Steps Your Nonprofit Can Take to Mitigate Fraud Risks - Part 2
Fraud Risks at Nonprofit Organizations - Part 1
Digital Planning Podcast Episode: Estate Planning and the Corporate Transparency Act
The Presumption of Innocence Podcast: Episode 38 - A Blueprint for Compliance: The Fraud Pentagon Theory
FCA Uncovered: Mitigating Risk in the Regulatory Spotlight — Regulatory Oversight Podcast
Tackling Credit Push Fraud: Understanding Nacha's Risk Management Package (Part Two) — Payments Pros: The Payments Law Podcast
False Claims Act Insights - Think You Know Whistleblowers? Think Again.
PilieroMazza Annual Review What DOJ’s Annual FCA Report Means for Government Contractors
Ad Law Tool Kit Show – Episode 6 – Mitigating Class Action Exposure
Compliance into the Weeds: The ACFE 2024 Anti-Fraud Technology Benchmarking Report
AD Nauseam: Cabbage Soup v. Keto Diet: The Evolving FTC and NAD Approach to Post-Holiday Weight Loss Claims
The Justice Insiders Podcast: The Sam Bankman-Fried Trial: Defendants Testifying (Poorly), FOMO, and How to Actually Blame Lawyers
Detecting Fraud in New Jersey Workers' Compensation
The Presumption of Innocence Podcast: Episode 25 - An Investigative Journalist’s Insight Into the COVID-19 Fraud Strike Force
Medical Device Legal News with Sam Bernstein: Episode 11
JONES DAY TALKS®: Looking for ESG Fraud – CFTC Solicits Carbon Markets Whistleblowers
ChatGPT Risks for Compliance Programs
The Justice Insiders Podcast: Varsity Blues Reversals Turn DOJ Red
Giving Compliance Advice
Crypto Enforcement Actions - The Crypto Exchange Podcast
Three Men Sentenced for $54 Million TRICARE Fraud Scheme - Three men were sentenced in connection with a $54 million bribery and kickback scheme involving TRICARE, a federal program that provides health insurance benefits...more
The Mitchell Williams Insurance Regulatory team of lawyers recently attended the National Association of Insurance Commissioners (NAIC) 2023 Summer National Meeting which was held in Seattle, Washington. We have prepared a...more
The New York State Office of the Medicaid Inspector General (“OMIG”) conducted three statewide sessions to outline its audit process as it pursues its mission to prevent and detect fraud, waste and abuse in the Medicaid...more
A Florida communications firm and its owner agreed to pay $293,771 to resolve False Claims Act (FCA) allegations that they failed to secure personal information on a federally funded Florida children’s health insurance...more
Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •AG James Sues Cryptocurrency Platform KuCoin, Alleging...more
Alliance for Shared Health, Inc. and an affiliated company and affiliated individuals (collectively, “ASH”) settled with California AG Rob Bonta for $2.1 million to resolve allegations that thousands of Californians purchased...more
The nation’s biggest health insurers are gaming a giant program to provide health coverage to seniors, exploiting the privatization of Medicare Advantage plans to rake in profits with schemes that have drawn fire from...more
SIU stands for Special Investigation Unit, and nearly all insurance companies have one, especially health insurers. SIUs exist to investigate complaints of fraud, waste or abuse, and train claims personnel to recognize and...more
Last week, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) issued Advisory Opinion No. 22-09 (AO 22-09), which addresses a proposed arrangement pursuant to which the operator of a...more
COVID-19 Task Force Established to Enhance Enforcement Efforts against Fraud - On May 17, 2021, the Department of Justice and U.S. Attorney General announced the establishment of the COVID-19 Fraud Enforcement Task Force,...more
Shepherd Premier Aims to Open 30 Small-Home Communities By 2022 - Aug 11th, 2019 via Senior Housing News. Small-home senior living provider, Shepherd Premier Senior Living, offers an alternative to traditional large-scale...more
The growth of direct-to-consumer DNA kits is a big deal with significant ramifications for the life insurance industry. Direct-to-consumer DNA kits, commonly used to track ancestry roots, increasingly allow individuals to...more
The government’s FCA enforcement efforts have continued to focus on key areas concerning the pharmaceutical and medical device industries. In fact, drug and device manufacturers accounted for nearly half of the enforcement...more
We’ve talked a fair amount about the switch to chip & pin card systems over the past few years. But how about a lack of cards altogether? Because that’s what the banks have in mind....more
When was the last time your organization reviewed your insurance policies? Not all policies are equal. Many religious organizations are underinsured. Most should have general liability, property, professional liability,...more
In late June, the New York Court of Appeals affirmed a trial court ruling that there was no coverage for a health insurance company policyholder, under a “Computer Systems Fraud” rider issued by its insurer, for an underlying...more
This Week: Leading Up to the SCOTUS King v. Burwell Decision... House Votes to Repeal the Medical Device Tax... CMS Announces It Will Bolster Transitional Reinsurance Payments... MedPAC Releases June Report to Congress....more
When it comes to health insurance fraud, Carl Sagan’s obsession with the words – billions and billions — are particularly accurate. As the government’s role in health care increases, it is inevitable that fraud against...more
In June 2013, the Department of Health and Human Services, Office of Investigator General (OIG) published a review of its audit of an outpatient therapy services provider. The OIG concluded that the outpatient therapy...more
1. The Claim - An insurer may use the alleged misrepresentations and/or omissions of an insured in the life, health and disability insurance application process in two ways: (i) affirmatively, by seeking rescission of...more
The federal government faces overwhelming challenges in trying to stem the tide of fraud in the health care system. The problem is massive, and even with the increase in resources, and adoption of new tools to fight fraud,...more
Healthcare fraudsters do not discriminate between private and public health insurance. Fraudsters use similar schemes to defraud Medicare and Medicaid and private insurance companies. ...more