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Department of Justice announced earlier this month that an Indian Rocks Beach, Florida-based woman has pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return. Department of Health and HumanServices Office of Inspector General, in a statement. have also agreed to pay up to $20.3
Department of Health and HumanServices aims to protect the integrity of federal healthcare programs, in addition to the health of beneficiaries. "We believe health technology should be used in the service of care to achieve better health and value," said VanLandingham.
An Adaptive Health Integrations data breach has recently been reported to the Department of Health and HumanServices’ Office for Civil Rights (OCR) that involved the protected health information (PHI) of 510,574 individuals. This post will be updated when further information becomes available.
This approach enhances both performance and compliance while minimizing human error. According to a Black Book survey , 90% of HIM professionals believe that upcoding is a significant ethical concern, while 85% say that discrepancies identified during coding audits often lead to denied claims or repayment demands due to system complexity.
Department of Health and HumanServices works to ensure the integrity of federal healthcare programs and to safeguard the health and welfare of those programs' beneficiaries. And I think it's important for us to recognize that we don't know a whole lot right now.
For corporate health care providers involved in a civil health care fraud or abuse investigation, the corporation may be required to enter into a Corporate Integrity Agreement (CIA) with the USDepartment of Health and HumanServices (HHS), Office of Inspector General (OIG) to settle the case.
A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Issue: Legitimate vaccination cards are being stolen from healthcare facilities and then used in a fraudulent manner. Participating in the fraud can result in the person(s) being prosecuted.
The Department of Health and HumanServices once again (for the ninth time) extended the public health emergency this past month , stretching it beyond mid-July. But sooner or later, that provision of the Public HealthService Act will draw to a close. We spoke recently with Allison M.
A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. The psychologist was convicted of four counts of healthcare fraud.
million scheme to defraud Medicare by billing for services under another doctor’s name after Medicare revoked his privileges to participate in the program. Once the new business was set up, he continued to bill Medicare for services just as he had prior to his revocation, only now exclusively under the name of his partner.
The Health Law Firm On June 9, 2015, the USDepartment of Health and HumanServices, Office of the Inspector General issued a special fraud alert on physician compensation arrangements. It also is used to ensure that the arrangement reflects fair market value for bona fide services actually provided.
Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.
Attendees will gain valuable insights into health information privacy, healthcare cybersecurity, HIPAA enforcement, and a wealth of information to help them maintain HIPAA compliance and take healthcare data privacy and security to the next level. Jillson, JD – Counsel to the Director, Bureau of Consumer Protection, U.S.
Board Certified by The Florida Bar in Health Law. The owner and operator of a Miami home health care agency pleaded guilty for his part in a $42 million home health Medicare fraud scheme, according to the Department of Justice (DOJ), the FBI and the Department of Health and HumanServices (DHHS).
USDepartment of Health and HumanServices (HHS) Office of Inspector General Christi A. Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs.
As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !
As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !
It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors? Department of Justice (DOJ), the U.S.
Stripe is not HIPAA compliant and – other than its payment processing services – should not be used by covered entities and business associates to create, collect, store, or transmit Protected Health Information (PHI). Stripe complies with multiple US and International data privacy regulations (i.e., What is Stripe?
On November 6, 2023, the USDepartment of Health and HumanServices (HHS), Office of the Inspector General (OIG), released 91 pages of "General Compliance Program Guidance" (GCPG) on its website. The GCPG provides general compliance guidance, tools, and references for use by federal health care program providers.
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.
Three schools across Broward County and Palm Beach County, Florida, were involved in this multimillion-dollar fake diploma scheme: Siena College of Health, Palm Beach School of Nursing, and Sacred Heart International Institute. In addition, an estimated 37 percent of student nurses with fake diplomas passed the NCLEX.
Board Certified by The Florida Bar in Health Law The USDepartment of Health and HumanServices (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). By George F. Indest III, J.D., Click here to see a sample of a subpoena duces tecum issued by the OIG.
