MedTrainer

MAY 3, 2024

Healthcare fraud, waste, and abuse is a costly problem for both public and private payers. The National Health Care Anti-Fraud Association estimates financial losses due to healthcare fraud could be as much as $300 billion annually. Keep in mind that these are just examples of provider fraud!

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Fierce Healthcare

JUNE 13, 2024

The CEO and clinical president of telehealth startup Done have been arrested and charged with fraud, accused by federal authorities of participating in a scheme to distribute Adderall online.

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HIT Consultant

JUNE 6, 2024

Healthcare fraud is a significant issue in the U.S. the cost of healthcare fraud in the country is close to $100 billion a year. Recent advances in technology are now enabling government agencies to be more effective in their efforts to detect and prevent healthcare fraud. According to the U.S. Department of Justice (D.O.J.),

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Fraud Medicare Medicare Governance 94

Healthcare Dive

JUNE 29, 2023

The multi-state bust that targeted 78 individuals represents “one of the largest healthcare fraud schemes ever prosecuted by the Justice Department,” Attorney General Merrick Garland said.

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Fraud 130

Healthcare IT News - Telehealth

MARCH 1, 2021

Department of Health and Human Services' Office of Inspector General recognized telehealth's potential while cautioning that steps must be taken to ensure virtual care will not be compromised by fraud. Grimm in her statement also differentiated between telehealth fraud and "telefraud" schemes. THE LARGER TREND.

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Fierce Healthcare

OCTOBER 27, 2023

The Department of Justice (DOJ) has filed charges against a former HealthSun Health Plans executive as part of an alleged multimillion-dollar Medicare fraud scheme. | The Department of Justice has filed charges against a former HealthSun Health Plans executive as part of an alleged multimillion-dollar Medicare fraud scheme.

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Fierce Healthcare

FEBRUARY 23, 2024

billion in settlements and judgments was related to health-related matters in the last fiscal year, about two-thirds of the monetary fraud recoveries by t | Health fraud settlements under the False Claims Act exceeded $1.8 Under the False Claims Act, more than $1.8 billion last year, according to the Department of Justice.

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Verisys

DECEMBER 13, 2023

Healthcare Fraud Crackdown! The post Healthcare Fraud Crackdown: Telehealth Fraud & Improper Billing Scams | Verisys appeared first on Verisys. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Secure your success by choosing Verisys.

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Fraud Telemedicine Licensing Compliance 52

Healthcare IT News - Telehealth

SEPTEMBER 20, 2021

Department of Justice announced this past week that it was bringing criminal charges against 138 total defendants for their alleged participation in various healthcare fraud schemes, resulting in about $1.4 billion in alleged losses. More than $1.1 billion of that loss involved allegedly fraudulent claims related to telemedicine.

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Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. This disparity highlights the difficulty in accurately assessing the risks and potential penalties associated with health care fraud violations.

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Healthcare IT Today

JUNE 2, 2023

With those competing priorities, fraud prevention does not always make its way to the top of the list of considerations, even when it should. According to the National Health Care Anti-Fraud Association, fraud costs the U.S. healthcare industry more than $50 billion each year. What Exactly is KYP?

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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. Each charge also comes with five years probation, while the fraud charge includes 18 months of house arrest.

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Healthcare IT News - Telehealth

APRIL 21, 2022

Attorney's Office for the Eastern District of New York announced Thursday that an orthopedic surgeon had been arrested and charged with healthcare fraud. Federal law enforcement has brought the hammer down on alleged telehealth fraud in several highly publicized cases. " ON THE RECORD.

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Compliancy Group

APRIL 25, 2024

Components of Medicare Fraud, Waste, and Abuse Training One of the most important elements of CMS Medicare fraud, waste, and abuse training is defining and differentiating these three terms : Fraud is the deliberate attempt to obtain financial gain through deceptive means, such as providing false information. See how it works!

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Fraud Medicare Medicare Compliance 59

Healthcare IT News - Telehealth

FEBRUARY 22, 2021

Department of Justice announced earlier this month that an Indian Rocks Beach, Florida-based woman has pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return. The DOJ describes the case as involving one of the largest healthcare fraud schemes in U.S. Kelly Wolfe and her company, Regency, Inc.,

Fraud 192

Fraud Telemedicine US Department of Health and Human Services Medicare 192

Fierce Healthcare

FEBRUARY 15, 2024

ACOs could face lasting financial difficulties because of a recent, alleged $2 billion Medicare catheter fraud scheme. Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months.

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Healthicity

SEPTEMBER 26, 2024

From her early days as a trauma nurse to her current role as a sought-after expert witness, Rebecca has seen it all in the ever-evolving world of healthcare compliance and fraud. CJ Wolf sits down with Rebecca Busch , a healthcare compliance expert with over four decades of experience.

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Healthcare IT News - Telehealth

JULY 22, 2022

billion in alleged fraud involving telehealth, phony genetic testing and durable medical equipment. "The Department of Justice is committed to prosecuting people who abuse our healthcare system and exploit telemedicine technologies in fraud and bribery schemes," said Assistant Attorney General Kenneth A. WHY IT MATTERS.

