Healthcare Compliance Blog

FEBRUARY 8, 2022

The United States has filed a lawsuit against an Alabama psychiatrist for improper prescribing of Nuedexta to nursing home residents. The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

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.

Fraud 59

Fraud Telemedicine Medicare Medicare 59

Compliancy Group

OCTOBER 28, 2024

Health and Human Services (HHS) Department’s efforts to eliminate fraud, waste, and abuse. Its compliance program guidance (CPG) has improved the efficiency and effectiveness of Medicare and many other federal programs. More specifically, the 2024 guidance for nursing facilities focuses on several areas.

Nurses 52

Nurses Compliance Nursing Homes Compliance Officers 52

MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

Medicare 52

Medicare Medicare Compliance Medicaid 52

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).

COVID-19 52

COVID-19 Fraud Telemedicine Medicaid 52

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicare Medicare Governance 40

The Health Law Firm

JANUARY 2, 2013

The Office of Inspector General (OIG) of the US Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer's centers across the country.

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Medicare 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!

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

MedTrainer

SEPTEMBER 20, 2023

Examples of covered entities include health plans, clearinghouses, and certain health care providers including but not limited to: doctors, clinics, psychologists, dentists, chiropractors, nursing homes, and pharmacies. There are a number of laws built to fight against Medicare/Medicaid noncompliance and fraud.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

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

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. A psychiatrist caught improperly billing over $1.36M to Medicare over the course of seven years. Fraud Scheme. Fraud Scheme.

Fraud 52

Fraud Medicaid Medicaid Nursing Homes 52

The Health Law Firm

AUGUST 8, 2017

It is reported that Blanco oversaw inspections by the Florida Agency for Health Care Administration or "AHCA" of Florida nursing homes owned by Phillip Esformes. Bertha Blanco faces a wide range of charges including accepting bribes to tip off individuals when state wide investigations were to begin. The Ring Alleged Ring Leader.

Governance 40

Governance Fraud Nursing Homes Medicare 40

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. HHS Examines Medicare Spending and COVID-19 Tests. HHS Concerned About Quality of Nursing Homes.

US Department of Health and Human Services 52

US Department of Health and Human Services Nursing Homes COVID-19 Medicare 52

Provider Trust

JULY 17, 2023

Their guidance aims to improve a number of potential risks within the healthcare space by improving care at nursing homes and strengthening the program integrity in managed care. OIG pointed to the increased instances of patient neglect abuse as well as the need for oversight within nursing homes.

Compliance 52

Compliance Nursing Homes Nurses Fraud 52

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. HHS Examines Medicare Spending and COVID-19 Tests. HHS Concerned About Quality of Nursing Homes.

US Department of Health and Human Services 52

US Department of Health and Human Services COVID-19 Nursing Homes Medicare 52

Health Care Performance

AUGUST 25, 2022

This month’s issue includes: A summary of the 48 OIG health care fraud enforcement cases announced last month. The OIG's audit report of nursing home life safety and emergency preparedness noncompliance. The OIG's audit report of nursing home life safety and emergency preparedness noncompliance. Price: $300/year.

Compliance 52

Compliance Nursing Homes HIPAA Fraud 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. HHS’s suspension and debarment programs are vital to upholding integrity in Federal grants and contracts.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

JANUARY 30, 2024

Compliance is Mandatory for Federal Programs One constant is that organizations and facilities that participate in federal healthcare programs, such as Medicare and Medicaid, must have a compliance program. Nursing Homes: Skilled nursing facilities, long-term care facilities, and other types of nursing homes.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. Office of Inspector General (OIG) Compliance Program Guidance Office of Inspector General (OIG) compliance program guidance is for individual providers like hospitals or nursing homes.

Compliance 52

Compliance Compliance Officers Fraud Compliance Framework 52

Hall Render

FEBRUARY 27, 2023

This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. Health Care Fraud Actions Medicaid. DOJ filed claims against multiple nursing homes and their management corporation for providing services that the DOJ alleged were grossly below the standard of care.

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

Med Law Blog

MAY 1, 2023

Howell, Constantine Yannelis and Abhinav Gupta positing that their research shows that “PE ownership increases short term mortality of Medicare patients by 10%, in nursing homes”.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

YouCompli

JANUARY 4, 2022

Unger, Chief of Medicaid Fraud Division, Office of the Massachusetts Attorney General; and Patrick Callahan, Healthcare Fraud Unit, US Attorney’s Office. Unger reported that her unit is focused on about 65% Medicare fraud and about 35% abuse and neglect. Millions in dollars in fraud are happening this way,” Callahan said.

