3 providers to pay $22.5M to settle Medicaid fraud allegations in California
Fierce Healthcare
DECEMBER 8, 2022
to settle Medicaid fraud allegations in California. Thu, 12/08/2022 - 16:58. 3 providers to pay $22.5M
2022 Fraud Medicaid 
Fraud, Waste, and Abuse (FWA) Refresher Training
American Medical Compliance
MARCH 6, 2025
Fraud, Waste, and Abuse (FWA) remain critical challenges in the healthcare industry, impacting patient care, financial integrity, and regulatory compliance. It strictly prohibits intentional payments – whether monetary or in-kind – in exchange for referrals or securing business under programs like Medicare and Medicaid.
Fraud 
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Fraud Indicators and Red Flags
AIHC
FEBRUARY 17, 2025
When Audit Managers Knowingly Skew Audit Results Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. on fraud detection and prevention in healthcare.
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Medicaid Fraud Control Unit’s 2022 Annual Report Key Takeaways
Provider Trust
MAY 9, 2023
What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.
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Understanding the Medicaid Fraud Control Unit’s 2023 Annual Report
Provider Trust
APRIL 30, 2024
This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). MFCUs reported 1,143 total convictions in FY 2023—a marked decrease from 1,327 convictions in FY 2022.
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10 Charged Over BEC Scams Targeting Medicare, Medicaid, and Private Insurance Programs
HIPAA Journal
NOVEMBER 21, 2022
million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. Medicare, Medicaid, and private health insurers suffered losses of more than $4.7
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New York Optician Convicted of Medicaid Fraud for Nursing Home Residents
Healthcare Compliance Blog
FEBRUARY 2, 2022
The optician fraudulently received approximately $74,000 in Medicaid payments between 2016 and 2019 by billing for the optician services that were not provided. On January 27, 2022, he was sentenced to 90 days in state prison, followed by 5 years’ probation, and was ordered to pay $74,00 in restitution.
Supreme Court To Review Scope of Identity Theft in Medicaid Fraud Case
The Health Law Firm
DECEMBER 6, 2022
Board Certified by The Florida Bar in Health Law On November 10, 2022, the US Supreme Court announced that it would weigh in on what it means to commit identity theft. In the case the Supreme Court accepted for review, the petitioner, a managing partner at a psychological services company, was convicted of Medicaid fraud in Texas in 2013.
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HHS & DOJ FY 2022 Enforcement Targeted Fraud in COVID-19, Telemedicine, Opioid and Prescription Drugs, and Substance Use Treatment Centers, Among Other Initiatives
Healthcare Law Blog
DECEMBER 1, 2023
The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released its “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2022 ” (the “Report”), highlighting continued enforcement and recovery actions under the Health Care Fraud and Abuse Control Program (HCFAC).
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Dental Fraud Schemes Uncovered
Compliancy Group
FEBRUARY 16, 2024
This month, fraud in the medical industry has been making headlines fairly frequently. We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. This went on from 2015 to 2022, when he was caught for fraud.
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Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations
The Health Law Firm Blog
FEBRUARY 23, 2024
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations
The Health Law Firm Blog
NOVEMBER 29, 2022
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations
The Health Law Firm Blog
OCTOBER 14, 2022
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations
The Health Law Firm Blog
MARCH 14, 2024
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations
The Health Law Firm Blog
FEBRUARY 1, 2024
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations
The Health Law Firm Blog
DECEMBER 19, 2022
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations
The Health Law Firm Blog
NOVEMBER 7, 2022
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Licensed Professional Counselor Sentenced to Prison for $1.3 Million Medicaid Fraud Scheme
The Health Law Firm Blog
JULY 13, 2023
Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.]
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Texas Adult Day Care Owner Sentenced for Healthcare Fraud Scheme
Healthcare Compliance Blog
APRIL 29, 2022
On April 25, 2022, a former owner of multiple Texas adult day care centers was sentenced to 60 months in prison and ordered to pay $1,784,817.96 in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. The money judgment represents the proceeds that she obtained as part of her scheme.
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70,000 Valle del Sol Community Health Patients Affected by Cyberattack
HIPAA Journal
OCTOBER 17, 2022
Valle de Sol did not state in its notification letters when hackers gained access to its network, or for how long they had access, but did confirm that the unauthorized activity was detected on January 25, 2022. A comprehensive review was conducted of all files that may have been accessed, which was completed on July 18, 2022.
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SAC Health Theft Incident and Multiple Ransomware Attacks Reported
HIPAA Journal
MAY 25, 2022
The break-in was discovered on March 4, 2022, with the subsequent investigation confirming on April 22, 2022, that six boxes of paper documents had been stolen from the facility, which included files relating to patients served by SAC Health in 1997 and between 2006 and 2020. Lifespan Services Suffers Ransomware Attack.
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OIG issues fraud alert warning practitioners of risks with telemedicine arrangements
Health Law Checkup
AUGUST 9, 2022
On July 20, 2022, the OIG released a Fraud Alert encouraging practitioners to exercise caution when entering into arrangements with telemedicine companies, given the various fraud and abuse risks associated with such arrangements, including an increased risk of fraudulent claims to Medicare, Medicaid, and other federal healthcare programs.
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Independent Living Systems Sued Over 4 Million-Record Data Breach
HIPAA Journal
MARCH 21, 2023
ILS Identified the breach in July 2022 and determined unauthorized individuals had access to its network between June 30, 2022, and July 5, 2022. Affected individuals were offered complimentary credit monitoring services and security measures have been enhanced to prevent further data breaches.
