Hot Topics - 11/14/2014

FRAUD

1. Exclusion: The Office of Inspector General for HHS settled the following cases alleging fraud due to the employment of an excluded individual:

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Med-Net
November 14, 2014
Client Alerts

Fraud, Hot Topics

Massachusetts AG’s Medicaid Fraud Division Recovers More Than $71M in Federal FY2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid

Nursing Home Psychologist Convicted of Healthcare Fraud Scheme

A federal jury convicted a licensed Illinois psychologist of defrauding

Foreign Medical Student Found Guilty in Home Health Fraud Scheme

A federal jury in Texas convicted a 65-year-old foreign medical

Michigan Podiatrist Convicted of $1.8 Million Healthcare Fraud Scheme

A federal jury convicted a Michigan man for his role

Five Individuals and Two Nursing Facilities Indicted on Healthcare Fraud Charges

Five individuals and two for-profit skilled nursing facilities (SNFs) in

Two Men Charged in $39M Personal Protective Equipment Fraud Scheme

Two Texas men have been charged with conspiracy to commit

Justice Department Charges Dozens for $1.2 Billion in Healthcare Fraud

The Department of Justice announced criminal charges against 36 defendants

Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme

A federal jury convicted a New York ENT doctor for

Healthcare Fraud and Abuse Control Program Fiscal Year 2021 Report

According to the Department of Health and Human Services (HHS)

Florida Healthcare Clinic Owners, Employees Sentenced for Roles in Multiple Fraud Schemes

A federal district judge in Miami sentenced the last of

Former Tennessee Medical Group Director Sentenced to Federal Prison

A former Tennessee medical group director, 62, was sentenced to

Michigan Registered Nurse Pleads Guilty in COVID-19 Vaccination Record Card Fraud

A registered nurse from a veteran’s hospital in Detroit pleaded

Oklahoma AG Announces Settlement with Medical Supply Company

Attorney General John O’Connor announced that a former Oklahoma-based medical

California Doctor to Pay over $9.48M, Sentenced to Prison, to Settle Fraud Allegations

California Attorney General Rob Bonta announced a settlement against a

Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks

Three independent clinical laboratories, their owner and holding company, an

South Carolina Woman Arrested for Exploiting Residents of an Assisted Living Facility

The South Carolina Attorney General announced that his office’s Medicaid

Ineligible Medicaid Provider Arrested for Defrauding Medicaid of More Than $68K

An ineligible Medicaid provider was arrested in Florida for defrauding

Florida Behavior Analyst Arrested for Falsifying Timesheets to Defraud Medicaid

A behavior analyst who was employed by a Florida home

Texas Adult Day Care Owner Sentenced for Healthcare Fraud Scheme

On April 25, 2022, a former owner of multiple Texas

Former Payroll Manager Pleads Guilty to Several Tax Offenses

The Department of Justice U.S. Attorney’s Office District of Connecticut

Ten Individuals Charged with Money Laundering Scheme to Defraud Medicare

An indictment was filed on February 25, 2022, against ten

Two Women Sentenced for Conspiracy to Commit Healthcare Fraud

Two women, one from Colorado and the other from Houston,

False Claims Act Settlements Exceed $5.6 Billion in Fiscal Year 2021

More than $5.6 billion in settlements and judgments have been

Louisiana Woman Arrested for Stealing from Nursing Home Resident

A Louisiana woman was arrested on January 31, 2022, for

Missouri Woman Sentenced for Medicare and Medicaid Fraud

A Missouri woman who had previously pled guilty to Medicare

South Carolina Man Arrested for Fraud and Exploitation of Vulnerable Adult

A South Carolina man has been arrested for financial transaction

Texas Man Extradited from Cameroon to United States to Serve Prison Sentence for Healthcare Fraud and Other Offenses

A Texas man was extradited to Houston on December 10,

Chicago Woman Sentenced for Conspiracy to Commit Healthcare and Wire Fraud

On November 30, 2021, a Chicago woman was sentenced to

Colorado RN Found Guilty of Obtaining Controlled Substances Using Fraud and Deception

A Colorado Registered Nurse (RN) was sentenced to 12 months

South Carolina Family Defrauded Medicaid of Over $3.6 Million

A South Carolina family has been sentenced to federal prison

Healthcare Fraud Self-Disclosure Protocol Revised by OIG

On November 8, 2021, the Department of Health and Human

A Former CFO of 17 Skilled Nursing Facilities Accused of Extensive Fraud

A company that operates seventeen skilled nursing facilities has filed

PA Caregiver Arrested for Using Fraudulent and Stolen Information of Intellectually Disabled Clients to Receive nearly $90,000 in Pandemic Unemployment Assistance Program

A Pennsylvania caregiver has been arrested stealing the personal identifying

DOJ Submits Annual Report to Congress on Activities to Combat Elder Fraud and Abuse

The Department of Justice (DOJ) has submitted their Annual Report

False Claims Allegations Lead to Largest Settlement of Government Healthcare Fraud

A private equity firm and former executives of a Boston

National Healthcare Fraud Enforcement Action Results in Charges of Over 138 Defendants Nationally & $308 Million in Intended Loss Against 52 Defendants in Florida

