FRAUD/ABUSE
The Department of Labor has issued a new manual/guide for interpretation of the Family and Medical Leave Act. The new reference includes a “roadmap” that walks the employer through the FMLA process from start to finish. A must read for all Human Resource Departments.
Please visit: https://www.dol.gov/whd/fmla/employeeguide.htm
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Massachusetts Attorney General Maura Healey announced that her office’s Medicaid
A federal jury convicted a licensed Illinois psychologist of defrauding
A federal jury in Texas convicted a 65-year-old foreign medical
A federal jury convicted a Michigan man for his role
Five individuals and two for-profit skilled nursing facilities (SNFs) in
Two Texas men have been charged with conspiracy to commit
The Department of Justice announced criminal charges against 36 defendants
A federal jury convicted a New York ENT doctor for
According to the Department of Health and Human Services (HHS)
A federal district judge in Miami sentenced the last of
A former Tennessee medical group director, 62, was sentenced to
A registered nurse from a veteran’s hospital in Detroit pleaded
Attorney General John O’Connor announced that a former Oklahoma-based medical
California Attorney General Rob Bonta announced a settlement against a
Three independent clinical laboratories, their owner and holding company, an
The South Carolina Attorney General announced that his office’s Medicaid
An ineligible Medicaid provider was arrested in Florida for defrauding
A behavior analyst who was employed by a Florida home
On April 25, 2022, a former owner of multiple Texas
The Department of Justice U.S. Attorney’s Office District of Connecticut
An indictment was filed on February 25, 2022, against ten
Two women, one from Colorado and the other from Houston,
More than $5.6 billion in settlements and judgments have been
A Louisiana woman was arrested on January 31, 2022, for
A Missouri woman who had previously pled guilty to Medicare
A South Carolina man has been arrested for financial transaction
A Texas man was extradited to Houston on December 10,
On November 30, 2021, a Chicago woman was sentenced to
A Colorado Registered Nurse (RN) was sentenced to 12 months
A South Carolina family has been sentenced to federal prison
On November 8, 2021, the Department of Health and Human
A company that operates seventeen skilled nursing facilities has filed
A Pennsylvania caregiver has been arrested stealing the personal identifying
The Department of Justice (DOJ) has submitted their Annual Report
A private equity firm and former executives of a Boston
As part of a nationwide federal law enforcement action to
An Illinois nurse was sentenced om September 16, 2021, to
On September 17, 2021, the Department of Justice announced criminal
The U.S. Department of Health and Human Services (HHS) Office
The District of Maryland U.S. Attorney’s Office has filed a
A California man was arraigned in federal court on July
The owner and chief executive officer (CEO) of a Tennessee
A federal grand jury returned an indictment on July 2,
An Iowa man has been arrested on a warrant for
A federal grand jury returned a four-count indictment on March
A California nursing home is accused of committing numerous abuses,
A man from Philadelphia PA has been arrested in connection
The Department of Justice (DOJ) recovered more than $2.2 billion
Jeannine LeCompte, Publishing and Research Coordinator The final component of an
On December 4, 2020, the Department of Health and Human
U.S. Attorneys announced October 7, 2020, that at least 40
The owner and Chief Executive Officer (CEO) and the company’s
New York Medical Transportation Company Admits Defrauding Medicaid A U.S. attorney recently
Employee of Pennsylvania Home Healthcare Service Provider Pleads Guilty in Healthcare
Owner of Michigan Counseling Treatment Center Charged with Medicaid Fraud Michigan’s
Government Files Lawsuit Against Nation’s Largest Long-Term Care Pharmacy and
Texas Mental Healthcare Counselor Pleads Guilty to Overbilling Medicare and
Federal Jury Convicts Three People in $154 Million Texas-Based Money Laundering
Large Kidney Dialysis Clinic Operator Resolves Fraudulent Billing Allegations for $5.2
Medicare Enrollment and Disenrollment: Avoiding Citations and Fraud, Waste, and
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
Fake Ambulance Company Used Stolen Medicare Identities in $4.7 Million
Theft Investigation at the Defense Supply Center in Philadelphia Uncovers $180 Million
Jury Finds Georgia Physician Guilty of Medicare and Medicaid Fraud After a trial
Examples of How Pressure Injury Incidents Can Lead to Fraud, Waste,
Medical Equipment Company CEO Sentenced for Medicare Fraud in “Operation Brace
