C&M Health Law

SEPTEMBER 11, 2023

Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (“CMS”) issued a much anticipated and contested proposed rule that seeks to establish minimum staffing level requirements for nursing homes. hours of nursing staff per resident per day, or 3.0 HPRD from nurse aids (NAs). [2]

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Nursing Homes Nurses Medicaid Medicaid 98

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.

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Fraud Nurses Medicaid Medicaid 59

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

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Fraud Medicaid Medicaid Nurses 52

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.

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Fraud Compliance Medicaid Medicaid 59

Compliancy Group

OCTOBER 28, 2024

Health and Human Services (HHS) Department’s efforts to eliminate fraud, waste, and abuse. Last November, the OIG published industry-specific compliance guidance for 2024 for several healthcare subsectors, including nursing homes and facilities. More specifically, the 2024 guidance for nursing facilities focuses on several areas.

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Nurses Compliance Nursing Homes Compliance Officers 52

The Health Law Firm

JANUARY 31, 2016

The Health Law Firm A nurse practitioner from Corinth, Mississippi, turned herself over to the authorities on Friday, January 8, 2016. Tami Bivens-Johnson was indicted on three counts of Medicaid fraud by an Alcorn County Grand Jury. Her Alleged Crimes Against Medicaid. Her Alleged Crimes Against Medicaid.

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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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

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Fraud Medicaid Medicaid Overpayments 52

Healthcare IT News - Telehealth

DECEMBER 13, 2021

"This forward-looking bill, based on expert, independent recommendations, provides clarity, certainty, and a foundation for building a telemedicine system that expands access, preserves patient choice, and includes basic safeguards against fraud and exploitation," said Doggett. WHY IT MATTERS. THE LARGER TREND.

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COVID-19 Telemedicine Fraud Medicare 158

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,

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Nursing Homes Nurses Fraud Medicare 52

Healthcare Compliance Blog

JANUARY 10, 2022

A South Carolina man has been arrested for financial transaction card fraud and exploitation of a vulnerable adult who was a resident of a nursing home. Due to his past criminal record, he also faces enhancement to the financial transaction card fraud charge.

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The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,

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Nursing Homes Nurses Fraud Medicare 52

The Health Law Firm Blog

MARCH 4, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy [.] Indest III, J.D.,

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Nursing Homes Nurses Fraud Medicare 52

Med-Net Compliance

JUNE 29, 2022

An Oklahoma nurse aide pleaded guilty to abusing a nursing home resident and was placed on a deferred sentence probation for three years under the supervision of the Oklahoma Department of Corrections. toward the cost of the investigation to the Office of the Attorney General Medicaid Fraud Control Unit (MFCU), $300.00

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Nursing Homes Nurses Fraud Medicaid 59

The Health Law Firm

FEBRUARY 27, 2014

Board Certified by The Florida Bar in Health Law In a citywide takedown, 25 people, including operators of home care agencies, operators of nurse staffing agencies, office workers and personal care assistants in Washington, D.C., were all arrested for alleged Medicare fraud schemes. Indest III, J.D.,

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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. 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.

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Health Law RX

AUGUST 1, 2022

While this new flexibility increased access to care, it also increased opportunities for fraud. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a Special Fraud Alert cautioning Practitioners about potential fraudulent telemedicine contracts ( Fraud Alert ). On July 20, 2022, the U.S.

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Fraud Telemedicine Nurses Governance 59

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

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Fraud Medicaid Medicaid Overpayments 52

MedTrainer

AUGUST 1, 2022

Medicare and Medicaid services are the backbone for supporting elderly and disabled Americans. Here’s a look at one of the OIG’s current medicare investigations to curb fraud, waste, and abuse. Established in 1976, the Office of Inspector General (OIG) was created to fight fraud and abuse in Medicare and Medicaid.

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Med-Net Compliance

OCTOBER 13, 2022

A jury found a North Dakota certified nursing aide (CNA) guilty of Aggravated Assault causing permanent impairment and Reckless Endangerment. The evidence at the trial showed that the CNA performed an improper, one-person lift of a nursing home resident which resulted in severe and painful injuries to the resident.

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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.

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Fraud COVID-19 Medicare Medicare 61

Healthcare Compliance Blog

APRIL 18, 2022

A certified nurse’s aide (CNA) who was working in an Oklahoma nursing home has pled guilty to stealing money from a resident. The former CNA was sentenced to serve 30 days in jail, and ordered to surrender her nurse aide certification and to hold no employment involving care of elderly or vulnerable adults while on probation.