As part of a nationwide federal law enforcement action to

Illinois Nurse Sentenced on Felony Drug and Healthcare Fraud Charges

An Illinois nurse was sentenced om September 16, 2021, to

National Healthcare Fraud Enforcement Action Results in Charges Involving over $1.4 Billion in Alleged Losses

On September 17, 2021, the Department of Justice announced criminal

OIG Is Alerting the Public about Fraud Schemes Related to COVID-19

The U.S. Department of Health and Human Services (HHS) Office

Three Individuals Facing Federal Charges for Participating in a Healthcare Fraud Scheme to Sell Fraudulent Nursing Degrees

The District of Maryland U.S. Attorney’s Office has filed a

California Man Charged with Scheming to Defraud Buyers of Medical-Grade Gloves During COVID-19 Pandemic-Related Shortage

A California man was arraigned in federal court on July

Owner of a Tennessee Laboratory Charged in Massive Medicare Fraud Scheme

The owner and chief executive officer (CEO) of a Tennessee

Two Louisiana Healthcare Companies Indicted for Multi-Million Dollar Bank Fraud Scheme

A federal grand jury returned an indictment on July 2,

Iowa Man Arrested for Spending His Father’s Money on Himself and Not Paying Nursing Home Bills

An Iowa man has been arrested on a warrant for

A Florida Man Indicted for COVID-19 Relief Fraud

A federal grand jury returned a four-count indictment on March

California Nursing Home Accused of “Dumping” Residents to Admit Higher Reimbursement COVID-19 Residents

A California nursing home is accused of committing numerous abuses,

Philadelphia Man Arrested for $700,000 PPE COVID-19 Fraud Scheme

A man from Philadelphia PA has been arrested in connection

Over $2.2 Billion Recovered by Department of Justice in False Claims in Fiscal Year 2020

The Department of Justice (DOJ) recovered more than $2.2 billion

Completing the Compliance Annual Assessment: Avoiding Fraud, Waste, and Abuse

Jeannine LeCompte, Publishing and Research Coordinator The final component of an

HHS Announces the Establishment of a False Claims Act Working Group

On December 4, 2020, the Department of Health and Human

Med-Net News & Views (October 2020 Edition)

“Operation Rubber Stamp” Upends Expansive Healthcare Telemedicine Fraud Schemes Across South Carolina and Georgia

U.S. Attorneys announced October 7, 2020, that at least 40

Illinois Nursing Home Executives Charged with Operating “Ponzi” Scheme

The owner and Chief Executive Officer (CEO) and the company’s

New York Medical Transportation Company Admits Defrauding Medicaid

New York Medical Transportation Company Admits Defrauding Medicaid A U.S. attorney recently

Employee of Pennsylvania Home Healthcare Service Provider Pleads Guilty in Healthcare Fraud Conspiracy

Employee of Pennsylvania Home Healthcare Service Provider Pleads Guilty in Healthcare

Owner of Michigan Counseling Treatment Center Charged with Medicaid Fraud

Owner of Michigan Counseling Treatment Center Charged with Medicaid Fraud Michigan’s

Government Files Lawsuit Against Nation’s Largest Long-Term Care Pharmacy and Its Parent Company for Fraud in Violating False Claims Act

Government Files Lawsuit Against Nation’s Largest Long-Term Care Pharmacy and

Texas Mental Healthcare Counselor Pleads Guilty to Overbilling Medicare and Medicaid

Texas Mental Healthcare Counselor Pleads Guilty to Overbilling Medicare and

Federal Jury Convicts Three People in $154 Million Texas-Based Money Laundering and Healthcare Fraud Scheme

Federal Jury Convicts Three People in $154 Million Texas-Based Money Laundering

Large Kidney Dialysis Clinic Operator Resolves Fraudulent Billing Allegations for $5.2 Million

Large Kidney Dialysis Clinic Operator Resolves Fraudulent Billing Allegations for $5.2

Medicare Enrollment and Disenrollment: Avoiding Citations and Fraud, Waste, and Abuse

Medicare Enrollment and Disenrollment: Avoiding Citations and Fraud, Waste, and

Connecticut Woman Charged with Embezzlement, Fraud, and Identity Theft from Healthcare Corporation

Connecticut Woman Charged with Embezzlement, Fraud, and Identity Theft from Healthcare Corporation A

Indiana’s Largest Nursing Home System Files Lawsuit Accusing Former Attorney General’s Cousin of Involvement in Fraudulent Kickback Scheme

Indiana’s Largest Nursing Home System Files Lawsuit Accusing Former Attorney General’s

Fake Ambulance Company Used Stolen Medicare Identities in $4.7 Million Fraud Scheme

Fake Ambulance Company Used Stolen Medicare Identities in $4.7 Million

Theft Investigation at the Defense Supply Center in Philadelphia Uncovers $180 Million Fraud

Theft Investigation at the Defense Supply Center in Philadelphia Uncovers $180 Million

Jury Finds Georgia Physician Guilty of Medicare and Medicaid Fraud

Jury Finds Georgia Physician Guilty of Medicare and Medicaid Fraud After a trial

Examples of How Pressure Injury Incidents Can Lead to Fraud, Waste, and Abuse

Examples of How Pressure Injury Incidents Can Lead to Fraud, Waste,

Medical Equipment Company CEO Sentenced for Medicare Fraud in “Operation Brace Yourself” Scheme