Texas Ambulance Owner Sent to Prison for Healthcare Fraud A Texas man
Pressure Injuries: How They Can Lead to Fraud, Waste, and
Complying with Communication Training Demands: Accountability, Fraud, and Competency Jeannine LeCompte,
Florida Healthcare Provider Pleads Guilty in Medicare Fraud Scheme Providing prescriptions for
Falsification of payroll timesheets constitutes grand larceny Compliance Perspective - Grand Larceny Policies/Procedures: The Compliance
Human Resources Perspective Policy/Procedure: Policies and procedures need to be up-to-date
If a resident, their family member, or responsible party/bill payer
If a resident, their family member, or responsible party/bill payer
Risk Management Perspective Policy/Procedure: Policies and procedures need to be up-to-date
QAPI Perspective Policy/Procedure: Policies and procedures need to be up-to-date and
Deliberately placing all patients in the highest therapy reimbursement level
Failure by a hospice facility to use qualified personnel to
Documenting that personal care services for Medicaid beneficiaries were provided
Providing medical equipment that is of lower quality than the
Failure of a nursing home to ensure that residents are
Submitting claims for Medicaid reimbursement for behavioral healthcare services that
A Home Health Agency that uses a massage therapist to
Would the theft of fentanyl intended for pain management of
Does a nursing home potentially violate the False Claims Act
Must a nurse investigate suspicions that certifications of medical necessity
Does submitting claims for reimbursement to Medicare and Medicaid for
Does care given by a nurse with a suspended license
Does compensating a physician in exchange for his referral of
Does using a laboratory service provider excluded by the Office
Whether or not a physician violates the False Claims Act
Avoiding Coding and Billing Errors: Detecting and Reporting Fraud, Waste,
The former office manager of a nursing home pleaded guilty
The Triple Check System as a Means of Avoiding Billing
Doctor, along with seven other defendants who participated in a
Skilled Nursing Facilities provide a much-needed service, and apart from
Compliance Perspective - Healthcare Fraud: The Compliance Officer together with the
Compliance Perspective - Healthcare Fraud: The Compliance Officer should review the
Compliance Perspective - Fraud: If an issue involving the use of
Compliance Perspective - Healthcare Fraud: The facility is not involved in
Compliance Perspective - Missing Narcotics: The Compliance Officer will review the
Compliance Perspective - Medicaid Fraud: The Compliance Officer should review the
Compliance Perspective: The Compliance Officer should periodically together with the Risk
Healthcare Compliance Perspective: The Compliance Officer will review the policies and
Healthcare Compliance Perspective - Death of a Resident: The Compliance Officer
A former employee (plaintiff) has filed a civil complaint against
Healthcare Compliance Perspective - Lifetime Exclusion from Medicaid: The Compliance Officer
Religious Discrimination Alleged in Civil Complaint against Health and Rehabilitation
Healthcare Compliance Perspective - Wrongful Termination: The Compliance Officer will review
Healthcare Compliance Perspective - False Claims Settlement: The Compliance Officer will
Healthcare Compliance Perspective - Nursing Home Evacuation: The Compliance Officer will
Healthcare Compliance Perspective - Resident Injured: The Compliance Officer should review
SNF and Employee Checks—Mandatory and Permissive Exclusions The Office of the
Healthcare Compliance Perspective - Nurse Faces Charge: The Compliance Officer should
Healthcare Compliance Perspective - False Claims Allegations: The Compliance Officer should
Healthcare Compliance Perspective - Embezzling: The Compliance Officer should review business
Healthcare Compliance Perspective - Squatting: The Compliance Officer should evaluate the
Healthcare Compliance Perspective - Retaliation Suit: The Compliance Officer will confer
Healthcare Compliance Perspective - False Claims: The Compliance Officer should verify
Given that bed rails fall under the category of restraints,
Healthcare Compliance Perspective - Medicaid Claims: The Compliance Officer will involve
Healthcare Compliance Perspective -Nursing Home Abuse: The Compliance Officer should involve
Healthcare Compliance Perspective - Identity Theft: The Privacy Officer needs to
Compliance Perspective - Elder Abuse: The Privacy Officer should investigate the
Healthcare Compliance Perspective: The Compliance Officer should review with the Compliance
Healthcare Compliance Perspective - Resident Abuse: The Compliance Officer together with
Compliance Perspective - False Claims: The Compliance Officer should work with
