Fraud and Medicaid - Health Care Compliance Brief

Judge dismisses Medicaid fraud suit against Centene’s board

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.

Medicaid

Medicaid Medicaid Fraud

Indiana insurers, hospitals accused of Medicaid fraud in giant whistleblower lawsuit

Fierce Healthcare

SEPTEMBER 19, 2024

Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower | A newly unsealed lawsuit alleges major health insurers and health systems defrauded Indiana Medicaid by hundreds of millions of dollars, with the government (..)

Medicaid

Medicaid Medicaid Fraud Hospitals

Government expects to recover more than $3B from healthcare fraud, misspent funds in fiscal year 2023

Healthcare Dive

DECEMBER 4, 2023

The HHS’ Office of the Inspector General’s report tallied 707 criminal enforcement actions and 746 civil actions for fraud and misspent funds in programs like Medicare and Medicaid.

Fraud

Fraud Governance Medicaid Medicaid

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). for every $1 spent How ProviderTrust Can Help With nearly 80 million individuals covered by Medicaid, every data point counts.

Fraud

Fraud Medicaid Medicaid Licensing

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. 3 providers to pay $22.5M Thu, 12/08/2022 - 16:58.

Fraud

Fraud Medicaid Medicaid

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.

Fraud

Fraud Medicaid Medicaid Nurses

The Future of Medicaid: 4 Considerations for MES Modernization

HIT Consultant

OCTOBER 10, 2024

Donna Migoni Executive Managing Director, Medicaid Enterprise Services at Maximus More than 75 million people access comprehensive and cost-effective care through Medicaid, including low-income families, older adults, and individuals with disabilities or chronic conditions. 1) Analyze and prioritize. 4) But don’t forget the data.

Medicaid

Medicaid Medicaid Governance Fraud

Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks

Med-Net Compliance

JUNE 13, 2022

Three independent clinical laboratories, their owner and holding company, an additional independent clinical laboratory and its owner, two laboratory marketing companies, and a Massachusetts physician have been charged in connection with Medicaid fraud, money laundering, and kickbacks involving urine drug tests?that

Fraud

Fraud Medicaid Medicaid

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. Dentist Ordered to Pay $8.5M

Fraud

Fraud Licensing Medicaid Medicaid

OIG: Most states not doing enough to monitor Medicaid telehealth fraud for behavioral health services

Fierce Healthcare

SEPTEMBER 21, 2021

OIG: Most states not doing enough to monitor Medicaid telehealth fraud for behavioral health services. Tue, 09/21/2021 - 16:26.

Fraud

Fraud Medicaid Medicaid

Missouri Woman Sentenced for Medicare and Medicaid Fraud

Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. Update your policies and procedures as needed.

Fraud

Fraud Medicaid Medicaid Medicare

Healthcare Providers’ Role in Preventing Fraud, Waste, and Abuse

American Medical Compliance

JUNE 21, 2024

The Department of Health and Human Services (HHS) estimated that improper payments in the Medicare and Medicaid programs exceeded $100 billion from 2016 to 2023. Fraud, waste, and abuse (FWA) in healthcare present significant challenges, causing substantial financial losses, eroding public trust, and compromising the quality of patient care.

Fraud

Fraud Compliance Medicaid Medicaid

Massachusetts AG’s Medicaid Fraud Division Recovers More Than $71M in Federal FY2022

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

Fraud

Fraud Medicaid Medicaid Compliance

Massachusetts Medicaid Fraud Division Recovers Over $55 Million in 2021

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

Fraud

Fraud Medicaid Medicaid Nursing Homes

Indiana Physician Fraud Conviction Highlights Compliance Risks

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. He was also ordered to pay $557,000 in restitution to Indiana Medicaid and Medicare. As such, providers should prioritize billing compliance.

Fraud

Fraud Compliance Medicaid Medicaid

Unraveling the Maze: Tackling Out-of-State Medicaid Claims and Credentialing Challenges

Healthcare IT Today

NOVEMBER 13, 2024

The following is a guest article by Crystal Campbell, Director Out-of-State Medicaid at Aspirion For healthcare providers, managing out-of-state (OOS) Medicaid claims can feel like traversing a regulatory minefield. This variation creates significant hurdles for hospitals treating OOS Medicaid patients.

Medicaid

Medicaid Medicaid Hospitals Malpractice

Advice for New Physicians on Avoiding Medicare and Medicaid Fraud and Abuse

HIPAA Journal

FEBRUARY 8, 2024

Department of Health & Human Services Office of Inspector General (HHS-OIG) has published a Roadmap for New Physicians on avoiding Medicare and Medicaid fraud and abuse. As a result of dishonest healthcare providers, laws have been created to combat fraud and abuse.