Medical Equipment Company CEO Sentenced for Medicare Fraud in “Operation Brace

Texas Ambulance Owner Sent to Prison for Healthcare Fraud

Texas Ambulance Owner Sent to Prison for Healthcare Fraud A Texas man

Pressure Injuries: How They Can Lead to Fraud, Waste, and Abuse Penalties

Pressure Injuries: How They Can Lead to Fraud, Waste, and

Med-Net News & Views (April Edition)

Complying with Communication Training Demands: Accountability, Fraud, and Competency

Complying with Communication Training Demands: Accountability, Fraud, and Competency Jeannine LeCompte,

Florida Healthcare Provider Pleads Guilty in Medicare Fraud Scheme

Florida Healthcare Provider Pleads Guilty in Medicare Fraud Scheme Providing prescriptions for

Two Licensed Nurses and the Former Director of a New York Hospital Convicted of Larceny-Bribery Scheme

Falsification of payroll timesheets constitutes grand larceny Compliance Perspective - Grand Larceny Policies/Procedures: The Compliance

Kansas Nurse Found Guilty of Medicaid Fraud, Drug Crimes, and Related Charges in Three Counties

Human Resources Perspective Policy/Procedure: Policies and procedures need to be up-to-date

Chicago Psychologist Indicted for Allegedly Billing Medicare and Private Insurers for Services Not Rendered

If a resident, their family member, or responsible party/bill payer

Thousands of Insurance Appeals Went to a Doctor Who Feds Say Is a Fraud

If a resident, their family member, or responsible party/bill payer

A.G. Underwood Announces Sentencing of Transportation Company, President, and Driver for Stealing $1.2 Million from Medicaid

Risk Management Perspective Policy/Procedure: Policies and procedures need to be up-to-date

New Jersey Woman Admits Healthcare Fraud Conspiracy Targeting State Health Benefits Programs

QAPI Perspective Policy/Procedure: Policies and procedures need to be up-to-date and

Large Nursing Home Company to Pay $30 Million in False Claims Act Case

Deliberately placing all patients in the highest therapy reimbursement level

Kansas Hospice Settles Medicaid False Claims Lawsuit for Over $300,000

Failure by a hospice facility to use qualified personnel to

Maryland Woman Charged with Healthcare Fraud

Documenting that personal care services for Medicaid beneficiaries were provided

Owner of Georgia Medical Equipment Company Guilty of Medicare Fraud and Identity Theft

Providing medical equipment that is of lower quality than the

Oklahoma Nursing Home Certified Nurse Aide Charged with Financial Exploitation

Failure of a nursing home to ensure that residents are

Two Healthcare Executives Plead Guilty in Connection with Medicaid Behavioral Health Fraud

Submitting claims for Medicaid reimbursement for behavioral healthcare services that

Florida Home Health Services Company Owner and Co-Conspirator Plead Guilty for Roles in $8.6 Million Healthcare Fraud Scheme

A Home Health Agency that uses a massage therapist to

Nurse Sentenced for Stealing Opioid Pain Reliever and Putting Patients at Risk by Deceptive Tampering

Would the theft of fentanyl intended for pain management of

Former Oklahoma Nursing Home Administrator Charged with Allegedly Stealing Over $217,000 from Residents

Does a nursing home potentially violate the False Claims Act

Five Medical Professionals Sentenced to Prison in $11.3 Million Medicare Fraud Scheme

Must a nurse investigate suspicions that certifications of medical necessity

Mississippi Former Hospice Owner Admits to $15M in Fraudulent Healthcare Claims

Does submitting claims for reimbursement to Medicare and Medicaid for

Staffing Agency Nurse Arrested and Charged with Grand Larceny and Working with a Suspended License

Does care given by a nurse with a suspended license

3 Fort Myers Durable Medical Equipment Providers Sentenced to Prison for Payment of Illegal Kickbacks

Does compensating a physician in exchange for his referral of

OIG Excludes Company and Owner from Federal Healthcare Programs

Does using a laboratory service provider excluded by the Office

Physician Convicted of False Billing Scheme

Whether or not a physician violates the False Claims Act

Avoiding Coding and Billing Errors: Detecting and Reporting Fraud, Waste, and Abuse

Avoiding Coding and Billing Errors: Detecting and Reporting Fraud, Waste,

Former Office Manager for Mississippi Nursing Home Pleads Guilty to Embezzlement and Exploitation

The former office manager of a nursing home pleaded guilty

The Triple Check System as a Means of Avoiding Billing and Coding Errors

The Triple Check System as a Means of Avoiding Billing

Doctor Sentenced for Participating in $30 Million Scheme to Defraud Medicare and Medicaid

Doctor, along with seven other defendants who participated in a

SNF Guidelines for Avoiding the Pitfalls of Fraud, Waste, and Abuse

Skilled Nursing Facilities provide a much-needed service, and apart from

Med-Net News & Views (August Edition)

Former CEO and Licensed Nurse Practitioner Pleads Guilty to Healthcare Fraud

Compliance Perspective - Healthcare Fraud: The Compliance Officer together with the