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Centene Agrees to Pay State of Washington $19 Million to Settle Medicaid Fraud Allegations
The Health Law Firm
OCTOBER 14, 2022
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Dozens of Defendants Charged with Healthcare Fraud
American Medical Compliance
MARCH 13, 2023
The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. The Centers for Medicare & Medicaid Services investigates these cases and prioritizes protecting patients. Healthcare organizations must take all possible steps to prevent instances of fraud. course today.
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Expert Insights on Hiring the Right Skillset
Healthicity
OCTOBER 5, 2022
The Office of Inspector General recently made Work Plan updates that impact price transparency rules, Medicaid fraud referrals, and inpatient rehabilitation. Have you heard? If you support compliance for hospitals or hospital systems, listen up! Our latest eBrief covers the updates you need to know.
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Mailing Error at CMS Vendor Affects 10,000 Medicare Beneficiaries
HIPAA Journal
APRIL 27, 2023
The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.
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Data Breaches Reported by Henderson & Walton Women’s Center & Genesis Health Care Inc.
HIPAA Journal
SEPTEMBER 9, 2022
That process concluded on June 24, 2022. As a precaution against identity theft and fraud, complimentary memberships have been offered to a credit monitoring service for 12 months. has recently notified the Montana Attorney General about a cyberattack that was detected on April 11, 2022.
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California Doctor to Pay over $9.48M, Sentenced to Prison, to Settle Fraud Allegations
Med-Net Compliance
JUNE 15, 2022
Division of Medi-Cal Fraud and Elder Abuse (DMFEA) and the US Attorney’s Office for the Eastern District of California intervened in the? The investigation culminated in the doctor pleading guilty to one count of federal healthcare fraud, and on May 2, 2022, he was sentenced to a?prison prison term?of
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Don’t Just Phone It In – Avoiding Fraud in Telehealth Contracts
Health Law RX
AUGUST 1, 2022
While this new flexibility increased access to care, it also increased opportunities for fraud. On July 20, 2022, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a Special Fraud Alert cautioning Practitioners about potential fraudulent telemedicine contracts ( Fraud Alert ).
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Georgia Rehabilitation Center Submitted 808 False Claims to Medicaid/Tricare
Healthcare Compliance Blog
APRIL 27, 2022
A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. The hearing is scheduled for May 2, 2022. The court has ordered the parties involved to appear within 30 days for a hearing on the issue of damages.
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Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations
The Health Law Firm Blog
JANUARY 8, 2024
Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida.
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Licensed Professional Counselor Sentenced to Prison for $1.3 Million Medicaid Fraud Scheme
The Health Law Firm Blog
APRIL 18, 2022
Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.].
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Ongoing License Monitoring Critical to Prevent Healthcare Fraud
Provider Trust
SEPTEMBER 29, 2022
A 49-year-old Brownsville, TX man named Fernando Mendez was taken into custody in early September after being charged with defrauding Medicaid. From August 2021 to February 2022, Mendez provided patient assessments and evaluations and ordered treatments and prescriptions, all while billing Medicaid for his services.
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Attention New York Medicaid Providers: It’s Time to Upgrade Your Compliance Program
Healthcare Law Blog
FEBRUARY 3, 2023
Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1]
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CMS Reminder to Practice Vigilance Against Medicare Fraud, Waste and Abuse
Innovaare Compliance
JULY 19, 2024
On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).
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HIPAA 2024 Year in Review – Ransomware, Risk Analysis, and Right of Access Remedies
Compliancy Group
DECEMBER 20, 2024
In May of 2022, OCR received a breach notification report from BCAA. In June of 2022, HHS notified BCAA of its investigation of the report, finding that BCAA had failed to conduct a HIPAA-compliant risk analysis. In late November of 2021, a ransomware infection began to encrypt files on BCAAs network.
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Florida Pharmacy Owner Pleads Guilty For Role in $8.3 Million Medicare Fraud Scheme
The Health Law Firm Blog
JANUARY 13, 2024
Board Certified by The Florida Bar in Health Law On September 27, 2022, a Florida pharmacy owner pled guilty to conspiring to commit healthcare fraud in an $8.3 By George F. Indest III, J.D., million scheme.
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OIG Posts False Claims Act Settlements for FY 2022 Q1–Q4 on the Risk Spectrum
Med-Net Compliance
OCTOBER 21, 2022
The Office of Inspector General (OIG) has recently posted the False Claims Act (FCA) settlements for FY 2022 Q1–Q4 on the risk spectrum. The government’s primary civil tool for addressing healthcare fraud is the FCA. Issue: Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate.
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Email Incidents Reported by Ultimate Care, CareOregon Advantage, and University Medical Center Southern Nevada
HIPAA Journal
MARCH 25, 2022
Ultimate Care said no reports have been received that indicate there has been any misuse of patient information; however, as a precaution against identity theft and fraud, individuals whose Social Security numbers were impacted have been offered complimentary one-year memberships with a credit monitoring service.
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Pharmacy Fraud: Data Tells the Story
Florida Health Care Law Firm
APRIL 18, 2022
Fraud in these cases is generally easy to prove. Simply verifying inventory, orders and dispensing records yields incredible data that when combined with comparative data from peer pharmacies can be used by law enforcement to establish that fraud has been committed. On April 13, 2022, the U.S. Latest Enforcement Activity.
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CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance
Innovaare Compliance
MAY 26, 2022
On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).
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HHS-OIG Excludes Theranos Founder and CEO from Federal Health Programs for 90 Years
HIPAA Journal
JANUARY 23, 2024
Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors. Balwani was convicted of conspiracy to commit wire fraud against Theranos’s patients and investors and was sentenced to 12 years and 11 months in prison.
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