Fraud

Fraud Medicaid Medicaid Medicare

Physician Indicted for Medicaid Fraud and Invasive and Medically Unnecessary Testing

Med-Net Compliance

AUGUST 5, 2022

New York Attorney General Letitia James announced the indictment of a physician and his company for defrauding Medicaid by forcing patients to get unnecessary and invasive medical tests. He then directed his staff to submit claims for payment to Medicaid for those medically unnecessary tests. ?.

Medicaid

Medicaid Medicaid Fraud

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud

Fraud Medicaid Medicaid Overpayments

DOJ charges dozens in $1.1B telehealth fraud crackdown

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.

Fraud

Fraud Telemedicine Medicare Medicare

Fraud, Waste, and Abuse in Healthcare

Compliancy Group

DECEMBER 15, 2023

Unfortunately, some Medicare and Medicaid funds are lost to fraudulent and wasteful behaviors. Knowing how to detect, report, and prevent inappropriate use of funds associated with the Centers for Medicare and Medicaid Services (CMS) is essential. What is Healthcare Fraud? taxpayers over $100 billion annually.

Fraud

Fraud Medicaid Medicaid Medicare

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud

Fraud Medicaid Medicaid Overpayments

Essentials of Medicare Fraud, Waste, and Abuse Training

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!

Fraud

Fraud Medicare Medicare Compliance

Health Connect America to pay $4.6M to resolve Medicaid fraud allegations

Fierce Healthcare

JULY 10, 2023

million to resolve allegations that it improperly billed Virginia's Medicaid program, the Department of Justice (DOJ) said Friday. Behavioral health provider Health Connect America will pay $4.6

Medicaid

Medicaid Medicaid Fraud

Dozens charged in sprawling $1.2B telehealth and genetics fraud crackdown

Healthcare IT News - Telehealth

JULY 22, 2022

billion in alleged fraud involving telehealth, phony genetic testing and durable medical equipment. Meanwhile, the Centers for Medicare and Medicaid Services' Center for Program Integrity also announced that it has taken administrative actions against more than 50 healthcare providers alleged to be involved in similar schemes.

Fraud

Fraud Telemedicine Medicare Medicare

Program Integrity Units in Medicaid: Safeguarding Healthcare Access and Resources

HealthIT Answers

FEBRUARY 26, 2024

Maccioli MD - To ensure the effective and efficient functioning of Medicaid, as well as to prevent fraud, waste, and abuse, Program Integrity Units should be established within the Medicaid system. The post Program Integrity Units in Medicaid: Safeguarding Healthcare Access and Resources appeared first on Health IT Answers.

Medicaid

Medicaid Medicaid Fraud

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud

Fraud Medicaid Medicaid Overpayments

Two Healthcare Organizations Caught Up in Medicare Fraud Schemes

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.

Fraud

Fraud Medicare Medicare US Department of Health and Human Services

Supreme Court To Review Scope of Identity Theft in Medicaid Fraud Case

The Health Law Firm

DECEMBER 6, 2022

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. Indest III, J.D.,

Fraud

Fraud Medicaid Medicaid

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. The post New York Optician Convicted of Medicaid Fraud for Nursing Home Residents appeared first on.

Nursing Homes

Nursing Homes Fraud Medicaid Medicaid

Unveiling the Dark Side of Dentistry: Worcester Dental Office Manager’s Shocking Role in Medicaid Fraud Scheme

Compliancy Group

AUGUST 23, 2023

In a shocking turn of events, a dental office manager from Worcester has been sentenced for participating in a scheme to defraud the Massachusetts Medicaid program, MassHealth. Prosecutors Evan Panich and Chris Looney from the Health Care Fraud Unit, alongside Special Assistant U.S. Senior District Court Judge Timothy S.

Fraud

Fraud Medicaid Medicaid Governance

Ineligible Medicaid Provider Arrested for Defrauding Medicaid of More Than $68K

Healthcare Compliance Blog

MAY 10, 2022

An ineligible Medicaid provider was arrested in Florida for defrauding Medicaid of more than $68,000. According to a Medicaid Fraud Control Unit investigation, the provider had failed to disclose his former felony convictions that precluded Medicaid from accepting the application.

Medicaid

Medicaid Medicaid US Department of Health and Human Services Fraud

Manager of Dental Office Sentenced to Prison for Defrauding Medicaid Out of More Than $813,000

The Health Law Firm Blog

MAY 21, 2024

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.]

