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.

Fraud 52

Fraud Compliance Overpayments Overpayment 52

HIT Consultant

OCTOBER 10, 2024

Donna Migoni Executive Managing Director, Medicaid Enterprise Services at Maximus More than 75 million people access comprehensive and cost-effective care through Medicaid, including low-income families, older adults, and individuals with disabilities or chronic conditions. 1) Analyze and prioritize. 4) But don’t forget the data.

Medicaid 105

Medicaid Medicaid Governance Fraud 105

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

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Nursing Homes 59

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Compliance 59

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. Medicare, Medicaid, and private health insurers suffered losses of more than $4.7

Medicaid 101

Medicaid Medicaid Medicare Medicare 101

Hall Render

MARCH 12, 2025

Background of the Case Relator Rosales filed a qui tam action in June 2020 against a hospice care provider and its subsidiaries, alleging fraudulent conduct aimed at securing payments from Medicare and Medicaid. The central issue before the Fourth Circuit was whether this dismissal was warranted.

Fraud 52

Fraud Governance Medicaid Medicaid 52

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 News - Telehealth

JULY 16, 2020

Now, the question becomes : How many of those changes, particularly regarding temporary waivers issued by the Centers for Medicare and Medicaid Services, will become permanent?

COVID-19 177

COVID-19 Medicare Medicare Governance 177

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

Fraud 107

Fraud Medicaid Medicaid Doctors 107

Med-Net Compliance

JULY 11, 2022

The report says that in FY 2021 the DOJ opened 831 new criminal healthcare fraud investigations. Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, and a total of 312 defendants were convicted of healthcare fraud related crimes during the year. 2,947 investigations were pending at the end of FY 2021.

Fraud 59

Fraud Compliance Medicaid Medicaid 59

Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. Court documents show that between 2008 and 2016 the former owner defrauded the Texas Medicaid program by billing for items and services that had not been provided to the clients of the day care centers. US Attorney Ashley C.

Fraud 59

Fraud Governance Compliance Medicaid 59

Compliancy Group

NOVEMBER 1, 2024

When you work in healthcare, you must comply with the most rigorous regulations that safeguard patient health and privacy, protect workers, and prevent fraud, waste, and abuse of federal funds. Anyone in this industry should know the healthcare compliance laws and regulations that guide how they do their jobs and provide quality care.

Compliance 52

Compliance HIPAA Electronic Medical Records Fraud 52

Healthcare IT News - Telehealth

AUGUST 11, 2021

Andrew Vanlandingham, senior counselor for Medicaid Policy and acting health IT lead at OIG, called attention to recent revisions to safe harbors under the Anti-Kickback Statute and Civil Monetary Penalty Rules around coordinated care. "This is going to be a whole-of-government and whole-of-industry approach," he added.

US Department of Health and Human Services 167

US Department of Health and Human Services Fraud Medicare Medicare 167

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

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

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. Abuse of government healthcare programs is a federal offense with severe penalties. government or a government contractor.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

The Health Law Firm

MARCH 5, 2012

The Medicaid Fraud Control Unit is a division of the Florida Office of the Attorney General charged with investigating and prosecuting health care providers suspected of defrauding the state's Medicaid program.

Fraud 40

Fraud Medicaid Medicaid Governance 40

Compliancy Group

OCTOBER 28, 2024

Health and Human Services (HHS) Department’s efforts to eliminate fraud, waste, and abuse. Although not intended to address all areas of compliance, the ICPG for nursing facilities is based on voluntary, self-monitored efforts to reduce the risk of fraud, waste, and abuse specific to this healthcare sector.

Nurses 52

Nurses Compliance Nursing Homes Compliance Officers 52

Compliancy Group

DECEMBER 15, 2023

Unfortunately, some Medicare and Medicaid funds are lost to fraudulent and wasteful behaviors. Knowing how to detect, report, and prevent inappropriate use of funds associated with the Centers for Medicare and Medicaid Services (CMS) is essential. What is Healthcare Fraud? taxpayers over $100 billion annually.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Healthcare Law Blog

JUNE 9, 2023

We have seen a growing trend of the government adding aggravated identity theft in healthcare fraud cases. In Dubin , petitioner was responsible for submitting a fraudulent Medicaid reimbursement claim that overstated the qualifications of the employee who performed psychologic testing. See Dubin v. United States.

Fraud 52

Fraud Governance Medicaid Medicaid 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. Prosecutors Evan Panich and Chris Looney from the Health Care Fraud Unit, alongside Special Assistant U.S. Senior District Court Judge Timothy S.

Fraud 52

Fraud Medicaid Medicaid Governance 52

Med-Net Compliance

AUGUST 16, 2022

Five individuals and two for-profit skilled nursing facilities (SNFs) in Pennsylvania were indicted on charges of conspiracy to defraud the United States and related healthcare fraud charges. Billing Medicare or Medicaid for services that were not provided is fraudulent activity that is often punishable by fines and imprisonment.

Fraud 59

Fraud Nurses Medicaid Medicaid 59

Health Law RX

AUGUST 1, 2022

To facilitate the provision of care during the pandemic, the federal government and many state governments enacted changes that encouraged physicians and other nonphysician practitioners (collectively, Practitioners) to use telehealth services. On July 20, 2022, the U.S. Insufficient Physician-Patient Contact.

Fraud 59

Fraud Telemedicine Nurses Governance 59

HIPAA Journal

FEBRUARY 8, 2024

Department of Health & Human Services Office of Inspector General (HHS-OIG) has published a Roadmap for New Physicians on avoiding Medicare and Medicaid fraud and abuse. As a result of dishonest healthcare providers, laws have been created to combat fraud and abuse.

Fraud 40

Fraud Medicaid Medicaid Medicare 40

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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

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

MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds.

Medicaid 59

Medicaid Medicaid Compliance Governance 59

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. Additionally, the Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), announced that it took administrative actions against 52 providers involved in similar schemes.

Fraud 59

Fraud Telemedicine Medicare Medicare 59

HIPAA Journal

MARCH 30, 2022

Had the level of abuse and fraud in the healthcare industry been allowed to continue, tens of billions of dollars would have been lost to unscrupulous actors. However, when HIPAA was passed, the standards governing health care data, patients´ rights, and the flow of information were still several years away. In March 1996, Rep.

HIPAA 137

HIPAA Fraud Health Insurance Health Care Reform 137

Verisys

MARCH 6, 2025

All parties must adhere to both federal and state laws, including those set by governing bodies, and follow ethical standards that safeguard the well-being of patients. The primary governing bodies that set healthcare compliance standards include: The U.S.

Compliance 52

Compliance HIPAA Licensing Governance 52

American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. The Department of Justice recently revealed charges against 78 individuals involved in healthcare fraud schemes.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

HIPAA Journal

MARCH 15, 2023

FHKC receives Medicaid funds and state funds for providing health insurance programs for children in Florida. The contract was renewed by FHKC through 2020, with the federal government covering 86% of the payments to Jelly Bean Communications Design.

Health Insurance 99

Health Insurance HIPAA Fraud Due Diligence 99

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.

Fraud 52

Fraud Medicare Medicare Compliance 52

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] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

Medicaid 52

Medicaid Medicaid Compliance Overpayments 52