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.

Fraud 52

Fraud Medicare Medicare Compliance 52

The Health Law Firm

AUGUST 20, 2021

is Board Certified by The Florida Bar in Health Law On August 6, 2021, federal prosecutors pushed back on claims that government agents tricked a Harvard University professor into making incriminating statements during his interrogation by federal agents. Indest III, J.D.,

Fraud 45

Fraud Governance 45

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. Therefore, healthcare providers must navigate a myriad of legal requirements and guidelines.

Compliance 95

Compliance Fraud HIPAA Health Insurance 95

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.

Fraud 40

Fraud Governance Compliance 40

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.

Telemedicine 40

Telemedicine Fraud Medicare Medicare 40

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. These status changes will help organizations identify which individuals may be at risk of their license becoming invalid due to the government investigation.

Fraud 52

Fraud US Department of Health and Human Services Licensing Compliance Officers 52

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. But what exactly is considered fraud, waste, and abuse? Risk Assessment. Legislation and Congressional Requests.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Med-Net Compliance

JULY 13, 2022

Two California brothers were both sentenced to 36 months of probation and ordered to pay $500 dollars in restitution after pleading guilty to misdemeanor conspiracy to steal or convert government property charges stemming from the theft of Centers for Disease Control (CDC) COVID-19 Vaccination Record Cards. Update your policies as needed.

COVID-19 Vaccine 59

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

Healthcare Compliance Blog

APRIL 12, 2022

However, instead of forwarding those taxes to the government, she kept them for her business. Additionally, she did not pay the government the employer’s portion of the FICA taxes, federal unemployment tax, employment tax, or state withholdings, which totaled over $1 million. The withheld taxes totaled over $900,000.

Medical Billing 59

Medical Billing Fraud Governance Medicare 59

Healthcare IT News - Telehealth

JANUARY 26, 2022

Healthcare IT News interviewed Griffin to take a closer look at what he will be presenting at the HIMSS22 conference. The evergreen concern about virtual care is that of fraud, waste and abuse and how to balance it with the demonstrated value of extended medical services to patients who are either geographically or economically underserved.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT Today

DECEMBER 21, 2023

However, the transition from traditional paper records to digital formats presents a challenge that extends beyond a simple “scan all” approach. Predominantly, the risk of fraud, theft, or abuse of customer or company information increases, which can cause regulatory violations resulting in significant fines and penalties.

Records Management 119

Records Management Regulatory Compliance Compliance HIPAA 119

Health Law Advisor

APRIL 13, 2023

These FAQs address subjects including “ General Questions Regarding Certain Fraud and Abuse Authorities ,” the “ Application of Certain Fraud and Abuse Authorities to Certain Types of Arrangements ,” and “ Compliance Considerations.” The vast majority of the principles articulated in the updated FAQs will undoubtedly be familiar to many.

Public Health 52

Public Health Fraud COVID-19 Medicaid 52

AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse.

Fraud 52

Fraud Medicare Medicare Compliance 52

HIPAA Journal

OCTOBER 10, 2022

According to the breach notice, a presentation was emailed to the DHS Children’s Long-Term Support Council in April 2021 that contained protected health information. Steps were also taken to recover all distributed copies of the presentation.

Medicaid 58

Medicaid Medicaid Governance Fraud 58

Healthcare Law Blog

JULY 5, 2022

The conference presenters grappled in real-time with the transitory nature of the healthcare landscape today, including the significant role that technology has played in driving shifts in care delivery. Here, we provide an overview of what our healthcare law experts learned at the conference across relevant topic areas: Technology.

Fraud 52

Fraud Governance Ransomware Licensing 52

Health Law RX

JUNE 17, 2022

The FCA imposes civil liability on any person requesting government funds or property who “knowingly presents. A pleading, “alleging fraud or mistake. must state with particularity the circumstances constituting fraud or mistake.” government. government. 3729(a)(1)(A). 9(b) (emphasis added). LLC, 853 F.

Fraud 52

Fraud Governance 52

McGuire Wood

OCTOBER 2, 2023

times the amount the government believed was due to improper billing, after a voluntary disclosure to the Department of Justice (DOJ). If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure.

Fraud 52

Fraud Governance Compliance Medicare 52

HIT Consultant

NOVEMBER 2, 2023

Even the most honest organizations with good-intentioned owners can inadvertently run afoul of the False Claims Act, often due to employee actions or a misinterpretation of government contract obligations. Consequently, businesses should always be ready to handle fraud reports, regardless of their merit.

Governance 52

Governance Compliance Fraud 52

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. Excluded individuals and entities are listed in the OIG’s exclusions database.

Fraud 59

Fraud Compliance Medicare Medicare 59

Hall Render

OCTOBER 18, 2022

Plaintiff alleged that only by misrepresenting the conditions present during the conversion of the manufacturing facility were Defendants able to obtain FDA approval and subsequently provide Gamunex pursuant to contracts with the Veterans Administration, TRICARE, and CMS. Practical Takeaways.

FDA 40

FDA Governance Fraud Compliance 40

Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

Healthcare Law Blog

JUNE 27, 2022

22-07 which evaluated the risk of fraud and abuse under the federal anti-kickback statute (“AKS”) posed by an arrangement involving physician-ownership of a medical device company. The opinion identified six characteristics of the arrangement which greatly reduced the risk of fraud and abuse.