Apart from considerations of resident comfort, there are a number
A resident who was alert and who did not normally
Healthcare Compliance Perspective - Multiple Felonies: The Compliance Officer should be
Healthcare Compliance Perspective - Resident Sues Nursing Home: The Compliance Officer
Healthcare Compliance Perspective: A Compliance Officer faced with multiple concerns, e.g.,
Healthcare Compliance Perspective - Wrongful Discharge: The "Ethics" of a Compliance
Healthcare Compliance Perspective - Healthcare Fraud Scheme: Compliance Officers should develop
Healthcare Compliance Perspective - Hurricane Season: The Compliance Officer needs to
Healthcare Compliance Perspective - Medicaid Transportation Fraud: Compliance Officers must audit
Healthcare Compliance Perspective - Defraud: A healthcare provider which uses independent
Healthcare Compliance Perspective - Fall Risk: CMS regulation F689 Accidents requires
Healthcare Compliance Perspective - Fraud: Under the HIPAA privacy rule a
Healthcare Compliance Perspective - Disability Discrimination: In light of growing concern
Healthcare Compliance Perspective - Healthcare Fraud: Knowingly making false statements and
Healthcare Compliance Perspective In general, all reported or filed complaints
Healthcare Compliance Perspective: The submission of a false claim based on
Healthcare Compliance Perspective: Although the initial act of allowing unauthorized individuals
Healthcare Compliance Perspective: Fraudulent behavior often involves all opportunities available
Democratic senators helped reign in the new month with proposed
Healthcare Compliance Perspective: A Compliance Officer, with guidance from Compliance Attorney,
All long-term care facilities are obligated to implement the new
A medical transcription service provider was notified last week by
Failure to Observe Narcotic Medication Protocol and Missing Fentanyl Patches A
Healthcare Compliance Perspective - Nursing Home State Fine: Policies and procedures
Healthcare Compliance Perspective - Healthcare Fraud: Services provided by non-licensed persons
A federal district court judge has sentenced a resident of
Healthcare Compliance Perspective: Suspicious activity that could potentially alert staff to
Healthcare Compliance Perspective: Medicare abuse describes practices that result in
Exclusion List/License Checks Case A certified nursing assistant had been working at
Anthony Enrico, a Passaic County Podiatrist, was sentenced to three
Healthcare Compliance Perspective: Licensed employees must not only refrain from acting
Healthcare Compliance Perspective: Light meals may be offered in conjunction with
Healthcare Compliance Perspective: Inappropriate use of healthcare provider computers increases the
Most SNF employers are aware of the necessity of screening
Healthcare Compliance Perspective: Public officials must maintain integrity for our
Healthcare Compliance Perspective: Audits must address medication diversion must account
Healthcare Compliance Perspective: Individual occurrences, in an of themselves, are
Healthcare Compliance Perspective: An effective Compliance and Ethics Program requires
Healthcare Compliance Perspective: An effective Compliance and Ethics Program requires a
By ShirleyAnn Janulewicz RN, BSN, PHN Competing in today’s healthcare market
Skilled nursing facilities (SNFs) receiving federal funds are obligated to
Healthcare Compliance Perspective: It is essential to develop elopement risk prevention
Healthcare Compliance Perspective: It is essential to have clear policies and
Healthcare Compliance Perspective: Medicare Fraud and Abuse is serious problem that
Healthcare Compliance Perspective: Medicare reimbursement requires medical services be performed in
Healthcare Compliance Perspective: A Compliance Program assists a healthcare provider in
Healthcare Compliance Perspective: All offers of employment for any position within
Healthcare Compliance Perspective: Healthcare providers are unfortunately a vulnerable target for
Healthcare Compliance Perspective: Sometimes a fraud comes along that is just
Healthcare Compliance Perspective: When a potential breach of Protected Health Information
Healthcare Compliance Perspective: All employees in the workplace are responsible for
Healthcare Compliance Perspective: Compliance Perspective: False claims and billing fraud may
Healthcare Compliance Perspective: It is essential that all current employees and
A resident has a wound that he claims is related
Healthcare Compliance Perspective: Each employee and vendor of a healthcare provider
Healthcare Compliance Perspective: When compliance violations are originally detected, it is
Healthcare Compliance Perspective: Physicians, employees, diagnostic testing facilities, and various other