Three Family Members Sentenced to Federal Prison for Healthcare Fraud Involving Durable Medical Equipment

Compliance Perspective - Healthcare Fraud: The Compliance Officer should review the

Owner of Florida Compounding Pharmacy Fraud Scheme Sentenced to 15 Years in Prison

Compliance Perspective - Fraud: If an issue involving the use of

South Carolina Speech Therapist Convicted of Healthcare Fraud and Aggravated Identity Theft

Compliance Perspective - Healthcare Fraud: The facility is not involved in

Legal Battle Erupts at New York Hospital Over Missing Narcotics

Compliance Perspective - Missing Narcotics: The Compliance Officer will review the

Federal Court Awards Nearly $3 Million in Damages and Penalties for Medicaid Fraud Scheme

Compliance Perspective - Medicaid Fraud: The Compliance Officer should review the

Lawsuit Filed Against Nursing Home Where Elderly Resident Died After Being Attacked by Another Resident

Healthcare Compliance Alert - Elderly Resident: The Compliance Officer should review

U.S. Settles False Claims Act Allegations Against Florida Ambulance Company for $1.2 Million

Compliance Perspective: The Compliance Officer should periodically together with the Risk

14 Arizona Assisted-Living Centers Found Discriminating Against Prospective Deaf Residents

Healthcare Compliance Perspective: The Compliance Officer will review the policies and

Nurse Staffing Agency and Nurse Aide Sued in Death of 101-Year-Old Nursing Home Resident

Healthcare Compliance Perspective - Death of a Resident: The Compliance Officer

Religious Discrimination Alleged in Civil Complaint against Health and Rehabilitation Center in Virginia

A former employee (plaintiff) has filed a civil complaint against

Medicaid Provider Agrees to Lifetime Exclusion from Medicaid

Healthcare Compliance Perspective - Lifetime Exclusion from Medicaid: The Compliance Officer

Religious Discrimination Alleged in Civil Complaint against Health and Rehabilitation Center in Virginia

Religious Discrimination Alleged in Civil Complaint against Health and Rehabilitation

Employee Checks in a SNF Environment—Employer Obligations

Employee Checks in a SNF Environment—Employer Obligations The extensive penalties imposed

Woman Sues Houston Area Nursing Home for Wrongful Termination

Healthcare Compliance Perspective - Wrongful Termination: The Compliance Officer will review

Home Healthcare Provider Agrees to $3 Million False Claims Settlement

Healthcare Compliance Perspective - False Claims Settlement: The Compliance Officer will

July Heatwave Forces New Jersey Nursing Home Evacuation When Air Conditioning System Fails

Healthcare Compliance Perspective - Nursing Home Evacuation: The Compliance Officer will

Resident of Skilled Nursing Home Injured in Smoking-Related Accident

Healthcare Compliance Perspective - Resident Injured: The Compliance Officer should review

SNF and Employee Checks—Mandatory and Permissive Exclusions

SNF and Employee Checks—Mandatory and Permissive Exclusions The Office of the

20 months After Family Files Complaint Unlicensed Nurse Finally Faces Charge

Healthcare Compliance Perspective - Nurse Faces Charge: The Compliance Officer should

Kentucky Skilled Nursing Facility, Corporate Management and Owner Agree to Pay $540,000 to Resolve False Claims Allegations

Healthcare Compliance Perspective - False Claims Allegations: The Compliance Officer should

Former Business Manager Arrested and Charged with Embezzling $227,000 from Healthcare Agency

Healthcare Compliance Perspective - Embezzling: The Compliance Officer should review business

Kentucky Man Jailed for Allegedly Stealing from Nursing Home Residents While “Squatting” in an Unoccupied Room

Healthcare Compliance Perspective - Squatting: The Compliance Officer should evaluate the

Med-Net News & Views (June Edition)

Staffing Agency Settles EEOC Sex Harassment and Retaliation Suit for $30,000

Healthcare Compliance Perspective - Retaliation Suit: The Compliance Officer will confer

Wound Services Provider to Pay Almost $400,000 for False Claims Act Allegations

Healthcare Compliance Perspective - False Claims: The Compliance Officer should verify

Bed Rails: Avoiding Noncompliance Penalties

Given that bed rails fall under the category of restraints,

Nearly $50,000 in Overstated Medicaid Claims by Nursing Home Revealed by Tennessee State Auditors

Healthcare Compliance Perspective - Medicaid Claims: The Compliance Officer will involve

Hidden Camera Footage Supports $1.2 Million Awarded in Nursing Home Abuse Case

Healthcare Compliance Perspective -Nursing Home Abuse: The Compliance Officer should involve

VA Hospital Worker Pleads Guilty to Identity Theft of More Than 1,000 Patients

Healthcare Compliance Perspective - Identity Theft: The Privacy Officer needs to

Woman Sentenced to Five Years for Setting Nursing Home Fire Two Years Ago

Healthcare Compliance Perspective Nursing Home Fire: The Compliance Officer should ask

