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

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

The Health Law Firm Blog

FEBRUARY 10, 2023

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] Indest III, J.D.,

Fraud 52

Fraud Health Insurance Overpayment Overpayments 52

Med-Net Compliance

JULY 7, 2022

A federal district judge in Miami sentenced the last of five defendants for his role in a healthcare fraud scheme operated out of a physical therapy clinic. According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.

Fraud 59

Fraud COVID-19 Health Insurance Compliance 59

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

The Health Law Firm Blog

FEBRUARY 23, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayment 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. Ritson identified the patients through the medical practice of Dr. Frank Alario.

Fraud 63

Fraud HIPAA FDA Health Insurance 63

The Health Law Firm Blog

MARCH 14, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

The Health Law Firm Blog

FEBRUARY 1, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

HIPAA Journal

JULY 9, 2024

The data compromised in the incident included names, addresses, phone numbers, Social Security numbers, birth dates, diagnoses, treatment information, prescriptions, physician names, medical record numbers, device serial numbers, and health insurance information. Another lawsuit was filed by plaintiff Arthur Podroykin in the U.S.

Fraud 119

Fraud Health Insurance HIPAA Compliance 119

The Health Law Firm Blog

JANUARY 8, 2024

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 40

Fraud Medicaid Medicaid Overpayment 40

The Health Law Firm Blog

NOVEMBER 29, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

The Health Law Firm Blog

DECEMBER 19, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

The Health Law Firm Blog

OCTOBER 14, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

HIPAA Journal

APRIL 25, 2024

The exposed and stolen data included contact information, Social Security numbers, driver’s license numbers, financial information, health insurance information, medical records, medical histories, diagnoses/conditions, and health insurance information.

Fraud 119

Fraud Health Insurance HIPAA Licensing 119

The Health Law Firm Blog

NOVEMBER 7, 2022

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. Indest III, J.D.,

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

HIPAA Journal

NOVEMBER 12, 2024

The affected systems contained information such as names, addresses, dates of birth, billing and claims information, health insurance claims information, diagnoses, medications, test results, x-ray images, and other treatment information. Passwords were reset and policies and procedures have been reviewed.

Health Insurance 59

Health Insurance Fraud Licensing HIPAA 59

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 with physician self-referral law requires strict adherence to its provisions.

Compliance 95

Compliance Fraud HIPAA Health Insurance 95

The Health Law Firm

NOVEMBER 4, 2021

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District of New York. Indest III, J.D.,

Fraud 40

Fraud Health Insurance 40

HIT Consultant

JULY 26, 2023

What You Should Know: HealthLock , a leading medical fraud and overbilling protection solution, today unveiled insightful findings from a recent attitudinal study exploring how adults in the United States feel about healthcare, from claims and billing to medical fraud and privacy.

Medical Billing 98

Medical Billing Fraud Health Insurance Doctors 98

AIHC

SEPTEMBER 25, 2024

The American Institute of Healthcare Compliance (AIHC), a Licensing/Certification partner with CMS, provides periodic news blasts highlighting noteworthy cases of fraud, waste, abuse and other violations. Government agencies expect your organization to stay informed. These are free ways to stay informed of lessons learned.

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

Health Care Law Brief

JUNE 5, 2023

We previously wrote about the United States Department of Justice’s (“ DOJ ”) Civil Cyber-Fraud Initiative (“ CCFI ”), which “aims to hold accountable entities or individuals that put U.S. To resolve these allegations, Jelly Bean and Spinks agreed to pay $293,771.

Fraud 52

Fraud Due Diligence Medicaid Medicaid 52

HIPAA Journal

OCTOBER 7, 2022

Questions are often sent to HIPAA Journal about the Health Insurance Portability and Accountability Act, one of which is how HIPAA has improved healthcare. In this article, I explain some of the main ways that healthcare has been improved by HIPAA for healthcare providers, health plans, and patients.