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Nursing Homes Nurses Fraud Medicaid 59

The Health Law Firm Blog

JULY 13, 2023

Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.]

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Licensing Medicaid Medicaid Fraud 52

Healthcare Compliance Blog

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. Additionally, the LPN’s nursing license was suspended for an unspecified period of time.

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Nurses Nursing Homes Licensing Fraud 59

Healthcare Law Blog

DECEMBER 1, 2023

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released its “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2022 ” (the “Report”), highlighting continued enforcement and recovery actions under the Health Care Fraud and Abuse Control Program (HCFAC).

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COVID-19 Fraud Telemedicine Medicaid 52

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

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Nurses Licensing Fraud Medicaid 52

The Health Law Firm Blog

MAY 8, 2024

Attorney's Office, in the Middle District of Florida, announced that a Florida man pled guilty to conspiring to commit health care fraud in a $36.2 million telemedicine fraud scheme. Indest III, J.D., Board Certified by The Florida Bar in Health Law On March 20th, 2024, the U.S. As part of [.]

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Fraud Medicare Medicare Telemedicine 52

The Health Law Firm

MAY 4, 2012

Over 100 doctors, nurses and other health professionals were arrested on charges relating to Medicare fraud by federal agents on May 2, 2012. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law. The arrests were made in seven cities nationwide, but more than half took place in South Florida.

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Fraud Medicare Medicare Medicaid 40

The Health Law Firm

JULY 12, 2012

A licensed practical nurse (LPN) at Florida State Hospital has been arrested and charged with one count of abuse of a disabled adult at the hospital. The nurse was arrested on a felony warrant by the Attorney General’s Medicaid Fraud Control Unit (MFCU). Indest III, J.D.,

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Nurses Fraud Licensing Medicaid 40

Hall Render

NOVEMBER 25, 2024

Department of Health and Human Services (“HHS”) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (“Nursing Facility ICPG”) for nursing home members of the health care compliance community.

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Nurses Compliance Compliance Officers Medicare 40

MedTrainer

JANUARY 10, 2024

The OIG is making major investments to systematically detect and prosecute fraud. In this guidance it’s clear the OIG expects healthcare organizations and suppliers to understand their role and responsibilities to fight fraud, waste, and abuse. We all should be a LOT more prepared!

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Compliance Fraud HIPAA Compliance Officers 94

Med-Net Compliance

SEPTEMBER 14, 2022

A Massachusetts home health aide, who was licensed as a Certified Nursing Assistant (CNA), has been indicted in connection with a home surveillance video showing her abusing an elderly patient, Attorney General Maura Healey announced. The aide was indicted by a grand jury on two charges of assault and battery on an elder by a caretaker.

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US Department of Health and Human Services Fraud Medicaid Medicaid 59

Verisys

NOVEMBER 20, 2022

If you are looking for something to read prior to turkey or afterwards, here is a round up of bad actors: Pharma Fraud: . Pharma Fraud. Pharma Fraud . Pharma Fraud. Fraud Scheme. The group steered members to bill Medicaid rather than going through the NICA. Fraud Scheme. Fraud Scheme .

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Fraud Medicaid Medicaid Nursing Homes 52

The Health Law Firm Blog

APRIL 18, 2022

Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.].

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Licensing Medicaid Medicaid Fraud 40

The Health Law Firm Blog

JUNE 1, 2023

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. Indest III, J.D., The scheme involved performing hundreds of medically unnecessary, [.]

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Fraud Doctors Medicaid Medicaid 52

The Health Law Firm Blog

MARCH 7, 2022

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. Indest III, J.D., The scheme involved performing hundreds of medically unnecessary,

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Healthcare Compliance Blog

MAY 11, 2022

The South Carolina Attorney General announced that his office’s Medicaid Fraud Control Unit (SCMFCU) had arrested a 57-year-old woman on two counts of Exploitation of a Vulnerable Adult and two counts of Breach of Trust with Fraudulent Intent, value of $10,000 or more.

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The Health Law Firm

AUGUST 30, 2012

An investigation led by the Attorney General’s Medicaid Fraud Control Unit (MFCU) ended with an arrest of a north Florida registered nurse (RN), in Suwannee County. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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