Guidance for the Installation and Maintenance of Bed Rails

Guidance for the Installation and Maintenance of Bed Rails The correct

Snapchat Used by Nursing Home Employees to Post Videos of Elder Abuse

Compliance Perspective - Elder Abuse: The Privacy Officer should investigate the

Charlottesville Nursing Home Resident Dies After Falling into Creek

Healthcare Compliance Perspective: The Compliance Officer should review with the Compliance

North Carolina Nursing Homes Fined $567,976 by Medicare for Resident Abuse

Healthcare Compliance Perspective - Resident Abuse: The Compliance Officer together with

Healthcare Company to Pay More Than $30 Million to Resolve False Claims Act Allegations Related to Rehabilitation Therapy

Compliance Perspective - False Claims: The Compliance Officer should work with

Resident of Assisted Living Center Files Suit Over Staff Accusations She Hallucinated About Bedbug Infestation

Healthcare Compliance Perspective - Bedbugs: The Compliance Officer should investigate any

Legal Considerations When Using Bed Rails

Apart from considerations of resident comfort, there are a number

Underinflated Air Mattress May Have Contributed to a Resident’s Fall and Injury

A resident who was alert and who did not normally

Former Nursing Home Owner and Manager Charged with Multiple Felonies

Healthcare Compliance Perspective - Multiple Felonies: The Compliance Officer should be

Deaf Resident Sues Nursing Home for Lack of Access to Interpreter

Healthcare Compliance Perspective - Resident Sues Nursing Home: The Compliance Officer

Facility Blamed in Death of Former Presidential Adviser’s Father

Healthcare Compliance Perspective: A Compliance Officer faced with multiple concerns, e.g.,

Former Employee Files Suit Claiming Wrongful Discharge and Unlawful Retaliation

Healthcare Compliance Perspective - Wrongful Discharge: The "Ethics" of a Compliance

Bed Rails in a SNF Environment: Physical Restraint or Resident Aid

Bed Rails in a SNF Environment: Physical Restraint or Resident

Middle Tennessee Podiatrist Sentenced to Federal Prison for Health Care Fraud Scheme

Healthcare Compliance Perspective - Healthcare Fraud Scheme: Compliance Officers should develop

Florida Nursing Homes Get Ready for 2018 Hurricane Season

Healthcare Compliance Perspective - Hurricane Season: The Compliance Officer needs to

Man in New York Recovery Center Found Dead and Decomposing

Compliance Perspective: A Compliance Officer's primary role is to be available

Med-Net News & Views (May Edition)

Two-Year Investigation of Medicaid Transportation Fraud Based in Essex County Results in the Arrest of 12 Individuals

Healthcare Compliance Perspective - Medicaid Transportation Fraud: Compliance Officers must audit

CNA Accused of Stealing Money and Using Personal Identity Information of Elderly Couple to Defraud

Healthcare Compliance Perspective - Defraud: A healthcare provider which uses independent

Dealing with HIPAA Privacy Breaches

In 2017, the Department of Health and Human Services’ Office

Nursing Home Miscalculated Resident’s Fall Risk, Possibly Contributing to Her Death

Healthcare Compliance Perspective - Fall Risk: CMS regulation F689 Accidents requires

Neglect of Elder Abuse Cases ‘Deep and Pervasive’ in the State of Minnesota

Healthcare Compliance Perspective - Elder Abuse Cases: While states provide broad

Georgia Man Gets 5-Year Sentence for Filing Fraudulent Income Tax Returns and Cashing U.S. Treasury and Other Checks

Healthcare Compliance Perspective - Fraud: Under the HIPAA privacy rule a

Massachusetts Skilled Nursing Facility Agrees to Settlement of Government Suit Alleging Disability Discrimination Involving Patient

Healthcare Compliance Perspective - Disability Discrimination: In light of growing concern

Biometrics in Nursing Homes. Huh?

To be honest, when I first thought of biometrics, images

The Development of a Resident Privacy Policy

An HIV-positive patient asked an office manager to fax his

Family Practitioner and Orthopedic Surgeon Convicted of Healthcare Fraud

Healthcare Compliance Perspective - Healthcare Fraud: Knowingly making false statements and

Woman Convicted and Sentenced for Healthcare Fraud

Healthcare Compliance Perspective - Healthcare Fraud: Knowingly billing Medicare for services

Missouri Nursing Home Being Investigated for Providing Sub-Standard Care to Residents

Healthcare Compliance Perspective In general, all reported or filed complaints

Chicago Area Physician Indicted for Allegedly Pocketing Nearly $1 Million in Medicare and Insurer Payments for Nonexistent False Claim Treatment

Healthcare Compliance Perspective: The submission of a false claim based on

Massachusetts Doctor Convicted by Jury of Illegally Sharing Patient Medical Files

Healthcare Compliance Perspective: Although the initial act of allowing unauthorized individuals

Athens County Home Health Care Agency Owner Sentenced for Committing $2M Fraud

Healthcare Compliance Perspective: Fraudulent behavior often involves all opportunities available

Internal Structural Requirements for HIPAA Compliance

A medical employee was fired in 2017 after she violated

Congressional Democrats Propose Legislation that Would Ban Noncompete Agreements

Democratic senators helped reign in the new month with proposed

Three Deaths and Numerous Incidents of Alleged Abuse and Neglect Result in Iowa Nursing Home’s Fines of $45,750

