The most prevalent type of defense investigations in healthcare are those related to Medicare or Medicaid fraud. Agencies such as the Department of Justice (DOJ) and the Department of Health and Human Services Office of Inspector General (HHS-OIG) rigorously investigate billing patterns that suggest excessive claims, duplication of services, or medically unnecessary procedures. Such...
As corporate practice of medicine (“CPOM”) restrictions continue to tighten across multiple states, stakeholders in the healthcare industry particularly those involved in multi-state operations must navigate a shifting legal landscape. These evolving regulatory frameworks increasingly limit the degree of control non-physicians may exert over medical practices. Yet, amid this national trend,...
Maintaining your healthcare license is the cornerstone of your professional career as a healthcare provider. Whether you are a physician, pharmacist, nurse, or a clinic administrator, ensuring unwavering compliance and safeguarding your license is not merely an option but a critical imperative. The regulatory landscape, marked by complex state and federal mandates, means that even highly...
Evidence suggests that insurance companies use AI to delay or limit health care that patients need. FatCameraE+ via Getty Images ~~~~~ Over the past decade, health insurance companies have increasingly embraced the use of artificial intelligence algorithms. Unlike doctors and hospitals, which use AI to help diagnose and treat patients, health insurers use these algorithms to decide whether to...
Medicare and Medicaid fraud is one of the most serious risks healthcare providers face today. Whether it’s a simple billing error or a larger compliance issue, any mistake can quickly lead to audits, financial penalties, or even criminal charges. That’s why preventing fraud before it happens is key. What Medicare and Medicaid Fraud Looks Like Medicare and Medicaid fraud happens when someone...
Stem cell treatments have long been a topic of debate within the medical and regulatory fields, balancing potential breakthroughs in medicine with questions of safety, ethics, and oversight. A recent proposal in Florida, brought forth through a Committee Substitute for House Bill 1617, has reignited that debate by challenging existing FDA guidelines and seeking to carve a pathway for expanded...