Medicaid

Medicaid Medicaid Fraud Medicare

CMS proposes risk adjustment changes, broker fraud crackdown for 2026 plan year

Fierce Healthcare

OCTOBER 4, 2024

A proposed rule from the Centers for Medicare & Medicaid Services (CMS) released Oct. | CMS is looking to shake up the risk adjustment model and wants the ability to suspend shady brokers from the insurance marketplace, the agency wrote among other updates in a new proposed rule.

Fraud

Fraud Medicaid Medicaid Medicare

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 Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.]

Licensing

Licensing Medicaid Medicaid Fraud

Verisys- Healthcare Fraud and Abuse

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. government or a government contractor.

Fraud

Fraud Medicaid Medicaid Medicare

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

Fraud

Fraud Medicaid Medicaid Overpayments

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

Fraud

Fraud Medicaid Medicaid Overpayments

Dental Office Manager Sentenced to 12 Months in Prison for Defrauding Medicaid Out of More Than $813,000

The Health Law Firm Blog

APRIL 23, 2024

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By Carole C. Schriefer, J.D. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

Medicaid

Medicaid Medicaid Fraud Medicare

Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000

The Health Law Firm Blog

MAY 7, 2024

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.]

Medicaid

Medicaid Medicaid Fraud Medicare

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

Fraud

Fraud Medicaid Medicaid Overpayments

What is a Certified Fraud Examiner (CFE)?

MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

Fraud

Fraud Compliance Governance Compliance Officers

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. Indest III, J.D., Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

Fraud

Fraud Medicaid Medicaid Overpayments

Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000

The Health Law Firm Blog

MARCH 26, 2024

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based based dental practice, according [.]

Medicaid

Medicaid Medicaid Fraud Medicare

Judge dismisses Medicaid fraud suit against Centene’s board

Indiana insurers, hospitals accused of Medicaid fraud in giant whistleblower lawsuit

Trending Sources

Government expects to recover more than $3B from healthcare fraud, misspent funds in fiscal year 2023

Understanding the Medicaid Fraud Control Unit’s 2023 Annual Report

3 providers to pay $22.5M to settle Medicaid fraud allegations in California

Medicaid Fraud Control Unit’s 2022 Annual Report Key Takeaways

The Future of Medicaid: 4 Considerations for MES Modernization

Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks

Dental Fraud Schemes Uncovered

OIG: Most states not doing enough to monitor Medicaid telehealth fraud for behavioral health services

Missouri Woman Sentenced for Medicare and Medicaid Fraud

Healthcare Providers’ Role in Preventing Fraud, Waste, and Abuse

Massachusetts AG’s Medicaid Fraud Division Recovers More Than $71M in Federal FY2022

Massachusetts Medicaid Fraud Division Recovers Over $55 Million in 2021

Indiana Physician Fraud Conviction Highlights Compliance Risks

Unraveling the Maze: Tackling Out-of-State Medicaid Claims and Credentialing Challenges

Advice for New Physicians on Avoiding Medicare and Medicaid Fraud and Abuse

Physician Indicted for Medicaid Fraud and Invasive and Medically Unnecessary Testing

Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations

DOJ charges dozens in $1.1B telehealth fraud crackdown

Fraud, Waste, and Abuse in Healthcare

Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

Essentials of Medicare Fraud, Waste, and Abuse Training

Health Connect America to pay $4.6M to resolve Medicaid fraud allegations

Dozens charged in sprawling $1.2B telehealth and genetics fraud crackdown

Program Integrity Units in Medicaid: Safeguarding Healthcare Access and Resources

Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations

Two Healthcare Organizations Caught Up in Medicare Fraud Schemes

Supreme Court To Review Scope of Identity Theft in Medicaid Fraud Case

New York Optician Convicted of Medicaid Fraud for Nursing Home Residents

Unveiling the Dark Side of Dentistry: Worcester Dental Office Manager’s Shocking Role in Medicaid Fraud Scheme

Ineligible Medicaid Provider Arrested for Defrauding Medicaid of More Than $68K

Manager of Dental Office Sentenced to Prison for Defrauding Medicaid Out of More Than $813,000

CMS proposes risk adjustment changes, broker fraud crackdown for 2026 plan year

Licensed Professional Counselor Sentenced to Prison for $1.3 Million Medicaid Fraud Scheme

Verisys- Healthcare Fraud and Abuse

Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations

Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations

Dental Office Manager Sentenced to 12 Months in Prison for Defrauding Medicaid Out of More Than $813,000

Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000

Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations

What is a Certified Fraud Examiner (CFE)?

Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000

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