Healthcare Compliance Perspective - Abuse and Neglect: Compliance Officers should be

Northeast Texas Hospital Self-Discloses and Resolves Healthcare Compliance Concerns

Healthcare Compliance Perspective: A Compliance Officer, with guidance from Compliance Attorney,

How to Detect Drug Diversion in a Facility

All long-term care facilities are obligated to implement the new

Medical Records Leaked by Transcription Service

A medical transcription service provider was notified last week by

Case Study: Failure to Observe Narcotic Medication Protocol and Missing Fentanyl Patches

Failure to Observe Narcotic Medication Protocol and Missing Fentanyl Patches A

Nursing Home Fighting $25,000 State Fine

Healthcare Compliance Perspective - Nursing Home State Fine: Policies and procedures

Med-Net News & Views (April Edition)

Owner of Assisted Living Home in Florida Accused of Elder Abuse Charges, Arrested and Jailed

Healthcare Compliance Perspective / Elder Abuse Charges: Unresolved citations for substandard

Oahu Physical Therapist Pleads Guilty to Healthcare Fraud

Healthcare Compliance Perspective - Healthcare Fraud: Services provided by non-licensed persons

Pittsburgh Pharmacist Sentenced to Prison for Misbranded Drug Scheme

A federal district court judge has sentenced a resident of

No Water and a Faulty Sprinkler Alarm Cited in Nursing Home Fire

Healthcare Compliance Perspective: Emergency preparedness auditing requires a hands on

U.S. DOJ Charges Missouri Nursing Home’s Social Services Director with Identity Theft from Elderly Residents

Healthcare Compliance Perspective: Suspicious activity that could potentially alert staff to

United States Files Suit Against Pennsylvania Physician for Prescribing Opioids Without Medical Purpose

Healthcare Compliance Perspective: Medicare abuse describes practices that result in

Scenario: Medication Error

A resident was given the wrong IV medication by a

Exclusion List/License Checks

Exclusion List/License Checks Case A certified nursing assistant had been working at

Doctor Lands in Prison for Unlicensed Staff

Anthony Enrico, a Passaic County Podiatrist, was sentenced to three

Med-New News & Views (March Edition)

VA OIG Report Reveals New York VA Medical Center Personnel Failed to Try and Resuscitate a Dying Patient

Healthcare Compliance Perspective: Licensed employees must not only refrain from acting

Employee Screening in Skilled Nursing Facilities: What Questions Not to Ask

Knowing which questions not to ask during employee screening is

Heart Pump Manufacturer Agrees to Pay $3.1 Million to Resolve Kickback Allegations

Healthcare Compliance Perspective: Light meals may be offered in conjunction with

Justice Department Launches Initiative to Fight Sexual Harassment in the Workplace

Healthcare Compliance Perspective: Healthcare providers must develop a written policy and

Internet Robots (Spiders, Crawlers and Web Bots) May Put Healthcare Organizations at Risk for HIPAA Violations

Healthcare Compliance Perspective: Inappropriate use of healthcare provider computers increases the

Employee Screening in Skilled Nursing Facilities: An Introduction

Most SNF employers are aware of the necessity of screening

Getting Compliance Right: Disciplinary Steps and Procedure Reassessment

Skilled nursing facilities (SNF) receiving federal funds are obligated to

Former Long-Term Care Ombudsman Pleads Guilty to Stealing from Nursing Home Resident

Healthcare Compliance Perspective: Public officials must maintain integrity for our

Springfield Nursing Home Residents Take Narcotics from Unsecured Medication Drawer

Healthcare Compliance Perspective: Audits must address medication diversion must account

California Nursing Home Sued for Injury to Former Resident’s Eye

Healthcare Compliance Perspective: Individual occurrences, in an of themselves, are

Med-Net News & Views (February Edition)

3 New Cases of Legionnaires at Illinois Veterans’ Home

Healthcare Compliance Perspective: An effective Compliance and Ethics Program requires

Woman Found Dead Inside Speedway Nursing Home Leads to Licensing Complaint

Healthcare Compliance Perspective: A licensed healthcare professional is responsible, not only

Cousins Committing $2.6 Million in Healthcare Fraud Get Suspended

Healthcare Compliance Perspective: An effective Compliance and Ethics Program requires a

Navigating Alternative payment models (APM) and the Data in 2018 for Home Care Agencies:

By ShirleyAnn Janulewicz RN, BSN, PHN Competing in today’s healthcare market

Wisconsin Nursing Homes Close as Costs Rise and Reimbursement Rates Can’t Keep Up

Healthcare Compliance Perspective: In situations of financial distress, it is important

Getting Compliance Right: Training and Auditing

Skilled nursing facilities (SNFs) receiving federal funds are obligated to

Elopement Assessment After Hospitalization

A resident was readmitted from the hospital, and staff did

Resident’s Death Raises Alarm About Security

Healthcare Compliance Perspective: It is essential to develop elopement risk prevention

Getting Compliance Right: Structure and Policies

Skilled nursing facilities (SNFs) receiving federal funds are obligated to

Physician Admits Guilt in Conspiring to Unlawfully Distribute and Dispense Controlled Substances and Health Care Fraud

Healthcare Compliance Perspective: It is essential that healthcare providers conduct background

