Fraud and Abuse

Global sting seizes $41 billion in illegal meds June 28, 2013 | Frank Irving - Editor
Global sting seizes $41 billion in illegal meds
The International Internet Week of Action, a global cooperative effort to combat the online sale and distribution of potentially counterfeit and illegal medical products, concluded June 25 with measures taken against more than 9,600 websites, according to an update from the U.S. Food and Drug Administration. Many of those sites, falsely claiming to be Canadian pharmacies, appeared to be operating as a part of an organized criminal network.
6 drivers of health plan fraud and waste June 11, 2013 | Frank Irving - Editor
Study uncovers 6 drivers of health plan fraud and waste
Healthcare fraud is not limited to the Medicare and Medicaid population, according to newly released research from Truven Health Analytics, which looked at insurance claims data for 11.6 million commercially insured individuals and their dependents at 150 large employers over a period of one year.
CMS clamping down on Medicare fraud June 07, 2013 | Frank Irving - Editor
CMS clamping down on Medicare fraud
Over the last four years, the Obama administration has recovered nearly $15 billion in healthcare fraud judgments, settlements, and administrative impositions, according to the Centers for Medicare & Medicaid Services, which has revoked 14,663 providers and suppliers' ability to bill in the Medicare program since March 2011.
Strike force finds $223M in alleged fraud May 16, 2013 | Anthony Brino - Contributing Writer
Strike force uncovers $223 million in alleged Medicare fraud
The federal government has uncovered a string of alleged Medicare fraud attempts involving 89 individuals in eight cities. About a quarter of the individuals charged are doctors, nurses and medical professionals, Justice Department officials said.
Law expert's views on excluded persons May 15, 2013 | Frank Irving - Editor
Paul Sanders
PhysBizTech talked to Paula Sanders, principal and chair of law firm Post & Schell's Health Care Practice Group, about the potential impact at the physician practice level of the Office of Inspector General's May 9 guidance on excluded persons. "The penalties can be catastrophic if you are working with someone who has been excluded," cautions Sanders.
OIG strengthens authority on exclusions May 14, 2013 | Frank Irving - Editor
OIG strengthens authority on exclusions
The Office of Inspector General has the authority to exclude from participation in Medicare, Medicaid and other federal healthcare programs persons who "have engaged in fraud or abuse and to impose civil money penalties (CMPs) for certain misconduct related to federal healthcare programs." Providers who employ or contract with an excluded person retain substantial potential CMP liability.
EHR education for all, AHIMA advises May 07, 2013 | Diana Manos
EHR education for all, AHIMA advises
Electronic health records, when used correctly, produce more accurate documentation leading to more complete coding, and ultimately, more accurate reimbursement claims, according to Sue Bowman, senior director of coding policy and compliance of the American Health Information Management Association, who spoke May 3 during a government-sponsored listening session.
6 tips for better data security April 29, 2013 | Bernie Monegain - Editor
When it comes to privacy and data security, healthcare entities face tremendous exposure to regulatory violations and monetary damages. William Tanenbaum, partner at New York-based technology law firm Kaye Scholer LLP, offers 6 recommendations that can help ensure better data security.

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