Fraud 40

Fraud Compliance Elder Abuse Medicaid 40

MedTrainer

NOVEMBER 6, 2023

While specific compliance requirements vary depending on the type of facility — from large hospitals and surgery centers to clinics and nursing homes — having a well-structured compliance plan is essential for all medical settings. But what exactly is a compliance plan in healthcare, and why is it so crucial?

Compliance 52

Compliance Fraud Nursing Homes Governance 52

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. On November 20, 2024, the Office of Inspector General (“OIG”) for the U.S.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Hall Render

DECEMBER 11, 2024

OIGs new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community emphasizes the importance of staff screening and exclusion checks. Under 42 CFR Sec.

40

40

Hall Render

MAY 20, 2022

HHS Announces $15M in Funding For Behavioral Healthcare In Nursing Homes. OIG: 25% of Medicare hospital patients experienced harm pre-pandemic. State Actions to Address Nursing Home Staffing During COVID-19. California aims to tighten licensing of nursing homes after pandemic exposes deadly lapses.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

JULY 12, 2023

If a deemed hospice fails to meet the Medicare requirements or shows continued condition-level noncompliance, deemed status is generally removed and oversight is placed under the SA. Selected hospices either successfully complete the SFP program or are terminated from the Medicare program. of hospice providers reported data.

Medicare 40

Medicare Medicare Nursing Homes Fraud 40

Hall Render

MAY 13, 2022

Prism pays $650K to settle Medi-Cal fraud claims filed in San Diego. Nursing Home Operator Leaving 8 Locations. COVID outbreaks strike 8 nursing homes as cases rise across Maine. Massachusetts to receive $250,000 from 5 nursing homes over patient neglect, inadequate care claims. CALIFORNIA.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

FEBRUARY 18, 2022

13-year Medicare payment dispute will return to HHS, court rules. Aspen University investigation: Students vent frustration amid nursing board probe into private college. ‘I feel extorted:’ Former FMC nurses told to pay $5K after being fired for refusing vaccine. Florida physician convicted of $110M fraud.

COVID-19 40

COVID-19 Nursing Homes Nurses COVID-19 Vaccine 40

Hall Render

FEBRUARY 25, 2022

40% of Nursing Home Residents Haven’t Received COVID-19 Boosters, Analysis Finds. No COVID-19 boosters for 70% of nursing home staffs, AARP says. The 55 hospitals penalized by Medicare 8 years straight over patient complications. Contract Nurse Agencies Are Making Big Money in the Age of COVID-19.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Hall Render

APRIL 29, 2022

About 20K nursing home staff now have vaccine medical exemptions. Hospitals sue HHS over Medicare billing calculation. More than 400 nursing home closures projected for 2022: report. Permanent telehealth expansion could cost Medicare $25B over 1 decade. Family nurse practitioners. CMS Proposes $1.6B

COVID-19 40

COVID-19 US Department of Health and Human Services Nursing Homes Nurses 40

Hall Render

MARCH 18, 2022

Former CMS Chief Seema Verma Blasts Nursing Home Reform Proposals. How the PE Nursing Home Crackdown Could Affect the Home Health Industry. New Bill Aims to Extend Acute Hospital Care at Home Waiver. Nursing home lobbyists request sit-down with Biden about reforms.

COVID-19 40

COVID-19 Nursing Homes US Department of Health and Human Services Nurses 40

Hall Render

MARCH 25, 2022

Hospital stays for nursing home residents down nearly 9%, federal data shows. Huntsville Hospital to launch new nurse training program. Alabama hospitals, nursing homes split $80 million in ARPA funds. New apprenticeship program to address nursing shortage in Alabama. vaccinated nursing home staff.

COVID-19 40

COVID-19 US Department of Health and Human Services Nursing Homes Nurses 40

Hall Render

APRIL 22, 2022

GAO investigating private equity ownership of nursing homes. This nursing home chain reported the highest COVID death rate. San Francisco’s Laguna Honda Hospital Loses Medicaid, Medicare Funding. Sutter Health: Nurses who staged 1-day strike must wait 5 days to return to work. Then it deleted deaths.

COVID-19 40

COVID-19 Nursing Homes US Department of Health and Human Services Nurses 40

Hall Render

SEPTEMBER 23, 2022

House report attacks, nursing homes fight back over allegations of deficient staffing, care and safe practices as pandemic hit. Colorado senior-care company pauses expansion into Indiana after Medicare audit. million to resolve Medicare fraud claims. Healthcare Compliance Will Be a Challenge in Post-PHE World.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40