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 Overpayments 52

HIPAA Journal

JULY 4, 2024

SkinCure Oncology has notified 13,434 patients about an email attack that occurred in June 2023, and the Wisconsin Department of Health Services has announced a breach of the personal information of 19,150 Medicaid recipients. SkinCure Oncology believes files in those email accounts were viewed and potentially obtained in the attack.

Medicaid 115

Medicaid Medicaid Fraud Licensing 115

HIPAA Journal

FEBRUARY 23, 2022

HIPAA is an acronym for the Health Insurance Portability and Accountability Act. When the Health Insurance Portability and Accountability Act was passed by Congress in 1996, the establishment of federal standards for safeguarding PHI was not one of the primary objectives. What is HIPAA? What is HIPAA Title II?

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HIPAA Fraud Health Insurance Medicaid 99

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 Overpayments 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 Overpayments 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 Overpayments 52

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 Overpayments 52

Kaiser Health News

APRIL 16, 2024

Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov. “Unfortunately, there’s so much fraud that legitimate agents who are really trying to help people are also being pushed out.”

ACA 141

ACA Health Insurance Governance Medical Billing 141

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

HIPAA Journal

MARCH 25, 2022

Ultimate Care said no reports have been received that indicate there has been any misuse of patient information; however, as a precaution against identity theft and fraud, individuals whose Social Security numbers were impacted have been offered complimentary one-year memberships with a credit monitoring service.

Health Insurance 118

Health Insurance Licensing Ransomware Fraud 118

HIPAA Journal

OCTOBER 17, 2022

The exposed information included names, dates of birth, Social Security numbers, driver’s license numbers, clinical/diagnosis information, health insurance member ID numbers, medical record numbers, and Medicare or Medicaid numbers.

Health Insurance 124

Health Insurance Licensing Fraud HIPAA 124

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 Overpayments 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 81

Health Insurance Fraud Licensing HIPAA 81

HIPAA Journal

MARCH 21, 2023

During that time they exfiltrated files that contained sensitive patient data, including names, contact information, Social Security number, Medicare/Medicaid IDs, health information, and health insurance information.

Fraud 113

Fraud Health Insurance Medicaid Medicaid 113

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 88

Compliance Fraud HIPAA Health Insurance 88

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 Overpayments 40

HIPAA Journal

SEPTEMBER 9, 2022

Those emails contained patient information such as names, dates of birth, Social Security numbers, medical information, health insurance information, driver’s license numbers, and state ID numbers. As a precaution against identity theft and fraud, complimentary memberships have been offered to a credit monitoring service for 12 months.

Licensing 111

Licensing Health Insurance Fraud HIPAA 111

Kaiser Health News

NOVEMBER 11, 2021

In response, the Centers for Medicare & Medicaid Services has threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers. She told the woman she had reported the calls to CMS, the AARP Fraud Watch Network Helpline and the FTC.

Medicare 145

Medicare Medicare Doctors Fraud 145

HIPAA Journal

MAY 25, 2022

SAC Health said it is unaware of any actual or attempted misuse of patient data as a result of the break-in; however, as a precaution against identity theft and fraud, affected individuals have been offered complimentary credit monitoring services. Notification letters were sent to those individuals on May 3, 2022.

Ransomware 133

Ransomware Fraud HIPAA Licensing 133

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

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.

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Hospitals Fraud Licensing HIPAA 87

The Health Law Firm Blog

MAY 6, 2024

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 40

Fraud Health Insurance Overpayments Overpayment 40

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

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

Verisys

NOVEMBER 8, 2023

Providers, employers, health plans, and payers use these numbers for billing purposes. CMS.gov The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the creation of a standard, unique health identifier for healthcare providers, which the NPI satisfies.

Fraud 97

Fraud HIPAA Medicare Medicare 97

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

JULY 4, 2023

As a precaution against identity theft and fraud, affected individuals have been offered 24 months of complimentary credit monitoring services. Affected individuals had one or more of the following exposed: name, address, driver’s license number, health insurance information, medical information, date of birth, and Social Security number.

Medicaid 81

Medicaid Medicaid Health Insurance Licensing 81

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. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

Fraud 52

Fraud Compliance Health Insurance Medicaid 52

HIPAA Journal

APRIL 25, 2023

On February 13, 2023, NationsBenefits confirmed that the data compromised in the attack included protected health information such as name, address, phone number, gender, date of birth, health insurance number, medical ID number, Social Security number, date(s) of service, medical device or product purchased, and provider/caregiver name.

Health Insurance 95

Health Insurance Public Health Ransomware Fraud 95

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. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

HIPAA Journal

NOVEMBER 15, 2022

At least five complaints have now been filed in the U.S. District for Southern New York against the management company – Somnia Inc. One lawsuit took issue with Somnia Inc.

HIPAA 85

HIPAA Fraud Licensing Health Insurance 85

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. The new broker provision aims to deter fraudulent sign-ups by clarifying that applicants must attest that the income projections listed are correct.

ACA 81

ACA Health Insurance Licensing Governance 81

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These audits should occur once per year.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

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. With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

American Medical Compliance

OCTOBER 25, 2024

These regulations secure sensitive health information and uphold the financial integrity of healthcare organizations. Audits serve as a critical defense against fraud and inefficiency while fostering trust in your practice. A powerful way to ensure this is through regular compliance audits.

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Compliance Fraud Compliance Framework HIPAA 85

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. This type of theft is just one example of healthcare fraud. trillion in 2015. trillion in 2015.

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare IT Today

FEBRUARY 17, 2023

government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. They expect to recoup 4.7

Overpayments 89

Overpayments Overpayment COVID-19 Medicare 89