Medicare Fraud Initiative Leads to Arrests of Over 100 Health Professionals
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A recent Medicare fraud operation conducted between several federal agencies has resulted in the arrest of over 100 doctors, nurses and other medical professionals. They have been charged with various crimes relating to Medicare fraud. The arrests were made on May […]
Alleged HIPAA Privacy Violations at the Center of a Recent Physician Group Settlement with HHS
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A small physician group has reached a settlement with the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) over alleged Health Insurance Portability and Accountability Act of 1996 (HIPAA) violations. The settlement […]
$24 Million Medicaid Fraud Scheme Alleged by Connecticut Attorney General
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Connecticut’s Attorney General, George Jepsen, alleges that 28 individuals, dental practices and corporations were involved in a $24 million Medicaid fraud scheme. He filed a civil action on May 31, 2012. It is the first case the state has […]
Compliance with Conditions of Participation Necessary for Reinstatement of Terminated Medicare Billing Privileges or Revoked Medicare Provider Number and Participation Agreement
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We have recently experienced an alarming increase in the number of Medicare providers receiving notices that their Medicare billing privileges are being terminated. These include home health agencies (HHAs), independent diagnostic testing facilities (IDTFs), ambulance and emergency transport […]
Man Charged with Medicare Fraud in Ambulance Scheme
By Miles Indest A Pennsylvania man has been charged in a 23-count indictment in relation to an alleged scheme to defraud Medicare by billing for fraudulent ambulance services. The charges were announced by the Department of Justice (DOJ) on June 29, 2012. Man Allegedly “Straw” Owner Used to Start Ambulance Company. According to the indictment the […]
Hospital to Pay $3.59 Million to Settle False Claims Act Allegations Involving Ambulance Services
By Miles Indest A hospital located in Columbia, Tennesse, has agreed to pay the federal government over $3.5 million to settle False Claims Act allegations that occurred between 2004 and 2009. The hospital submitted a voluntary self-disclosure to the U.S. Attorney’s Office and the Department of Health and Human Services (DHHS) Office of Inspector General (OIG). Hospital […]
New Hampshire City Auditing Ambulance Service for Allegedly Overbilling
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 16, 2012, a New Hampshire city allegedly launched an audit into its primary ambulance service, American Medical Response (AMR), after the company acknowledged overbilling hundreds of patients since 2011, according to a Union Leader article. AMR […]
Copying and Pasting Clinical Notes in Electronic Health Records Could Be Considered Healthcare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is concerned about healthcare providers carelessly copying and pasting clinical notes in electronic health records (EHRs). According to an audit report released on December 10, […]
OIG Audit Finds Federal Database of Terminated Medicaid Providers Needs Improvement
By Lenis L. Archer, J.D., M.P.H., The Health Law Firm The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) to establish a process for sharing information about terminated Medicaid providers. The federal database, called Medicaid and Children’s Health Insurance Program State Information Sharing System (MCSIS), is designed to prevent terminated […]
Cyber Attack at Community Health Systems Affects 4.5 Million Patients-Could This be a New Trend?
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 18, 2014, Community Health Systems, a Tennessee-based hospital chain that has 206 hospitals in 29 states, announced that its computer system was hacked. According to a number of news reports, an outside group of hackers, originating […]
OIG Issues Advisory Opinion to Specialty Pharmacy for Support Service Payments
By Lenis L. Archer, J.D., M.P.H., The Health Law Firm There is an inherent risk in entering into financial arrangements where payments to a service provider are only made when a referral is generated. On August 15, 2014, the Office of Inspector General (OIG) made this perfectly clear in an unfavorable advisory opinion issued to […]
Department of Health and Human Services Announces Mental Health Parity Final Rule
By Lance O. Leider, J.D., The Health Law Firm On November 8, 2013, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the promulgation of the agency’s final rule related to parity of coverage of mental health and substance use treatment. According to Sebelius: “For way too long, the healthcare system […]