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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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.

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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.

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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.

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Med-Net Compliance

JULY 20, 2022

According to court documents and evidence presented at trial, the doctor billed Medicare and Medicaid for an incision procedure of the external ear for hundreds of patients, when in fact all he actually performed was an ear exam or ear wax removal. He was convicted of one count of healthcare fraud and one count of making a false claim.

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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.

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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.

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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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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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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.,

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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. Trust is core to the provider-patient relationship.

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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.

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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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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.

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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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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.

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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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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.

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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.

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Healthcare IT Today

DECEMBER 26, 2024

Deepfake technology presents another critical threat, with AI-generated video and voice content enabling unprecedented impersonation attacks. Recent incidents involving fake video calls and voice cloning demonstrate the technology’s potential for sophisticated fraud.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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NY Health Law

JUNE 25, 2019

The unlicensed are not bound by the ethical rules that govern the quality of care delivered by a physician to a patient. The New York Court of Appeals found that the facts presented in the Carothers PC case were very similar to those in State Farm Mut. Larger sums were transferred to Sher. v Mallela , 372 F3d 500, 503 (2d Cir.

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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.

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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?

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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.

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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.

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Healthcare Law Blog

MAY 31, 2022

These advancements, present challenges and raise novel questions as to how the current healthcare and life sciences legal regime would apply to the metaverse. The healthcare system in the United States is governed by an expansive network of state and federal laws, including the aforementioned HIPAA regulations. Healthcare Laws.

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