Healthcare IT Today

NOVEMBER 24, 2024

Cotiviti launched 360 Pattern Review , which combines pre-pay fraud, waste, and abuse prevention with post-pay review across the claim payment cycle. UbiSim VR updated its nurse education module , with v1.16 giving nurses practice on care delivery amid distractions such as phone calls and incoming orders.

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HIT Consultant

DECEMBER 10, 2021

What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Certified Clinical Nurse Specialist. Nurse Practitioner. Report Background.

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Fierce Healthcare

SEPTEMBER 22, 2023

A Florida nurse practitioner was convicted this week by a federal jury for her participation in a $200 million healthcare fraud scheme.

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Med-Net Compliance

OCTOBER 27, 2022

According to court documents and evidence presented at trial, the psychologist caused the submission of fraudulent Medicare claims from July 2016 through June 2019 for psychotherapy services purportedly provided to nursing home residents in Chicago and surrounding areas. The psychologist was convicted of four counts of healthcare fraud.

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HIPAA Journal

DECEMBER 15, 2022

A former nurse employed by the Roswell Park Comprehensive Cancer Center in Buffalo, NY, has been sentenced to 37 months in prison for tampering with and stealing controlled medications intended for cancer patients. Mulvey, 30, of Grand Island, NY, worked as a registered nurse at Roswell Park between February 2018 and June 2018.

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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.

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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. The post Five Individuals and Two Nursing Facilities Indicted on Healthcare Fraud Charges appeared first on Med-Net.

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Healthcare IT Today

OCTOBER 26, 2024

At MEDITECH Live, John chatted with Mike Elder and Kelsey Reed at the southwest Georgia health system, which recently opened a Living and Learning Center to really recruit and train the next generation of nurses. Read more… CIO Podcast : What Makes Mental Health Different. Read more… Breaking Down Healthcare’s Data Walls.

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Healthcare Compliance Blog

FEBRUARY 2, 2022

A New York optician has pled guilty to grand larceny for submitting false claims for optician services that he alleged were for specific nursing home residents, but which were never provided. Many of the residents for whom the optician submitted claims were deceased, and he never visited the nursing homes on the dates of the those claims.

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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 registered nurses (RNs) and 2.45

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The Health Law Firm

MARCH 9, 2023

Board Certified by The Florida Bar in Health Law In late February 2023, multiple states began taking action against licensed practical nurses (LPNs) and registered nurses (RNs) because of the FBI's "Operation Nightingale." This is also being pushed by the National Council of State Boards of Nursing (NCBSN). Indest III, J.D.,

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Hall Render

MARCH 4, 2025

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. Medical Directors in Nursing Homes 42 CFR 483.70(g)

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Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Secure your success by choosing Verisys.

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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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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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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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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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Healthicity

SEPTEMBER 26, 2024

From her early days as a trauma nurse to her current role as a sought-after expert witness, Rebecca has seen it all in the ever-evolving world of healthcare compliance and fraud. CJ Wolf sits down with Rebecca Busch , a healthcare compliance expert with over four decades of experience.

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Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. Discussion Points: Review your policy and procedure for preventing and reporting false claims, kickbacks, or other fraud, waste, and abuse violations.

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Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

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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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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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Healthcare Compliance Blog

MARCH 11, 2022

A Boston registered nurse (RN) has pled guilty to one count of tampering with a consumer product and one count of obtaining a controlled substance by fraud and deception. The RN was working in a nursing home when she tampered with morphine that was prescribed to a resident under her care.

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Health Care Performance

FEBRUARY 21, 2023

The scheme 25 people were charged with wire fraud – administrators and employees of three Florida nursing schools as well as recruiters. The recruiters sought out individuals that were willing to pay $10,000 to $15,000 for fake nursing school documents that allowed them to take national nursing licensure examinations.

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Healthcare IT News - Telehealth

SEPTEMBER 12, 2024

Based on a media release, doctors and nurses at Hervey Bay Hospital are being prepared for the Queensland Telestroke Service pilot happening in the coming weeks. The InterSystems integration also allows didgUgo to leverage AI for fraud prevention. Queensland is the remaining Australian state to launch a telestroke service.

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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. Issue: Nursing staff should monitor telemedicine appointments held with their residents, review related medical record documentation, and report any concerns with observed practices immediately.

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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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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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MedTrainer

AUGUST 1, 2022

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. The OIG has recently set its sights on one particular group — skilled nursing facilities. A Look at the OIG.

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The Health Law Firm

FEBRUARY 3, 2021

Board Certified by The Florida Bar in Health Law On September 23, 2020, a Tennessee woman who posed as a nurse working at several medical facilities was sentenced to more than four years in prison. In December 2019, she pled guilty to wire fraud, healthcare fraud, identity theft, and practicing nursing without a license.

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Healthcare Compliance Blog

MARCH 10, 2022

Complaints of resident abuse in a Michigan nursing home led to an investigation by the Michigan Office of Attorney General’s Health Care Fraud Division, working with the Michigan Sentinel Project. The investigation determined that a nurse was working at the nursing home while her license was suspended, which is a felony.

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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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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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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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HIPAA Journal

AUGUST 30, 2022

The Wilsonville, OR-based home health care service provider and nursing home operator, Avamere Holdings, is facing a class action lawsuit over a major data breach that affected 96 senior living and healthcare facilities and resulted in the exposure of the protected health information of more than 380,000 individuals.

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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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