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Allegations of fraudulent billing can negatively impact the physician who faces the accusations and their medical practice. It is important for both parties to take steps to protect their interests. It is helpful to learn from other cases to better prepare for the...
The U.S. Department of Justice (DOJ) continues to crack down on allegations of health care fraud. The agency has many different legal tools it uses to pursue those accused of a violation, including charges of conspiracy to commit health care fraud. This is a serious...
In New York, a commercial health insurance audit examines a medical provider’s compliance in terms of processing claim payments. If an auditor finds discrepancies, it can lead to negative consequences that can affect your organization’s finances, operations and...
In New York, the Office of Professional Discipline (OPD) investigates complaints about dentists to determine if there is a violation of professional conduct. Patients, colleagues, and others can file a complaint. The OPD will review the complaint and, if warranted,...
As we enter 2024, federal authorities have intensified their scrutiny of healthcare fraud nationwide, engaging with numerous cases against medical professionals. These cases are pivotal, with more than a dozen currently progressing through legal channels. Common...
The Health Insurance Portability and Accountability Act (HIPAA) is getting attention with use of AI and machine learning in the healthcare industry — and for good reason. Although these tools can provide a more efficient and potentially reliable means to organizing...
Anyone who receives notification of an investigation or allegations of healthcare fraud may wonder where the accusations came from. This is a question that can have a few different roots. Two examples include the following. Option #1: A whistleblower One of the more...
Pharmacies help people in their communities. Those who work in these healthcare facilities try to help provide patients and community members with the medications they need to treat illness or injury. In a recent case, the government claims a pharmaceutical manager...
Healthcare fraud sounds like the kind of crime committed by a physician or nurse who conducts unscrupulous procedures or provides prescriptions in exchange for money. Although these are examples of activities that can result in criminal charges for healthcare fraud,...
The United States Department of Justice (DOJ) recently announced criminal charges against 78 healthcare professionals. Attorney General Merrick Garland noted in the press release about the matter that the feds are intensifying their efforts to prosecute healthcare...
