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Healthcare Systems Rack up Millions of Dollars in HIPAA Penalties

Several healthcare organizations recently have been the subject of HIPAA penalties totaling nearly $7 million. On October 23, the U.S. Department of Health and Human Services Office for Civil Rights (OCR), announced it had imposed a civil money penalty of $2.154 million against Jackson Health System (JHS) in Miami for numerous violations of the Health […]

You Received an Audit Letter, Now What?

It’s not unusual for our office to receive a phone call from a healthcare provider stating that they received an audit request. Some call us after they have already responded and now have additional concerns. Others call us before they have taken any action. As the government continues to find value in recovering overpayments, we […]

UnitedHealth Group Drops SCOTUS Appeal in Cross-Plan Offsetting Case

UnitedHealth Group has decided not to pursue its appeal to the United States Supreme Court of an appellate court ruling that found United’s policy of withholding payments to out-of-network physicians and doctors in order to recover previous overpayments is not permissible. As we previously wrote, the case was filed by Dr. Louis J. Peterson on […]

Provider Beware: Healthcare Scam Warning Signs

Nearly every day, stories appear about healthcare professionals who get caught up in fraudulent activity. From billing for medically unnecessary services or for services never rendered, to accepting kickbacks for patient referrals, there is an unending stream of healthcare fraud taking place. Often, those perpetrating the crimes are well aware that their activity is, at […]

Proposed Changes to Stark and Anti-Kickback Laws

The U.S. Department of Health and Human Services Office of the Inspector General, in conjunction with the Centers for Medicare & Medicaid Services, has unveiled long-awaited proposals to revise safe harbor protections under the federal anti-kickback statute for certain coordinated care and associated value-based arrangements. The proposed new regulations also would add protections under the […]

Lying on Financial Disclosure Statements Can Land You in Jail

A Florida businessman who was already serving 57 months in prison on charges of tax and bank fraud, now faces another five years behind bars for making false statements on a financial disclosure statement that he was required to submit to the government. According to a news release from the U.S. Department of Justice, Casey […]

A September to Remember for Healthcare Fraud

To say that federal healthcare fraud investigators have been busy in September would be an understatement. In the last few weeks, nearly 400 people have been implicated in a wide range of healthcare fraud related crimes totaling more than $3 billion. Included in that total are 178 medical professionals. In addition some 50 million in […]

Telemedicine Company Owner, Doctor Plead Guilty in Multimillion-Dollar Fraud

The owner and chief executive of a telemedicine company, along with a New Jersey physician, have pleaded guilty for their roles in one of the largest healthcare schemes ever, that resulted in charges against 24 defendants. On September 6, Lester Stockett pleaded guilty to one count of conspiracy to defraud the U.S. and pay and […]

Watchdog Agency Cracking Down on Improper Billing by HHAs

Last month, the U.S. Department of Health and Human Services Office of the Inspector General issued its latest report on a home health agency that it contends did not comply with Medicare billing requirements. It was one in a series of actions the watchdog agency has taken this year against HHAs, and part of what […]

DOJ Cites Significant Costs and Burdens on Request to Dismiss Qui Tam Case

The Department of Justice has once again exercised its authority under the False Claims Act in seeking the dismissal of a relator’s qui tam lawsuit. Government attorneys, in their motion to dismiss filed on Aug. 20, told the court that further litigation would result in imposing “significant costs and burdens on the government and waste […]

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