Podcasts about civil money penalty

  Banks has always been a secretive establishment, heightened even more so by The Bank Secrecy Act. This makes most, if not all transactions with them a bit unclear and complicated. Bob Roark sits down with https://www.linkedin.com/in/robinjroberts (Robin Roberts), CEO of https://ppnb.com/ (Pikes Peak National Bank), to delve into this law and how the 9/11 incident strengthened it through the Patriot Act. She explains why it is better to simply go on with your usual bank transactions instead of structuring it. Robin also talks about the penalties that come with breaking the Bank Secrecy Act both on the side of the customer as well as the banks. --- Watch the episode https://youtu.be/xzO4mty6K7E (here) The Bank Secrecy Act, What It Is And Why Business Owners Should Be Aware With Robin Roberts, CEO Pikes Peak National Bank Have you ever wondered why banks sometimes do things that are not quite clear? In this series, I have Robin Roberts. She's the CEO of https://www.ppnb.com/ (Pikes Peak National Bank). She's going to be talking about the Bank Secrecy Act and how that might apply to you as a business owner. Enjoy. Thank you. --- How many times you have said, “I've got a secret and I'm not telling.” The banks have secrets too, but it's not because they want to have secrets. It's because they have a Bank Secrecy Act. We thought we would take in, pull the cover off of the secrets in the Bank Secrecy Act. You talk about them and how they might affect you as the business owner and a client of a bank. Robin, thank you. This is Robin Roberts the CEO of https://www.ppnb.com/ (Pikes Peak National Bank). We are in the demystifying stage of talking about lending, banking and business owners. I always felt like I need to talk about the Bank Secrecy Act because it's a law. First of all, it was created in 1971 or 1972 to at least find racketeering, drug rings and money laundering being done through the banking system. After 9/11, with the Patriot Act, the Bank Secrecy Act was strengthened. Several things were added to the Bank Secrecy Act that banks have been doing since 2001. The Patriot Act continues to be renewed by Congress so they stay in place. I'm not telling any secrets. You can look up the Bank Secrecy Act and the regulations, it's publicly available but I don't think it's public knowledge. [bctt tweet="Any business dealing in money is going to have to follow the Bank Secrecy Act." username=""] Most people do not understand how much the bank is reporting about you and not under penalty of law for the bank but under penalty of law for individual employees who do not follow the Bank Secrecy Act. This is a particular law where the employee themselves can be assessed that is called a Civil Money Penalty or assessment where they have to pay a fine because they didn't follow the Bank Secrecy Act. There are severe penalties for not following it. That's how seriously the Bank Secrecy Act is looked at by bank regulators and by bankers in general. [caption id="attachment_5889" align="aligncenter" width="600"] Bank Secrecy Act: Most people do not understand how much the bank is reporting about you and not under penalty of law for the bank, but under penalty of law for individual employees who do not follow the Bank Secrecy Act.[/caption]   With that being said, one must not cross the Bank Secrecy Act. Our favorite discussion is the one about if I deposit X dollars at this bank and X dollars at this branch, is that a reportable thing? Please don't ask that. Do not go up to the teller and ask them, “I've got this cash. I need to bring it in but I don't want it to be reported. What's the threshold if I take it over here to this branch?” The fact that you are asking that, the teller has to report that you wanted to structure transactions. It's called structuring. There are basic thresholds under the Bank Secrecy Act. $10,000 is a general fine. $9,999 is not going to cut it? At least $10,001

Hey Medicare Nation! www.TheMedicareNation.com Today, I'm finishing up my series on the Medicare Plan Sponsors that CMS has issued Sanctions and/or Civil Money Penalties for in 2020! THREE more plan sponsors to discuss! CMS sent notice to Ms. Aparna Abburi, President of Health Care Service Corporation (HCSC), on February 28, 2020, that CMS was imposing a Civil Money Penalty in the amount of $381,272.00! HUGE Penalty people! According to CMS Summary of Non-Compliance, HCSC disclosed to CMS that it "discovered" a backlog of unprocessed Part C (Medical) Appeals. The Majority of these appeals were from claims from providers (doctors and/or facilities) or ..... reimbursement requests from enrollees. HCSC has the right to Appeal CMS Decision.   NEXT Up..... is Triple-S Management Corporation! CMS sent a Notice to Ms. Madeline Hernandez-Urquiza, President of Triple-S Management Corporation, on February 28, 2020. CMS notified Triple-S that they had made a determination to impose a civil money penalty in the amount of $329,872.00! CMS reported that Triple-S failed to comply with Medicare requirements related to Part D Formulary and benefit administration. Triple-S has the right to Appeal CMS decision. Last up..... is Tufts Health Plan, Inc.  CMS sent notice to Mr. Thomas Crosswell, President and CEO of Tufts Health Plan, Inc., to advise them of CMS' determination to impose a Civil Money Penalty in the amount of $28,302.00. CMS Auditors reported that Tufts failed to comply with Medicare requirements related to Part D Formulary and benefit administration and coverage determinations, appeals, and grievances in violations of Medicare regulations. Tufts has the right to Appeal CMS' decision. If YOU are unhappy with any of the three Medicare Advantage Plan Sponsors, give Medicare a call. You can request a "Special Election Period," based on your experience with any of these companies. Call Medicare at  800 - 633 - 4227  24hrs a day, 7 days a week. www.TheMedicareNation.com   Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening!  

