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

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

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 Overpayment Overpayments 40

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

Fraud 40

Fraud Medicaid Medicaid Overpayment 40

The Health Law Firm Blog

JUNE 10, 2023

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Indest III, J.D., Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 The doctor argued that the [.]

Fraud 52

Fraud Medicare Medicare Doctors 52

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

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

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

Fraud 52

Fraud Medicaid Medicaid Overpayment 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

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

Fraud 52

Fraud Medicaid Medicaid Overpayment 52

Health Law RX

MARCH 30, 2023

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. The defendants disagreed.

Overpayments 52

Overpayments Overpayment Fraud Governance 52

The Health Law Firm

AUGUST 18, 2022

Unfortunately, the unfortunate truth is that Florida has become synonymous with healthcare fraud. As a result, auditing and subsequent overpayment demands are some very real possibilities. Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

MARCH 16, 2022

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Indest III, J.D., Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 The doctor argued that the.

Fraud 52

Fraud Medicare Medicare Doctors 52

Provider Trust

JUNE 30, 2023

Maintaining the highest payment integrity standards helps payers avoid unnecessary payments, recover overpayments, and prevent fraud, waste, and abuse (FWA) in healthcare billing. This means payers must rely on post-payment reviews and audits to identify those errors, overpayments, and fraudulent claims.

Overpayments 52

Overpayments Overpayment Fraud Compliance 52

Health Care Law Brief

APRIL 12, 2023

405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. Notable Omissions from Proposed Rule CMS declined to adopt previously proposed amendments to the standard for “identified overpayments” under Medicare Parts A, B, C, and D. 3729(b)(1)(A) of the False Claims Act (“FCA”). See Proposed Rule at 79559.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare Law Blog

FEBRUARY 3, 2023

In addition, each MMCO must develop a fraud, waste and abuse prevention plan and submit it to OMIG within 90 days of the effective date of the new rules or upon signing a new contract with the New York State Department of Health to begin participation as an MMCO.

Medicaid 52

Medicaid Medicaid Compliance Overpayments 52

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. Ensure Ongoing Compliance.

Compliance 52

Compliance Due Diligence Fraud Governance 52

Florida Health Care Law Firm

DECEMBER 2, 2021

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The OIG recognized that there are benefits to disclose potential fraud.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40

Healthicity

APRIL 12, 2022

The OIG’s Annual Workplan for 2022 includes the continuous auditing and monitoring of items and services.

Overpayments 52

Overpayments Overpayment Fraud Medicare 52

Health Law Advisor

AUGUST 25, 2023

Social Services Law § 363-d) codified in New York State law federal requirements and OMIG policies require Medicaid providers who have received an overpayment to report, return, and explain the overpayment by making a disclosure to OMIG within sixty (60) days of identifying the overpayment. Lines of Communication.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

Compliancy Group

FEBRUARY 7, 2024

CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary. Given their significant impact, healthcare organizations must take UPIC audits seriously.

Fraud 52

Fraud Compliance Medicare Medicare 52

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 Compliance Health Insurance Medicaid 52

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

Health Law RX

NOVEMBER 9, 2021

For the first time since 2013, on November 8, 2021, the Department of Health and Human Services Office of Inspector General (“OIG”) updated its Health Care Fraud Self-Disclosure Protocol (“SDP”). The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5

Fraud 52

Fraud Overpayments Overpayment Governance 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse. Fraud – Billing for supplies or services that were not given or provided to the patient.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Fraud Compliance 52

The Health Law Firm Blog

JANUARY 8, 2024

This agency investigates allegations of fraud, waste, and abuse of Medicare, Medicaid, and other federally funded healthcare programs. [.] Indest III, J.D., Board Certified by The Florida Bar in Health Law The U.S. Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG).

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT News - Telehealth

JUNE 8, 2022

While it is important to carefully consider the most effective methods of providing care and the intended purpose behind various reimbursement, privacy, and fraud and abuse regulations, it is also clear that healthcare delivery has always and continues to evolve, and the regulatory framework needs to do the same.

US Department of Health and Human Services 187

US Department of Health and Human Services Compliance COVID-19 Overpayments 187

The Health Law Firm

JULY 24, 2017

The unfortunate truth is that Florida has become synonymous with health care fraud. As a result, auditing and subsequent overpayment demands are very real possibilities. Indest III, J.D.,

Medicaid 40

Medicaid Medicaid Overpayments Overpayment 40

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. The risk categories are described as follows: Highest Risk—Exclusion: Parties that the OIG determines present the highest risk of fraud will be excluded from Federal healthcare programs to protect those programs and their beneficiaries.

Fraud 59

Fraud Compliance Medicare Medicare 59

Health Law Blog

MAY 22, 2018

Substance Abuse Treatment Center Fraud Scheme Results in Guilty Plea. The Department of Justice recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.”

Fraud 52

Fraud Overpayments Overpayment Licensing 52

AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud 52

Fraud Medicare Medicare Compliance 52

Compliancy Group

FEBRUARY 2, 2024

In the case of healthcare fraud or other forms of noncompliance, the organization at fault could enter a corporate integrity agreement (CIA) with the Office of the Inspector General (OIG). The corporation might still face penalties, which could be reduced if they show good faith in identifying and remedying the offense.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

The Health Law Firm Blog

OCTOBER 14, 2022

This agency investigates allegations of fraud, waste, and abuse of Medicare, Medicaid, and other federally funded healthcare programs. [.]. Indest III, J.D., Board Certified by The Florida Bar in Health Law The U.S. Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG).

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Compliancy Group

FEBRUARY 29, 2024

A Corporate Integrity Agreement outlines the healthcare entity’s future compliance obligations and the steps to prevent future fraud, abuse, and illegal activity incidents. Being able to opt into a Corporate Integrity Agreement typically depends on the severity and nature of the infraction and the entity’s previous compliance record.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

The Health Law Firm

JULY 17, 2015

The unfortunate truth is that Florida has become synonymous with health care fraud. As a result, auditing and subsequent overpayment demands are very real possibilities. Florida health care providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country.

Medicaid 40

Medicaid Medicaid Overpayments Overpayment 40

HIT Consultant

JANUARY 9, 2024

Varying levels of economic development and legal systems lead to potential fraud and currency control complications as well. They can reduce the burden on clinical and financial staff for payments, disputes, reporting and reconciliations, all while minimizing site and study overall costs and overpayments.

Overpayments 95

Overpayments Overpayment COVID-19 Fraud 95

Healthcare Compliance Blog

JUNE 9, 2022

In March of 2022, in a related matter, the man pleaded guilty to Healthcare Fraud, Money Laundering, and Theft of Public Money for defrauding Medicare, Medicaid, and the US Department of Health and Human Services between 2016 and 2020. He is awaiting sentencing on those charges.

US Department of Health and Human Services 59

US Department of Health and Human Services Overpayments Overpayment Medicare 59