Based on the state audit , the department fell short in governance, risk management, and evaluation of the telehealth expansion. It also did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, before implementing the temporary and permanent MBS telehealth items.

COVID-19 187

COVID-19 Governance Medicare Medicare 187

Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. Some denials result from noncompliance with federal fraud, waste, and abuse laws. Such noncompliance can result in non compliance fines.

Fraud 52

Fraud Compliance Medicare Medicare 52

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 72

Fraud Medicare Medicare Overpayments 72

Hall Render

MARCH 12, 2025

Although the government declined to intervene, Byers and other relators filed a joint amended complaint on October 26, 2021, asserting five FCA claims, including one under the Anti-Kickback Statute. This decision ensures that whistleblowers can still bring new and distinct allegations of fraud even if similar cases were filed previously.

Fraud 52

Fraud Governance Medicaid Medicaid 52

Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Secure your success by choosing Verisys.

Fraud 52

Fraud Telemedicine Licensing Compliance 52

Healthcare IT Today

MARCH 27, 2025

Without strict governance, AI tools could inadvertently violate HIPAA and other healthcare privacy laws, placing patient confidentiality at riskmissteps that are not easily forgiven. The Risks: Ethics, Bias, and Compliance Challenges AI’s role in healthcare is evolving, but so are its associated challenges.

Governance 64

Governance Compliance HIPAA Regulatory Compliance 64

Healthcare IT News - Telehealth

SEPTEMBER 12, 2024

Queensland to pilot telestroke service at Hervey Bay Hospital The Queensland government has designated Hervey Bay Hospital as the pilot site for the upcoming statewide telestroke service. The state government has committed A$5.8 The InterSystems integration also allows didgUgo to leverage AI for fraud prevention. million ($3.8

Doctors 162

Doctors Governance Fraud Hospitals 162

Compliancy Group

APRIL 8, 2024

The complex nature of the healthcare industry calls for a robust framework to ensure governance, mitigate risks, and maintain compliance with various regulations. Let’s delve into Healthcare Governance Risk and Compliance (GRC) and explore its significance, key components, and the imperative role it plays in safeguarding the health industry.

Governance 52

Governance Compliance Regulatory Compliance Fraud 52

HIT Consultant

DECEMBER 18, 2024

Identity theft, fraud, and long-term financial harm are just a few examples of the personal fallout patients may face following a data breach. He is among the top thought leaders in Cyber Security and has participated in various policy programs with Government of India and other industry bodies.

Ransomware 105

Ransomware Fraud Doctors HIPAA 105

The Health Law Firm

MARCH 14, 2022

Board Certified by The Florida Bar in Health Law On March , 2022, a New York ophthalmologist was sentenced to 96 months in prison for fraudulently obtaining two government-guaranteed small business loans and for a seven-year fraudulent healthcare billing scheme, the Justice Department announced. Indest III, J.D.,

COVID-19 98

COVID-19 Fraud Governance Doctors 98

Hall Render

MARCH 11, 2025

The magnitude of harm : While the government was harmed, the actual damages were quantifiable at $2.75 Government fraud enforcement remains aggressive : Despite this ruling, health care providers should continue prioritizing compliance with Medicare and Medicaid billing regulations.

Medicare 52

Medicare Medicare Governance Fraud 52

Healthcare IT News - Telehealth

AUGUST 11, 2021

Grimm: "It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse or misuse." "This is going to be a whole-of-government and whole-of-industry approach," he added. billion, with a B, of alleged fraud.

US Department of Health and Human Services 167

US Department of Health and Human Services Fraud Medicare Medicare 167

Total Medical Compliance Resources

MAY 11, 2023

trillion is spent on healthcare in the United States, of which an estimated $60 billion is attributable to fraud and abuse. In order to combat this, HIPAA established the Healthcare Fraud and Abuse Control Program (HCFAC). Criminal Health Care Fraud Statute – 18 U.S.C. Every year a minimum of $4.3

Fraud 59

Fraud HIPAA Medicare Medicare 59

American Medical Compliance

FEBRUARY 21, 2025

American Medical Compliance , known for its high-quality, government-approved compliance training, reaffirmed its commitment to assisting healthcare organizations in meeting international regulatory and accreditation standards.

Compliance 71

Compliance ADA Governance Medical Billing 71

HIPAA Journal

AUGUST 31, 2022

HC3 warns that Evil Corp may conduct attacks at the request of the Russian government, including attacks that steal intellectual property, and members of the group are known to cooperate with the Russian intelligence agencies.

Ransomware 143

Ransomware Fraud Governance Public Health 143

AIHC

FEBRUARY 24, 2025

Part 2: When Criminal Behavior Infiltrates Your Audit Program Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) We Recommend Reading Part 1 Fraud Indicators and Red Flags When Audit Managers Knowingly Skew Audit Results as this article is Part 2, the rest of the story.

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Healthcare IT News - Telehealth

JULY 16, 2020

Though interstate licensure is a hot-button issue for providers who care for patients in other states, he said it's more likely that the federal government will work closely with state medical associations on a path forward there.

COVID-19 178

COVID-19 Medicare Medicare Governance 178

Bill of Health

AUGUST 2, 2022

However, characteristics that make UBI attractive, particularly the direct support it provides, sans bureaucratic red tape, can be applied to other government programs. The government could directly provide all citizens with food or, more simply, with nutrients. With UBNI, government funds are only used for required nutrients.

Governance 147

Governance COVID-19 Fraud Public Health 147

Healthcare IT Today

SEPTEMBER 21, 2022

New types of fraud are continually emerging, and it’s also become harder to uncover with traditional approaches. The telehealth market is growing at a significant rate, and fraud is continuing to grow with it. This kind of fraud isn’t new, but the explosion in telehealth as a whole has made it much more common.

Fraud 61

Fraud COVID-19 Medicare Medicare 61

Health Law Attorney

NOVEMBER 22, 2024

Unlike the 2000 guidance, which largely centered on fraud prevention, the new ICPG places quality of care and resident safety at the forefront. This shift reflects OIG’s recognition of the direct relationship between care quality and compliance.

Nurses 52

Nurses Compliance Fraud Governance 52

Compliancy Group

DECEMBER 15, 2023

Differentiating Fraud, Abuse, and Waste Detecting and stopping fraud, abuse, and waste rely on distinguishing these behaviors in the healthcare context. What is Healthcare Fraud? Providers commit Medicare and Medicaid fraud when they knowingly submit or contribute to the submission of a false claim for financial gain.

Fraud 52

Fraud Medicaid Medicaid Medicare 52