HIPAA 98

HIPAA Fraud Health Insurance Compliance 98

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

HIPAA Journal

SEPTEMBER 7, 2023

The information accessed in the attack included names, addresses, dates of birth, Social Security numbers, financial account information, medical record numbers, health insurance plan member IDs, and claims data. The affected individuals were notified by mail on August 11, 2023.

HIPAA 100

HIPAA Health Insurance Fraud 100

Bill of Health

NOVEMBER 17, 2024

by Rebekah Ninan A recent lawsuit in the Southern District of New York has alleged that the health insurance company Anthem Blue and Cross Blue Shield violated state laws and committed fraud by maintaining “ghost networks” of mental health providers.

Licensing 124

Licensing COVID-19 Fraud Health Care Access 124

HIPAA Journal

MARCH 30, 2023

On November 14, 2022, a hacker gained access to Rise’s network and accessed files containing sensitive patient data, including names, email addresses, phone numbers, provider information, diagnoses, expected delivery dates, and health insurance information.

Health Insurance 105

Health Insurance Fraud HIPAA 105

Compliancy Group

AUGUST 28, 2024

The Importance of HR Compliance Training Courses Compliance regulations in healthcare are designed to help organizations prevent fraud, waste, and abuse. It also goes a long way toward avoiding penalties that cost your organization money and its hard-earned reputation.

Compliance 97

Compliance Fraud Regulatory Compliance HIPAA 97

Compliancy Group

JUNE 13, 2024

Since the start of the data privacy rule in 2003 alone, there have been at least 350,000 Health Insurance Portability and Accountability Act complaints with 1,188 compliance reviews. Being placed on this list means that an individual or entity has committed fraud or harmed a patient(s).

Compliance 59

Compliance Fraud Regulatory Compliance Health Insurance 59

HIPAA Journal

FEBRUARY 22, 2023

The database included names, addresses, dates of birth, Social Security numbers, health insurance information, medical record numbers, and patient account numbers. CentraState confirmed that the hackers gained access to part of its systems that contained an archived database, and stole that database.

Ransomware 108

Ransomware Fraud Health Insurance HIPAA 108

Compliancy Group

NOVEMBER 6, 2024

Importance of Workforce Compliance Compliance with workforce requirements in healthcare involves ensuring the organization and its members comprehend and adhere to laws governing patient safety and privacy, maintaining secure working conditions, and preventing fraud, waste, and abuse.

Compliance 52

Compliance Compliance Officers Fraud Health Insurance 52

HIPAA Journal

APRIL 23, 2024

Kisco Senior Living said additional security features have been implemented to prevent similar breaches in the future and the affected individuals have been offered 12 months of complimentary credit monitoring services, which include a $1 million identity fraud loss reimbursement policy.

Ransomware 111

Ransomware Fraud Licensing HIPAA 111

HIPAA Journal

MAY 2, 2024

Hackers gained access to the BioPlus network for more than 2 weeks between October and November 2021, and potentially stole names, dates of birth, contact information, health insurance information, prescription information, and Social Security numbers.

Fraud 109

Fraud HIPAA Health Insurance Compliance 109

Electronic Health Reporter

JUNE 26, 2019

health insurance companies have begun implementing prior authorization processes. These insurers do not possess the specialized knowledge needed to determine medical necessity, so they have to shift the responsibility to providers in order to minimize instances of fraud and abuse. Recently, major U.S.

Fraud 117

Fraud Health Insurance 117

HIPAA Journal

JULY 4, 2024

The exposed information varied from individual to individual and may have included names, birth dates, medical record numbers, medical histories, and health insurance information. SkinCure Oncology believes files in those email accounts were viewed and potentially obtained in the attack. to 5:30 p.m.

Medicaid 116

Medicaid Medicaid Fraud Licensing 116

HIPAA Journal

JUNE 28, 2023

Individuals that have suffered identity theft, medical fraud, tax fraud, other forms of fraud, and other actual misuses of their personal information, can submit claims for documented, unreimbursed extraordinary losses that are reasonably traceable to the data breach of up to a maximum of $5,000.

Hospitals 89

Hospitals Fraud Licensing HIPAA 89