Fraud 52

Fraud Hospitals Medicare Medicare 52

C&M Health Law

AUGUST 3, 2023

Under the new 42 CFR 1003.1580 , OIG may introduce the results of a statistical sampling study as evidence of the number and amount of claims, specified claims, and/or requests for payment that were presented, or caused to be presented by the respondent.

Fraud 52

Fraud HIPAA Governance Compliance 52

HIT Consultant

MAY 2, 2023

Modern NEMT solutions streamline the ride booking and scheduling process, introduce new modalities, improve the overall experience for patients, and decrease fraud, waste and abuse (FWA). In recent years, technology has played a significant role in the advancement of the NEMT industry.

Medicaid 96

Medicaid Medicaid Medicare Medicare 96

Provider Trust

JULY 26, 2022

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. Donna Thiel.

Licensing 52

Licensing Fraud Compliance Nurses 52

Healthcare Law Blog

APRIL 19, 2023

The issue is a significant one for both the government and relators on one side, and potential defendants on the other, as False Claims Act (FCA) liability imposes treble damages and penalties exceeding $20,000 per claim as well as relators’ attorneys’ fees and costs. The Court’s questioning did not signal the likely decision.

Governance 52

Governance Fraud Compliance 52

Health Care Law Brief

JUNE 2, 2022

Therefore, a telehealth platform operating in all 50 states will, for example, need to comport with the laws governing corporate formation, provider licensure, scope of practice, and telehealth encounters in all 50 states. Variety of Risks Present in Telehealth Arrangements. Provider Licenses. How is this disclosed to consumers?

Public Health 52

Public Health Compliance COVID-19 Licensing 52

Healthcare IT Today

OCTOBER 16, 2023

To evaluate the benefits and challenges of each deployment scenario, healthcare organizations should consider risk factors around management, governance, security, and cost to ensure that the right applications move to the cloud at the right time. Data interoperability is a critical component of a hybrid adoption strategy.

Fraud 117

Fraud Governance Compliance Hospitals 117

Healthcare Law Today

DECEMBER 12, 2022

In this episode of Health Care Law Today, Nate Lacktman and Maureen Stewart are joined by Mark Josephs, Deputy General Counsel of LifeMD to discuss the current regulatory and legal environment for telemedicine companies regarding online subscription services, and the recent investigations by the federal government of these services.

Telemedicine 49

Telemedicine Fraud Governance Compliance 49

Hall Render

NOVEMBER 10, 2023

These ICPGs will address fraud and abuse risk areas for each specific industry subsector and compliance measures that can be taken to reduce fraud and abuse risks. OIG plans to periodically update these ICPGs to address newly identified risk areas and compliance measures and to ensure timely and meaningful guidance.

Compliance 40

Compliance Compliance Officers Fraud Governance 40

Health Care Law Brief

FEBRUARY 7, 2022

See e.g. , Advisory Opinion 21-10 as an example of the former, available at Advisory Opinion 21-10 | Office of Inspector General | Government Oversight | U.S. See , e.g. , Advisory Opinion 21-18, available at Advisory Opinion 21-18 | Office of Inspector General | Government Oversight | U.S. at 1368 (emphasis added).

Fraud 52

Fraud Governance Compliance Regulatory Compliance 52

Healthcare IT News - Telehealth

JUNE 8, 2022

While it is important to carefully consider the most effective methods of providing care and the intended purpose behind various reimbursement, privacy, and fraud and abuse regulations, it is also clear that healthcare delivery has always and continues to evolve, and the regulatory framework needs to do the same.

US Department of Health and Human Services 190

US Department of Health and Human Services Compliance COVID-19 Overpayments 190

Healthcare Compliance Blog

FEBRUARY 8, 2022

One example included in the complaint alleges that in November 2016, the pharmaceutical company paid the psychiatrist a $2,000 speaker’s fee for a presentation in Alabama, but the company’s records show there were no attendees. Failure to promptly report a false claim can result in lawsuits, fines, and other sanctions.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

Healthcare Law Blog

MARCH 17, 2022

Like these other AOs, OIG found that while the Proposed Arrangement could generate fraud and abuse risks under both the Federal anti-kickback statute (i.e., Section 1128A(a)(5) of the Act), the Proposed Arrangement nevertheless presented a minimal risk of fraud and abuse under the law on the facts presented.

US Department of Health and Human Services 52

US Department of Health and Human Services Informed Consent Medicare Medicare 52

Provider Trust

JULY 8, 2022

In this quick guide, we’ll explore the importance of including NPDB monitoring in your routine license and exclusion monitoring to protect your organization and the patients you serve from fraud, waste, and abuse. Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S.

Licensing 52

Licensing Malpractice Fraud Compliance 52

Med Law Blog

MAY 1, 2023

As you might expect from a federal investigation, conducted by politicians with media present, the tone of the meeting was more hostile rather than supportive. In March 2023, the House Ways and Means Committee hosted an investigative hearing on “private equity’s expanded role in the US healthcare system”.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52