Healthcare Compliance Perspective: The Anti-Kickback Statute makes it a crime to
Healthcare Compliance Perspective: Facilities should consistently audit various aspects of their
Healthcare Compliance Perspective: Substandard quality of care arising from ineffective
Healthcare Compliance Perspective: Employees for healthcare companies shall adhere to a
Healthcare Compliance Perspective: A pattern of submitting claims to Medicare or
Healthcare Compliance Perspective: Under federal law, directors, officers, and physicians who
Healthcare Compliance Perspective: Each resident's drug regimen must be free from
Healthcare Compliance Perspective: Healthcare providers, under the Americans with Disabilities Act,
The “Initial Pool Process” (IPP) forms the first major component
Healthcare Compliance Perspective: Healthcare providers must ensure that employed individuals have
Healthcare Compliance Perspective: Healthcare providers must ensure that any documentation containing
Healthcare Compliance Perspective: The Anti-Kickback Statute makes it a crime for
Healthcare Compliance Perspective: Medicare Fraud is knowingly submitting false claims to
Charged with 20 criminal counts of "theft and receiving stolen
Healthcare Compliance Perspective: Compliance Officers must focus on ensuring that products
Healthcare Compliance Perspective: Healthcare Providers can work in partnership with local
The “Systematic Analysis and Systemic Action” element of the Centers
Healthcare Compliance Perspective: It is the obligation of the employee to
Healthcare Compliance Perspective: Knowingly submitting claims for services provided that are
Healthcare Compliance Perspective: If a breach of protected
The “Feedback, Data Systems, and Monitoring” element of the Centers
Healthcare Compliance Perspective: Healthcare providers are prohibited from basing pay rates,
Healthcare Compliance Perspective: Civil penalties for violating the Federal False Claims
Healthcare Compliance Perspective: Quality Assurance and Performance Improvement studies can be
Healthcare Compliance Perspective: Compliance Officers need to monitor their staff for
Compliance Perspective: Harassment occurs when the unwanted conduct is a condition
The “Design and Scope” element of the Centers for Medicare
By: David Barmak, Esq. Three recent class action suits involving long-term-care
Healthcare Compliance Perspective: Compliance and Ethics Committees must be cognizant of
Healthcare Compliance Perspective: If sidestepping standard medical procedures to boost profits
Healthcare Compliance Perspective: An effective Compliance and Ethics Program
Healthcare Compliance Perspective: Compliance Officers must ensure that Human Resources and
Healthcare Compliance Perspective: Patient Abuse violates Medicare Conditions of Participation which,
Last August, a woman with Alzheimer’s disease was reported missing
Healthcare Compliance Perspective: False claims may result when a healthcare provider
Compliance Perspective: It is the Compliance Officer's responsibility when a
Compliance Perspective: Deliberately ignoring or failing to obtain a resident's or
Healthcare Compliance Perspective: The Compliance Officer is responsible for developing and
“Man’s inhumanity to man” has no boundaries as evidenced by
Compliance Perspective: The compliance officer shall commence an investigation as soon
Compliance Perspective: Audits must be performed to ensure that nursing home
Healthcare Compliance Perspective: Kickbacks paid to referral sources and/or Medicare beneficiaries
Healthcare Compliance Perspective: A Compliance Officer must ensure that families understand
The new CEO and vice president of the company that
Healthcare Compliance Perspective: A culture of compliance and ethics requires manager/owner's
Healthcare Compliance Perspective: This new statute applies to New Jersey only;
Healthcare Compliance Perspective: License, exclusion, credentialing checks are essential to detect
Healthcare Compliance Perspective: Worthless services coupled with intentionally falsified documentation lead
Healthcare Compliance Perspective: Excluded providers shall not participate in federally funded
Healthcare Compliance Perspective: Auditors must not only look at pink and
Healthcare Compliance Perspective: False documentation creates harm on multiple levels -
A 70-year-old woman, who had been a family physician, was
Recent ransomware attacks against healthcare facilities have exposed many institutions
Healthcare Compliance Perspective: If Compliance Officers are faced with an actual
Healthcare Compliance Perspective: Healthcare fraud may at times pale by comparison
Healthcare Compliance Perspective: The Office of Inspector General developed new approaches