The Office of Inspector General (OIG) for the USDepartment of Health and HumanServices (HHS) has made educational resources available for healthcare providers to comply with federal healthcare laws and regulations. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.
According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application. The provider had created a business to provide home and community-based services to Medicaid recipients. List of Excluded Individuals/Entities ?(LEIE).
The Office of Inspector General (OIG) of the USDepartment of Health and HumanServices (HHS) is investigating a Tennessee-based nursing care company. By Danielle M. Murray, J.D. Click here to read the entire article from the Wall Street Journal.
In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and HumanServices’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. Increased Telehealth Services.
In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and HumanServices’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. Increased Telehealth Services.
Board Certified by The Florida Bar in Health Law. The Office of Inspector General (OIG) for the USDepartment of Health and HumanServices (HHS) has reportedly launched an investigation into CVS’ practice for refilling prescriptions. By George F. Indest III, J.D.,
hours entering electronic health records (EHR data), and managing patient loads of 2,000 or more. These healthcare organizations (HCOs) will deploy task-oriented and domain-specific models that build on large-language models (LLMs), using reinforcement learning and knowledge graphs to deliver relevant, accurate, and stable data outputs.
His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”.
Both defendants also admitted that Defendant 1 stole at least 20 CDC Vaccination Record Cards in March of 2021, that he sent his brother, Defendant 2, some of the stolen vaccination record cards, and that they agreed to use them and sell them to others for $50. Participating in the fraud can result in the person(s) being prosecuted.?.
The onboarding process is pivotal in ensuring employees understand their job duties, engage in best cybersecurity practices, and comply with important regulations like the Health Insurance Portability and Accountability Act, Occupational Health and Safety Administration, and prevention of Fraud, Waste, and Abuse in healthcare.
Insurance agents who handle protected health information (PHI) are required to comply with the Health Insurance Portability and Accountability Act (HIPAA). A breach of PHI can lead to identity theft, financial fraud, and other forms of harm to clients. 104-191 Department of Health and HumanServices.
Many businesses and organizations came to an abrupt halt as all systems using CrowdStrike received the infamous blue screen of death. Richard Bird, Chief Security Officer at Traceable AI The CrowdStrike event serves as an incredibly important reminder that the digital world is nothing more than a tool that serves the human world.
Because care requires using and exchanging sensitive patient information, adherence to U.S. When personal health information transcends international borders, vendors outside the U.S. When unauthorized parties gain access to this information, identity theft, fraud, and diminished care often result. law extends to you.
Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.
Board Certified by The Florida Bar in Health Law Every year the Office of the Inspector General (OIG) of the USDepartment of Health and HumanServices (HHS), publishes a “Work Plan” disclosing the areas of health practice upon which it intends to concentrate its audit and anti-fraud activities for the upcoming year.
Do your hiring managers and Human Resources colleagues know what to look for? Department of Health and HumanServices Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. Provision of unnecessary or substandard services.
Board Certified by The Florida Bar in Health Law On July 14, 2015, Ann Maxwell, Assistant Inspector General for Evaluation and Inspections of the Office of Inspector General (OIG), USDepartment of Health and HumanServices (HHS), gave testimony to Congress on the Medicare Part D Program. Indest III, J.D.,
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Board Certified by The Florida Bar in Health Law. A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. Indest III, J.D., On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida.
Federal payments for healthcare services account for 28% of all healthcare spending in the United States. The List of Excluded Individuals/Entities (LEIE) is maintained by the Department of Health and HumanServices (HHS) Office of the Inspector General ( OIG) and dictates which providers are excluded from receiving federal funds.
These hackers are costing health organizations millions of dollars and threatening the safety of patients. However, unauthorized access is causing more than just identity fraud. In January of 2018, Hancock Health of Indiana experienced a serious ransomware attack that forced their entire network to shut down.
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