Hey Medicare Nation! Medicare Nation CMS Imposes a Civil Money Penalty against HUMANA! CMS conducted an "Audit" of Humana's Medicare Operations from June 3, 2019 through June 21, 2019. Humana failed to comply with Medicare requirements related to Part D formulary and benefit administration and coverage derterminations, appeals, and grievances in violation of 42 C.F.R. Part 423, Subparts C and M. Humana's failures in these areas were systemic and adversely affected, or had the substantial likelihood of adversely affecting, enrollees. CMS provided notice to Humana's CEO, Mr. Bruce Broussard, on February 28, 2020, that CMS imposed a Civil Money Penalty in the amount of ........ $257, 262! Humana failed to properly administer the CMS "transition" policy. This means if you are enrolling in a new plan, and you take a prescription that is NOT on the new plan's formulary (drug list), the plan MUST allow you to "transition" by allowing you a 31 day supply of your prescription drug.  This allows you time to speak with your doctor to see if there is an alternative prescription drug on the new plan ...... or...... you can request a "Formulary Exception." This means your doctor is requiring you to take this medication, because it is the one that is stablizing or correcting your condition, and that you need to continue to take it. If the drug is NOT on the new plan's formulary and they Approve the formulary exception, you WILL be charged a higher amount for taking a drug that is not on their formulary. Humana has the right to appeal the decision by requesting a hearing. The notice is signed by John Scott, Acting Director of the Medicare Parts C and D Oversight and Enforcement Group. Medicare Nation NEXT CMS Penalty is given notice to......... SOLIS Health Plans out of Miami, Florida On December 4, 2019, CMS gave notice to Mr. Daniel Hernandez - CEO of Solis Health Plans. CMS imposed a CIVIL MONEY PENALTY of $41,552.00! CMS stated in their summary that Agents employed by SOLIS engaged in an aggressive marketing campaign that was conducted by a contractor provider clinic. Solis Agents conducted a marketing presentation in a secluded area and enroll patients upon conclusion of the presentation. CMS determined that Solis violated the communication and marketing requirements, which had the substantial likelihood of adversely affecting its enrollees. Solis Failed to oversee and manage the marketing process to ensure its agents and brokers did not engage in inappropriate marketing practices including "misleading" beneficiaries. Solis may request a hearing to appeal CMS's determination. Both notices are signed by John Scott, acting director of the Medicare parts C and D Oversight and Enforcement Group. Thank you for listening to Medicare Nation! If you are part of my “Sandwich Generation,” Share this show with your parents and/or grandparents. They have many questions about Medicare and this show will answer them! Buy them a “Smart Phone,” and introduce them to Medicare Nation! If you are a Baby Boomer, share Medicare Nation with other “Baby Boomers.” I want to educate as many of you as I can about Medicare! I certainly can use  your help in putting the word out! If you have any questions, send them to Support@TheMedicareNation.com If I can answer it in one email - I will personally answer you! If your question requires research or additional contact with you, I do offer consulting if you would like me to assist you in that manner. Want to hear a topic on Medicare Nation? A special guest? Let me know and I'll do my best to get them on the show! Thanks again for listening! Diane Daniels    

Hey Medicare Nation! www.TheMedicareNation.com Today, I'm discussing how the Centers for Medicare & Medicaid Services (CMS) SLAPPED Agewell New York LLC with a Civil Money Penalty of $39,200! CMS conducts audits to ensure Medicare Advantage Prescription Drug Plans are following conditions of the current contract as well as Medicare rules & regulations.  From March 9, 2018 through May 15, 2018, CMS Conducted an audit of Agewell's 2016 Medicare financial information. In a financial audit report issued on September 20, 2018, CMS auditors reported that Agewell failed to comply with Medicare requirements related to Part C (Medicare Advantage) cost sharing. Specifically, auditors found that in 2016 Agewell failed to comply with cost-sharing requirements by charging "incorrect" co-payments to enrollees for medical services. Enrollees were affected in the following area: Bronx, NY; Kings County Brooklyn, NY; Nassua County, NY, Manhattan, Queens and Westchester County, NY. Agewell's failure was "systemic," and "adversely affected" enrollees or the substantial likelihood of adversely affecting enrollees because they experienced