Patient Options and Law
2018 was a banner year for HIPAA compliance issues
At patient options we always want to keep you up to date with what is happening in our world of compliance. Lets look at the 2018 report of major trends. After a relatively slow first six months, 2018 turned into an active year for HIPAA enforcement, with the Department of Health and Human Services’ (HHS)…Read More
Even the big dogs are getting caught up in fraud.
Coming to us via NBC26 we see reports of Walgreens settling a huge case of fraud in the state of Wisconsin. Even the large corporations can have what we hope are oversights in their plans so your compliance is essential to keeping your practice safe. The U.S. Attorney in the Eastern District of Wisconsin says…Read More
In 2018 the DOJ recovered 2.5 Billion dollars from Healthcare Fraud
Welcome to the new year. Lets begin by looking back. The DOJ has just released it’s final total funds recovered figure for 2018… It is 2.5B dollars. Lets take a look right from the horse’s mouth on the justice.gov website. Keep in mind that this is just federal dollars that we are talking about here…Read More
What the claim investigation market is doing
A quick way to see what we are going to deal with as providers down the road is to look into what the healthcare fraud industry’s latest advances. Insight partners has released a report on the future of the fraud detection industry in their report, “Healthcare Fraud Detection Market Size and Key Trends in terms…Read More
The most basic case of fraud.
Healthcare fraud happens all the time but the most classic case of fraud is charging for something and not performing the service. Let’s look at the at the recent arraignment of Primera healthcare executives in Atlanta Georgia. Tim Darnell from the ATL based paper patch writes in his article, “Primera Medical Group Execs Charged With…Read More
Serious Fraudulent billing in Texas. Don’t do this.
As a physician you have taken an oath to serve your patients to the best of your ability. In the environment of healthcare it is very easy to commit fraud, whether it be intentional or unintentional, it happens. One way to make sure that you land on the radar for an audit is to just…Read More
Healthcare rumblings with Stark law and how it can impact you.
Let’s delve into Stark law and how it impacts the delivery of healthcare. Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services (“DHS”) if the physician (or an immediate family member) has a financial relationship with that entity. This weeks article…Read More
Keep an eye on your billing companies.
Keep an eye on your billing companies. If you use a billing company you will want to read this story coming out of Miami Florida. The Miami Herald originally ran this article, Their company did medical billing. Now, four of them are headed for federal prison by David J. Neal. This is a pretty sobering situation for…Read More
healthcare fraud and the opioid crackdown
U.S. charges hundreds in healthcare fraud, opioid crackdown Nate Raymond (Reuters) – The U.S. Justice Department on Thursday announced charges against 601 people including doctors for taking part in healthcare frauds that resulted in over $2 billion in losses and contributed to the nation’s opioid epidemic in some cases. The arrests came in dozens of…Read More
Most favored nations in healthcare
What is a most favored nations clause and why is it relevant to healthcare? Put simply it means that the insurer is getting the best price that the doctor is willing to give. How do many people violate this? Cash discounts. Lets look into the details straight from Evan Sznol’s Issue Brief: Most Favored Nation…Read More