Pathologist Testifies Nursing Home Staff Had Chance to Save Lives

Healthcare Compliance Perspective: It is essential to have clear policies and

Attorney General Sues Fentanyl Maker for Deceptive Promotion of Prescription Opioid

Healthcare Compliance Perspective: Prescription drug off-label marketing potentially injures many people

Home Health Care Provider to Pay $6.4 Million to Settle Allegations of False Medicaid Billing

Healthcare Compliance Perspective: Medicare Fraud and Abuse is serious problem that

U.S. Obtains $16.2 Million Judgment Against MRI Provider for Submitting False Claims

Healthcare Compliance Perspective: Medicare reimbursement requires medical services be performed in

Hospital Agrees to Pay $89,000 to Settle EEOC Religious Discrimination Suit

Healthcare Compliance Perspective: A Compliance Program assists a healthcare provider in

Doctor and Patient Recruiters Charged in $18 Million Illegal Distribution of Prescription Drugs Scheme

Healthcare Compliance Perspective: All offers of employment for any position within

Preparing for a Compliance Program Audit

Preparing for a Compliance Program Audit By: Louise LindseyEditor & Betty

Dealing with an EEOC Charge Relating to Sexual Harassment/Discrimination

If all attempts to settle a complaint of sexual harassment

Indiana Hospital Ransomware Attackers Demand Bitcoin Payment

Healthcare Compliance Perspective: Healthcare providers are unfortunately a vulnerable target for

Georgia State Authorities Dismantle Systematic Elder Abuse and Medicaid Fraud Scheme

Healthcare Compliance Perspective: Sometimes a fraud comes along that is just

Healthcare Provider to Pay $2.3 Million to Settle Potential HIPAA Violations

Healthcare Compliance Perspective: When a potential breach of Protected Health Information

Colorado Nursing Home Deaths Lead to 5 Homicide Charges

Healthcare Compliance Perspective: The Residents' Bill of Rights ensures that every

California Healthcare Corporation Agrees to $325K Settlement in Disability Discrimination Class Action Suit

Healthcare Compliance Perspective: All employees in the workplace are responsible for

Medicaid Fraud Complaint Filed Against Former Physicians and Their Business Entities for Filing False Claims

Healthcare Compliance Perspective: Compliance Perspective: False claims and billing fraud may

Training Staff to Avoid Sexual Harassment Incidents

The best way an institution can avoid damaging sexual discrimination

Former Nursing Home Executives Plead Guilty in Kickback Scheme

Healthcare Compliance Perspective: It is essential that all current employees and

Nursing Home Resident Received a Wound Possibly from a Cigarette Burn

A resident has a wound that he claims is related

U.S. Sues Diagnostics Company for Allegedly Billing Medicare for Unnecessary Home Sleep Tests

Healthcare Compliance Perspective: Each employee and vendor of a healthcare provider

Virginia Doctor Sentenced to 30 Years for Oxycodone Distribution Conspiracy

Healthcare Compliance Perspective: Vendors must be screened prior to conducting business

Resident Died and No Defibrillator (AED) Was Used

A resident notified a nurse that she would like to

Developing the Correct Procedure to Deal with Sexual Harassment Claims

Once a sexual discrimination or harassment claim has been made,

Arrests Made in Alleged Cover Up of Neglect and Abuse in Nursing Home

Healthcare Compliance Perspective: Intentional and/or reckless false documentation is a crime,

Pennsylvania DOH Fines Nursing Home Nearly $800,000

Healthcare Compliance Perspective: When compliance violations are originally detected, it is

Three New York Diagnostic Testing Facility Owners Charged for Fraud Scheme

Healthcare Compliance Perspective: Physicians, employees, diagnostic testing facilities, and various other

Defining Sexual Harassment and Discrimination

Having a clear definition of what constitutes sexual harassment and

Imaging Companies and Owners Resolve Swapping and Medicare Fraud Allegations

Healthcare Compliance Perspective: The Anti-Kickback Statute makes it a crime to

Oncology Company Agrees to Pay $26 Million to Settle False Claims Act Allegations

Healthcare Compliance Perspective: Facilities should consistently audit various aspects of their

Med-Net News & Views 2017 (December Edition)

Connecticut Nursing Home Fined

Healthcare Compliance Perspective: Substandard quality of care arising from ineffective

Medical Center Agrees to Settle ADA Claim with Individual Who Is Deaf

Healthcare Compliance Perspective: Residents/patients have the right to be fully informed

Investigation: The Third Stage of the CMS New Survey Process

The “Investigative Process” forms the third major component of the

Hospital Pharmacy Technician Suspended for Diversion of Medications and Compounding Medication Errors

Healthcare Compliance Perspective: Employees for healthcare companies shall adhere to a

DPH Assesses Fines on Nursing Homes for Care Infractions

Healthcare Compliance Perspective: A pattern of submitting claims to Medicare or

Former Owner and Co-Conspirator of Sleep Study Clinics Charged With Estimated $200 Million in Health Care Fraud and Tax Evasion

Healthcare Compliance Perspective: Under federal law, directors, officers, and physicians who

Nurse Charged in Resident’s Death for Medication Errors

Healthcare Compliance Perspective: Each resident's drug regimen must be free from