out-of-pocket costs. CMS determined that Agewell was charging a $30 "specialist" co-pay was applied to "primary care physician" claims instead of a $0 co-pay as stated in the plan's Explanation of Coverage. Enrollees were NOT Refunded the overcharged amounts until AFTER the financial audit concluded, which was 2 years after the incurred cost. In 2016, If you paid a $30 co-pay to see YOUR Primary Physician, when you were only obligated to pay $0,  you should contact Agewell at 888-586-8044 and ask to speak to a supervisor, regarding the CMS penalty. Advise the supervisor of the date & time of your appointment with your Primary Doctor and that you have proof of a payment that you made of $30 for your visit. Advise the supervisor that you would like to be refunded the $30 immediately.  Write down the name of the supervisor, the date & time you called Agewell and what the supervisor stated Agewell would do for you. If you donot receive your refund within 14 business days, call Medicare directly at 800-633-4227 and advise Medicare of the situation. If you have any "complaints" regarding the way you were treated by any representative at Agewell, you can make an annonymous complaint to Agewell's confidential hotline - 888-336-7240. You can also make a complaint to Medicare directly by calling 800-633-4227. If you have a complaint, regarding any physician or facility in the Agewell network, you can call the Agewell confidential hotline to make your complaint - 888-336-7240. If you are uncomfortable making a formal complaint and you would like assistance with your complaint you can : 1. contact the Insurance Agent or Medicare Specialist who enrolled you into the Agewell plan  or 2. contact your local "SHIP" (State Health Insurance & Assistance Program) representative by "clicking" on your State here - https://www.shiptacenter.org/ when the page opens, go all the way to the bottom of the page and you'll see an "orange" button that reads - Find Your Local SHIP "Click" on that ORANGE buton and a list will come up of all 50 States. "Click" on the State where you reside, to contact your local SHIP center. If YOU need help with finding the Medicare Advantage Plan that is right for your UNIQUE needs, contact me at either: Support@TheMedicareNation.com or  call me at 855-855-7266 If I can answer your question in ONE paragraph in an email, I will directly answer your question! If it takes more than one paragraph to answer your question or I need to do research to answer your question....then....I will respond by advising you that you will need to contact me and request my consultative services.  I currently charge $199.00 an hour, and I consult with Medicare beneficiaries and the Adult Children of beneficiaries ALL over the country! Please SUBSCRIBE to Medicare Nation so that you will receive EVERY NEW episode that is published! Give Medicare Nation a ***** 5-Star Review on iTunes! The more reviews we get, the more people can find the show! Go to www.itunes.com and type MEDICARE NATION in the search bar. When the page opens, "Click" on the Review tab and leave your review! Thanks so much for listening! If you'd like to hear about a specific topic on the show or you'd like a specific guest on the show...... send me an email to Support@TheMedicareNation.com I appreciate your Support! Diane Daniels  

Hey Medicare Nation! Here I am bringing you yet another Medicare Advantage Plan Sponsor, being slapped by CMS, for failing to comply with Medicare requirements related to Part C (Medicare Choice) and Part D (Medicare Prescription Drug Plans). Today, I will be discussing the CMS Civil Money Penalty (CMP) that was imposed on Fallon Community Health Plan. On June 29, 2017, a letter was issued to Mr. Richard Burke, the President and CEO of Fallon Community Health Plan, from Vikki Ahern, Director of the Medicare Parts C and D Oversight and Enforcement Group. The letter was written relating to a "Notice of Imposition of Civil Money Penalty for Medicare Advantage-Prescription Drug Contract Numbers: H2411, H2470 and H9001. Summary of Noncomplliance CMS conducted an audit of Fallon's Medicare operations from February 16, 2016 through February 26, 2016. In the audit report issued on July 20, 2016, CMS auditors reported that Fallon failed to comply with Medicare requirements related to...."Part C and Part D organization/coverage determinations, appeals and grievances in violation of 42 CFR" (Code of Federal Regulations).  The audit report lists the exact subsections of 42 CFR that were violated The letter goes on to state....Fallon's failures in these areas were systemic and resulted in enrollees inappropriately experiencing delayed or denied access to benefits and/or increased out-of-pocket costs. CMS made a determination to impose a civil money penalty (CMP) for Fallon's failure to comply, in the amount of $344,100.00. That's a BIG fine!  