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Judge dismisses Medicaid fraud suit against Centene’s board

Healthcare Dive

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

Healthcare Dive

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.

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Hospice Update: Surveyors Called to Identify Quality of Care Concerns and Potential Fraud Referrals

Hall Render

The Centers for Medicare & Medicaid Services (CMS) is reinforcing its emphasis on hospice quality of care and identifying fraud. CMSs Focus on Surveys and Fraud Identification The CMS Memo highlights the dual purpose of hospice surveys: Ensuring Compliance : Evaluating whether hospice providers meet CoPs.

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DOJ charges dozens in $1.1B telehealth fraud crackdown

Healthcare IT News - Telehealth

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

Fierce Healthcare

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 (..)

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Fraud, Waste, and Abuse (FWA) Refresher Training

American Medical Compliance

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.

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

Fierce Healthcare

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

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