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Fraud Telemedicine Medicare Medicare 142

Fierce Healthcare

JULY 1, 2024

ACOs may soon be able to take a breath of fresh air, as CMS shared Friday that it has no intention of punishing them for a urinary catheter fraud scandal. Accountable care organizations concerned they would be held responsible for bad actors exploiting the Medicare system can breathe a sigh of relief.

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HIT Consultant

DECEMBER 15, 2023

What You Should Know: Healthcare Fraud Shield (HCFS) , a leading provider of fraud, waste, abuse, and error (FWAE) protection solutions for the healthcare insurance market, today launched FWA360Leads , a new product that automatically identifies and prioritizes FWA leads based on order of importance and impact severity.

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Fraud 52

Compliancy Group

DECEMBER 15, 2023

Differentiating Fraud, Abuse, and Waste Detecting and stopping fraud, abuse, and waste rely on distinguishing these behaviors in the healthcare context. What is Healthcare Fraud? Providers commit Medicare and Medicaid fraud when they knowingly submit or contribute to the submission of a false claim for financial gain.

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Healthcare Dive

AUGUST 20, 2024

The insurer, which did not admit wrongdoing, agreed to the settlement on the eve of a jury trial.

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Healthcare IT News - Telehealth

DECEMBER 17, 2021

Department of Justice announced this past Friday that it had charged four people, one of whom is a licensed physician, in an international telehealth fraud and kickback scheme. million in a case the DOJ described as one of the "largest healthcare fraud schemes in United States history. WHY IT MATTERS. " ON THE RECORD.

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Fraud Telemedicine Nurses Licensing 138

HealthIT Answers

MARCH 31, 2024

22 for civil fraud and false claims settlements and judgments recovered for taxpayers by the agency in fiscal 2023, or from Oct. The post Justice Department Sleeping at the Healthcare Fraud Wheel appeared first on Health IT Answers. By David R. Burda - Here are the DOJ stats released on Feb. 1, 2022, through Sept.

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Fraud 52

HIT Consultant

JULY 1, 2024

Rishi Shah, co-founder and former CEO of Outcome Health What You Should Know: – Three former executives of Outcome Health, a Chicago-based health tech startup, were sentenced for their roles in a massive fraud scheme that defrauded clients, lenders, and investors of an estimated $1B. Securities and Exchange Commission.

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HIT Consultant

OCTOBER 18, 2021

Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud. The second type, indirect fraud, involves several bad actors that coordinate their efforts.

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Healthcare Dive

JULY 12, 2024

The Department of Justice investigation follows a multi-year international probe into Steward's deal to improve three hospitals in Malta.

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Fraud Hospitals 242

The Health Law Firm Blog

MAY 8, 2024

Attorney's Office, in the Middle District of Florida, announced that a Florida man pled guilty to conspiring to commit health care fraud in a $36.2 million telemedicine fraud scheme. Indest III, J.D., Board Certified by The Florida Bar in Health Law On March 20th, 2024, the U.S. As part of [.]

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Fraud Medicare Medicare Telemedicine 52

Healthcare Dive

JULY 17, 2024

A Pennsylvania pension fund had argued Centene board members failed in their oversight responsibilities and ignored red flags about a Medicaid overbilling scheme.

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Medicaid Medicaid Fraud 159

The Health Law Firm Blog

APRIL 29, 2024

Attorney's Office, in the Middle District of Florida, announced that a Florida man pled guilty to conspiring to commit health care fraud in a $36.2 million telemedicine fraud scheme. Indest III, J.D., Board Certified by The Florida Bar in Health Law On March 20th, 2024, the U.S. As part of [.]

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Fraud Medicare Medicare Telemedicine 52

The Health Law Firm Blog

APRIL 8, 2024

Attorney's Office, in the Middle District of Florida, announced that a Florida man pled guilty to conspiring to commit health care fraud in a $36.2 million telemedicine fraud scheme. Indest III, J.D., Board Certified by The Florida Bar in Health Law On March 20th, 2024, the U.S. As part of [.]

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Fraud Medicare Medicare Telemedicine 52

Fierce Healthcare

JUNE 29, 2023

The Department of Justice (DOJ) uncorked healthcare fraud charges against 78 defendants whose alleged telemedicine, prescription drug, opioid distribution and clinical lab testing schemes billed fo | Among the charges was an alleged $1.9

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Healthcare IT Today

JANUARY 19, 2021

The Federal Trade Commission (FTC) announced a consumer fraud settlement against a company that displayed a ‘HIPAA Compliant’ seal on its website.

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Fraud HIPAA Compliance Hospitals 145

Healthcare Dive

SEPTEMBER 25, 2024

Regulators say Medicare needs more data and oversight to avoid fraud and misuse. Digital health advocates argue the service is still crucial for managing chronic conditions.

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Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Fraud Medicare Medicare US Department of Health and Human Services 52

Mobi Health News

JULY 7, 2022

A jury found Balwani guilty on all 12 charges he faced, including ten counts of wire fraud and two counts of conspiracy to commit wire fraud.

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Fraud 109

HIT Consultant

AUGUST 17, 2023

Erin Rutzler, VP of Fraud, Waste, and Abuse at Cotiviti As behavioral health claim volumes continue to increase, there’s a growing need for health plans to be vigilant in spotting fraud, waste and abuse. But not every plan has access to a large SIU to combat fraud, waste and abuse in behavioral health.

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