Home Healthcare Company Settles EEOC Disability Discrimination Suit for $25,000

Healthcare Compliance Perspective: Healthcare providers, under the Americans with Disabilities Act,

Initial Pool: The First Stage of the CMS’s New Survey Process

The “Initial Pool Process” (IPP) forms the first major component

CNA Accused of Credit Card Theft Has License Placed Under Emergency Restriction

Healthcare Compliance Perspective: Healthcare providers must ensure that employed individuals have

Sensitive Medical Records Carelessly Dumped in Public Recycling Bin

Healthcare Compliance Perspective: Healthcare providers must ensure that any documentation containing

Physician-Owned Hospital to Pay $7.5 Million to Settle Kickback Allegations to Physicians in Exchange for Surgical Referrals

Healthcare Compliance Perspective: The Anti-Kickback Statute makes it a crime for

A 70-year-old Woman Arrested for Possession of Toxic Ricin Poison

Healthcare Compliance Perspective: Residents have the right to personal items only

Nursing Home Resident Dies After Van Accident

Healthcare Compliance Perspective: Employees can only perform at the level of

The New Survey Process: What is it, and Why?

November 28, 2017 was the Centers for Medicare & Medicaid

Man Sentenced on Health Care Fraud Conviction

Healthcare Compliance Perspective: Medicare Fraud is knowingly submitting false claims to

Social Media and HIPAA Violations: A Risk for Healthcare Providers

Social Media and HIPAA The time when social media involved only

Woman Pleads Guilty to Stealing from Nursing Home Residents

Charged with 20 criminal counts of "theft and receiving stolen

EEOC’S Final Judgment Finds Health Center Guilty of Sexual Discrimination

Healthcare Compliance Perspective: Harassment based on specific characteristics is unacceptable conduct

Operator of Purported Durable Medical Equipment Providers Pleads Guilty

Healthcare Compliance Perspective: Compliance Officers must focus on ensuring that products

Lawsuit Accuses Senior Living Facility of Elder Abuse and Negligence

Healthcare Compliance Perspective: Healthcare Providers can work in partnership with local

Creating the “Systematic Analysis and Systemic Action” Element of a QAPI

The “Systematic Analysis and Systemic Action” element of the Centers

Doctor Pleads Guilty to Billing Health Care Programs with No Medical License or Office

Healthcare Compliance Perspective: It is the obligation of the employee to

Med-Net News & Views 2017 (November Edition)

Nursing Home Companies Settle Allegations of Poor Care

Healthcare Compliance Perspective: Knowingly submitting claims for services provided that are

Setting up the “Performance Improvement Project” Element of a QAPI

The “Performance Improvement Project” (PIP) element of the Centers for

Federal Agents Investigating Exposure of Patient Data

Healthcare Compliance Perspective: If a breach of protected

Feedback, Data Systems, and Monitoring: The Third Element of QAPI

The “Feedback, Data Systems, and Monitoring” element of the Centers

San Diego Pharmacy to Pay $60,000 to Settle Equal Pay Discrimination Suit

Healthcare Compliance Perspective: Healthcare providers are prohibited from basing pay rates,

Physician Sentenced to Prison for Fraudulent Prescriptions

Healthcare Compliance Perspective: Civil penalties for violating the Federal False Claims

Nurse Sentenced to 2 Years in Prison for Misappropriating Residents’ Pain Pills

Healthcare Compliance Perspective: Quality Assurance and Performance Improvement studies can be

Nursing and Rehabilitation Center Fined for Financial Abuse of Resident

Healthcare Compliance Perspective: Compliance Officers need to monitor their staff for

Bomb Threat Causes Evacuation of Assisted Living and Rehab Facility

Healthcare Compliance Perspective: It is required by law for all healthcare

Employee’s Claims of Sexual Harassment by Patients Is Not Severe Enough to Support Her Claim of a Hostile Working Environment

Compliance Perspective: Harassment occurs when the unwanted conduct is a condition

Operators of Bogus Medical Clinics Charged in Conspiracy to Divert Massive Amounts of Prescription Narcotics to the Black Market

Healthcare Compliance Perspective: License, exclusion, credentialing checks are essential to detect

State and Federal Attorneys Announce $4.4 Million Settlement with NY Visiting Nurse Service and Managed Long-Term Care Plan

Healthcare Compliance Perspective: Overpayments, received for whatever reason, must not only

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United States Files Suit Against Pennsylvania Physician for Prescribing Opioids Without Medical Purpose

Adhering to the Law: Ensuring Vendor Compliance

Federal Investigations Led to Recovery of $383K from Pennsylvania Homecare Service

Human Trafficking and Healthcare Facilities

Insurance Company Accused of Violating Teen’s Privacy

Georgia State Authorities Dismantle Systematic Elder Abuse and Medicaid Fraud Scheme

Two Major Health Insurance Companies Impacted by Third Party Ransomware

CMS Releases Revisions to Special Focus Facility Program

New Hampshire Nursing Home’s Pen Pal Program Bridges Isolation Gap for Residents

Lawsuits Pending Against South Carolina Nursing Home from DHEC Violations and Claims of Reckless Neglectful Care

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