Fallon Comunity Health Plan was founded in 1977. They have a product portfolio of group and individual health plan options. Fallon also has a Senior Care Services Division, oversees all products, programs and solutions which focus on the senior population. If you are a member of a Fallon Medicare Advantage Plan and you have questions regarding your plan, I would call the Senior Care Services Division. The number is - 800-868-5200. If you are a current member of a Fallon Medicare Advantage Prescription Drug Plan, your benefits are intact and working for you.  The $300,100 CMP was issued due to the incorrect classifications of "grievances", "organization determinations" for Part C complaints or "coverage determinations" for Part D complaints by members. These incorrect classifications resulted in members not receiving the required level of review, and/or experiencing delayed access to medically necessary or life-sustaining treatments. How does something like this happen, you may ask?  Insufficient training of Fallon customer representatives and agents. Employers like Fallon, need to ensure their employees are properly trained in CMS Medicare Advantage Plan and Medicare Part D regulations as well as Fallon's Medicare Health Plans and benefits. Train your employees Fallon!  Fallon needs to ensure their employees are competent and complying with Medicare rules & regulations relating to Medicare Advantage Part C and Medicare Part D.  What Should You Do if You or Your Parent(s) are on a Fallon Medicare Advantage Prescription Drug Plan? Pay attention to your MONTHLY Explanation of Benefits (EOB) letter. Look the document over and ensure all the prescriptions you filled that month are correct! Look and make sure the provider(s) listed on your EOB are doctors or facilities you visited. Ensure any treatments or diagnostic tests were ones you actually did! If you find a discrepancy, call Fallon customer service to notify them of it. A Fallon customer service rep should be able to assist you with this issue. If Fallon customer service is unable to assist you or if they refuse to assist you, you have two good options: 1. Call your Medicare Agent or Medicare Advisor. They enrolled you in the Fallon Medicare plan and should be a liaison between you and Fallon. 2. Call Senior Medicare Patrol.      Senior Medicare Patrol (SMP) is an awesome resource that is available to you for free!      SMP Volunteer's are seniors and understand what you're going through. They are trained to investigate or notify the agency who can investigate, suspicious or fraudulent charges on your EOB statement.      Go to the SMP website to find an SMP location near you:       www.SMPresource.org If you believe you were denied coverage or delayed in receiving your benefits, you have a right to appea Ask your Medicare Agent or Medicare Advisor to assist you and explain your options. Your coverage and benefits are intact and not in danger at Fallon Health Plan. Fallon has the right to appeal the CMS CMP by August 29, 2017.  We'll see what happens. In the meantime, due your due-dilligence and monitor your EOB statements no matter which Medicare Advantage or Medicare Prescription Drug Plan you are on. Report any discrepancies or suspicions right away. I am available for consultations if you feel you have been denied a claim or your benefits were delayed due to an incorrect classification. I also can initiate a reconsideration appeal for Part C claims or a redetermination appeal for Part D claims. Contact me at Support@TheMedicareNation if you'd like me to consult with you. Thank you for listening to Medicare Nation! I appreciate you taking the time to learn more about Medicare and Medicare Plans. Help your parents and grandparents learn about Medicare, by showing them how to gain access to the Medicare Nation Podcast! Questions about Medicare or your Medicare Plan you need answered? Send me an email to Support@TheMedicareNation.com or go to my website www.callsamm.com Have a very happy, peaceful and prosperous week everyone! Diane Daniels  

So far in 2016, we have seen four HIPAA enforcement cases resolved by OCR.  One involved only the second Civil Money Penalty ever assessed. The three others were resolution agreements.  Add those cases to what was done in 2015 and you have the most active 12 month period of HIPAA enforcement ever.  Certainly, the first quarter of 2016 has been the most active quarter ever when it comes to HIPAA enforcement announcements.   In this episode we discuss the cases resolved so far in 2016 and more thoughts on what is coming up for 2016.     Read more at our website HelpMeWithHIPAA.com/46