Fraud, Medicaid and Medicare - Health Care Compliance Brief

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

Essentials of Medicare Fraud, Waste, and Abuse Training

Compliancy Group

APRIL 25, 2024

Maintaining Medicare compliance and avoiding legal and financial repercussions requires Medicare compliance training for employees at all organizational levels. Examples of Medicare fraud include billing for unrendered services and using a billing code or a service that’s more expensive than what a patient received.

Fraud

Fraud Medicare Medicare Compliance

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. General Legal Duties and Antitrust Laws.

Fraud

Fraud Medicaid Medicaid Medicare

Webinars

From Diagnosis to Delivery: How AI is Revolutionizing the Patient Experience

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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

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

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

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

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

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

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

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

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

How to Prevent Medicare Advantage Fraud, Waste, and Abuse

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. This year, 50% of Medicare enrollees are expected to sign up for Medicare Advantage.

Fraud

Fraud Medicare Medicare US Department of Health and Human Services

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. Unlike fraud, waste is not necessarily intentional but results from inefficiencies.

Fraud

Fraud Compliance Medicaid Medicaid

Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud

Fraud Medicare Medicare Telemedicine

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

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. million, and $6.4 million, and $6.4

Medicaid

Medicaid Medicaid Medicare Medicare

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

Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud

Fraud Medicare Medicare Telemedicine

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 The scheme involved securing orders for medically unnecessary prescriptions billed to Medicare and paying bribes and kickbacks, [.] Indest III, J.D., million scheme.

Fraud

Fraud Medicare Medicare Medicaid

Florida Man Pleads Guilty To $36.2 Million Telehealth Medicare Fraud Scheme

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 [.]

Fraud

Fraud Medicare Medicare Telemedicine

Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges

The Health Law Firm Blog

JUNE 10, 2023

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Indest III, J.D., Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 The doctor argued that the [.]

Fraud

Fraud Medicare Medicare Doctors

Florida Man Pleads Guilty To $36.2 Million Telehealth Medicare Fraud Scheme

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 [.]

Fraud

Fraud Medicare Medicare Telemedicine

Florida Man Pleads Guilty To $36.2 Million Telehealth Medicare Fraud Scheme

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 [.]

Fraud

Fraud Medicare Medicare Telemedicine

Required Training For Medicare-Enrolled Providers

MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

Medicare

Medicare Medicare Compliance Medicaid

CMS officials say agency is monitoring concerns from ACOs about DME costs

Fierce Healthcare

APRIL 11, 2024

Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid Services (CMS) said Thursday that the | Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid (..)

Fraud

Fraud Medicaid Medicaid Medicare

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

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

Hospices get higher-than-expected Medicare pay hike

Modern Healthcare

JULY 28, 2023

The Centers for Medicare and Medicaid Services gave hospice providers a reimbursement bump for next year, along with a warning about fraud and waste.

Medicare

Medicare Medicare Fraud Medicaid

Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges

The Health Law Firm

FEBRUARY 14, 2022

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Additionally, the doctor indicated that he was sought to directly address CMS and the Medical Practice's ability to bill Medicare and Medicaid. Indest III, J.D.,

Medicare

Medicare Medicare Fraud Doctors

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

Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Medicare and Medicaid data demonstrated that he was identified as an outlier and the highest biller for this procedure in New York State.

Fraud

Fraud Doctors Medicare Medicare

Florida Man Pleads Guilty in Medicare Beneficiary Identifier Trafficking Case

HIPAA Journal

MARCH 6, 2023

The Department of Justice has announced one of its first prosecutions under the Medicare Access and CHIP Reauthorization Act of 2015 in a case involving the theft and sale of Medicare Beneficiary Identifiers. MACRA also made it illegal to buy, sell, or distribute Medicare Beneficiary Identifiers without proper authority.

Medicare

Medicare Medicare Fraud Medicaid

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

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.

Medicare

Medicare Medicare Medicaid Medicaid

Nursing Home Psychologist Convicted of Healthcare Fraud Scheme

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. The psychologist was convicted of four counts of healthcare fraud.

Nursing Homes

Nursing Homes Fraud US Department of Health and Human Services Nurses

Updates to OIG Work Plan Affecting Medicare Fraud Units, Skilled Nursing Facilities, and AIDS Relief Funds

Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

Fraud

Fraud Nurses Medicare Medicare

Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges

The Health Law Firm Blog

MARCH 16, 2022

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Indest III, J.D., Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 The doctor argued that the.

Fraud

Fraud Medicare Medicare Doctors

Florida Behavior Analyst Arrested for Falsifying Timesheets to Defraud Medicaid

Healthcare Compliance Blog

MAY 2, 2022

A behavior analyst who was employed by a Florida home health agency has been arrested for Medicaid fraud. The man provided behavior analyst services for three Medicaid recipients, all of whom had disabilities. The parent of one of the children noticed incorrect information on a Medicaid online portal and reported it.

Medicaid

Medicaid Medicaid Fraud Medicare

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

Dental Healthcare Fraud, Waste, and Abuse (FWA) Training

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

Fraud

Fraud Medicare Medicare Compliance

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).

COVID-19

COVID-19 Fraud Telemedicine Medicaid

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%).

Fraud

Fraud Medicare Medicare Medicaid

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

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

Essentials of Medicare Fraud, Waste, and Abuse Training

Webinars

Trending Sources

Missouri Woman Sentenced for Medicare and Medicaid Fraud

Webinars

Two Healthcare Organizations Caught Up in Medicare Fraud Schemes

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

Understanding the Medicaid Fraud Control Unit’s 2023 Annual Report

Indiana Physician Fraud Conviction Highlights Compliance Risks

Medicaid Fraud Control Unit’s 2022 Annual Report Key Takeaways

DOJ charges dozens in $1.1B telehealth fraud crackdown

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

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

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

How to Prevent Medicare Advantage Fraud, Waste, and Abuse

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

Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme

Fraud, Waste, and Abuse in Healthcare

10 Charged Over BEC Scams Targeting Medicare, Medicaid, and Private Insurance Programs

Massachusetts Medicaid Fraud Division Recovers Over $55 Million in 2021

Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme

Florida Pharmacy Owner Pleads Guilty For Role in $8.3 Million Medicare Fraud Scheme

Florida Man Pleads Guilty To $36.2 Million Telehealth Medicare Fraud Scheme

Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges

Florida Man Pleads Guilty To $36.2 Million Telehealth Medicare Fraud Scheme

Florida Man Pleads Guilty To $36.2 Million Telehealth Medicare Fraud Scheme

Required Training For Medicare-Enrolled Providers

CMS officials say agency is monitoring concerns from ACOs about DME costs

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

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

Hospices get higher-than-expected Medicare pay hike

Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges

Verisys- Healthcare Fraud and Abuse

Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme

Florida Man Pleads Guilty in Medicare Beneficiary Identifier Trafficking Case

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

Mailing Error at CMS Vendor Affects 10,000 Medicare Beneficiaries

Nursing Home Psychologist Convicted of Healthcare Fraud Scheme

Updates to OIG Work Plan Affecting Medicare Fraud Units, Skilled Nursing Facilities, and AIDS Relief Funds

Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges

Florida Behavior Analyst Arrested for Falsifying Timesheets to Defraud Medicaid

What is a Certified Fraud Examiner (CFE)?

Dental Healthcare Fraud, Waste, and Abuse (FWA) Training

HHS & DOJ FY 2022 Enforcement Targeted Fraud in COVID-19, Telemedicine, Opioid and Prescription Drugs, and Substance Use Treatment Centers, Among Other Initiatives

CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance

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

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