The United States Department of Justice’s U.S. Attorney’s Office District of New Jersey recently published a news release claiming a New York man defrauded a health benefit fund of over $4 million. The feds claim the man was part of an intricate healthcare fraud...
The United States Centers for Medicare and Medicaid Services (CMS) has a lot of rules. What happens if a healthcare provider fails to follow them? In some cases, it could mean the provider cannot get reimbursement from Medicare and Medicaid. In others, the answer is...
The federal government recently charged a New York businessman with health care fraud. The entrepreneur ran a non-emergency medical transportation business in the Buffalo area. The business provided services from 2016 through 2020. It was composed of about 15 vehicles...
The feds are aggressively pursuing allegations of healthcare fraud related to relaxed regulations and incentives to help address the pandemic. In a recent example, the government charged 14 people with healthcare fraud related to the pandemic. They claim that those...
In what the Health and Human Services Office of Inspector General is calling the largest audit penalty every imposed on a Medicare Advantage company, the feds have recently completed and an audit and are calling on the company to pay over $200 million back in Medicare...
The United States Department of Health and Human Services (HHS) recently announced updates to its Phase 2 Health Insurance Portability and Accountability Act (HIPAA) Audit Program. These audits aim to check for an entity’s compliance with certain requirements. The...
The Federal Trade Commission (FTC), U.S. Department of Justice Antitrust Division, and offices of state attorneys general along with the Canadian Competition Bureau, European Commission Directorate General for Competition, and U.K.’s Competition and Markets...
In a recent win for hospitals throughout the state, the New York Department of Financial services recently stated insurance providers cannot deny hospital claims based on “administrative reasons.” More specifically, the letter states that insurance provers cannot deny...
An investigation by your state medical board is a big deal. It can lead to steep fines and even a revocation of your medical license, making it impossible to continue your practice in that state. Unfortunately, this could just be the beginning. In some cases, an...
Lawmakers in New Jersey are working to reform the regulations surrounding hospice care in the state. Governor Phil Murphy has already singed one proposal into law and two additional proposals are currently under consideration. Lawmakers point to the fact that New...