By: Betty Frandsen, MHA, RN, NHA, CDONA, FACDONA, C-NE, IP-BC
Healthcare Compliance Perspective: A skilled nursing facility is obligated to proactively
Healthcare Compliance Perspective: Overpayments, received for whatever reason, must not only
Healthcare Compliance Perspective: The most challenging compliance exposure to root out
Healthcare Compliance Perspective: Compliance Officers must ensure that the services billed
The defendant is accused of submitting approximately $9 million
Healthcare Compliance Perspective: The recurring theme of fraud as a slippery
By: Betty Frandsen, MHA, RN, NHA, CDONA, FACDONA, C-NE, IP-BC and Jeannine
Healthcare Compliance Perspective: Healthcare providers must continuously remind themselves of the
An 80-year-old woman, was admitted to a healthcare and rehabilitation
A highly-rated Catholic nursing home in Newbury Park has agreed
Healthcare Compliance Perspective: The Federal Anti-Kickback Statute 42 U.S.C. § 1320a-7(b)
A 57-year-old male resident at a Chicago Hispanic nursing home
Preventing Abuse and Fraud with Antibiotic Stewardship Programs By: Betty Frandsen, MHA,
A second “whistleblower” lawsuit which alleges that one of the
A Department of Health and Human Services (HSS) memo instructing
The U.S. Department of Health and Human Services (HHS) Office
By: Louise Lindsey, B.S., M.A., D.Div. A recent article in the
Bullying does not just exist out in the world, but
The healthcare industry has suffered a 62 percent increase in
Nursing Home Intrusion: Not On Your Watch? By: David S. Barmak,
Healthcare Fraud: A Safe and Profitable Return on Criminal Investment By:
False Imprisonment: A Legal Cause of Action By: Betty Frandsen, MHA, RN,
Negligence in Long Term Care: Avoiding Potential Liability By: Betty Frandsen, MHA,
FRAUD/ABUSE 1.The Food and Drug Administration’s new policy proposal on repackaging
FRAUD/ABUSE FRAUD/ABUSE Masoncare’s Wallingford nursing home has been named in a lawsuit
FRAUD/ABUSE FRAUD/ABUSE Office of Inspector General recently reported to Congress on its
FRAUD/ABUSE FRAUD/ABUSE Employee of Ambulance Company Sentenced for Fraud: An employee of
FRAUD/ABUSE FRAUD/ABUSE Owners of Physical Therapy Company Charged For Role in Fraud
FRAUD/ABUSE FRAUD/ABUSE Qui Tam Lawsuit Filed Against Medical Providers by Medical Society:
FRAUD/ABUSE FRAUD/ABUSE Ten Regional Nursing Home Task Forces to Be Created: The
FRAUD/ABUSE DE Senator Questions HHS Regarding Inappropriate Social Media Posts by
FRAUD/ABUSE Prison Sentence Handed Down in Scheme to Claiming to Reduce
FRAUD/ABUSE A Nursing home sued after posting nude photos A lawsuit
FRAUD/ABUSE CNA Receives Prison Sentence for Resident Abuse: A CNA working
FRAUD/ABUSE Company Agrees to Pay $600,000 in Settlement: Genesis Healthcare LLC
FRAUD/ABUSE 71 Month Prison Sentence in Fraud Case: A Texas psychiatrist
FRAUD/ABUSE Laboratory to Pay $8.5 Million in False Claims Settlement: Wisconsin
FRAUD/ABUSE Ohio Long-Term Care Facility to Pay $1 Million Following Death
FRAUD/ABUSE South Carolina Hospital To Pay $237 Million to Resolve False
FRAUD/ABUSE Long-Term Care Pharmacy Agrees to Settlement: PharMerica Corp., a long-term
FRAUD/ABUSE $118.7 Million False Claims Settlement Reached: A Florida-based healthcare company
FRAUD Bookkeeper Convicted of Stealing from Trust Fund Accounts of Patients:
EMPLOYMENT Workplace Violence Bill Proposed in MA: The Massachusetts Nurses Association
DISCRIMINATION (NON-EMPLOYMENT) ADA Settlement: A Virginia nursing home has agreed to
FRAUD/ABUSE Settlement Reached Following Anti-Kickback and Stark Law Violations: The Westchester
FRAUD/ABUSE Three Sentenced in Medicare Fraud Scheme: According to the Department
FRAUD/ABUSE Payroll Scam: Two employees of a Pennsylvania nursing home have
FRAUD/ABUSE 1. Anti-Kickback Violations: According to McKnight’s Long Term Care News,
FRAUD/ABUSE 1. Anti-Kickback Violations: According to McKnight’s Long Term Care News,
FRAUD/ABUSE 1. Exclusion – According to a 4/29/15 special Investigative Report
MEDICARE/MEDICAID NEWS &APPEALS OF CMS PENALTIES/REMEDIES 1. MDS Focused Surveys to
FRAUD 1. Kickbacks - Long Term Care Pharmacy: United States Department
LITIGATION 1. Production of Quality Assurance Committee documents under the Federal
FRAUD 1. A new bill introduced by Representatives Ted Deutch (D-FL)
FRAUD 1. Exclusion: The Office of Inspector General for HHS settled
FRAUD 1. Pharmacy: A NJ pharmacist, with a compounding pharmacy in
FRAUD 1. Two Whistle-Blower suits, under the False Claims Act, were
I. FRAUD Health and Human Services issued a proposed rule on
FRAUD 1. Two Detroit-area residents were arrested and charged with conspiracy
FRAUD 1. Maryland nursing home agrees to pay $1.3 million settlement
Have you seen . . .
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