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 246

Fraud Governance Medicaid Medicaid 246

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 205

Fraud Telemedicine Medicare Medicare 205

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.

Fraud 212

Fraud Telemedicine Department of Veterans Affairs COVID-19 212

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 199

Fraud Telemedicine US Department of Health and Human Services COVID-19 199

Medisys Compliance

MARCH 31, 2025

Introduction For many physician practices, Medicare beneficiaries represent a significant portion of their patient population. However, navigating the complexities of Medicare billing can be a challenging task, especially when considering its distinct differences from private insurance models.

Medicare 59

Medicare Medicare Medical Billing Medical Billing Outsourcing 59

Healthcare Dive

JUNE 29, 2022

Lawmakers on both sides of the aisle are taking a harder look at coverage denials, fraud and waste in the popular MA program.

Medicare 261

Medicare Medicare Fraud 261

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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Fraud Medicare Medicare 128

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. Raffai, together with others, is allegedly connected to the submission of approximately $10 million in fraudulent claims to Medicare. THE LARGER TREND. " ON THE RECORD.

Fraud 176

Fraud Telemedicine Medicare Medicare 176

Compliancy Group

FEBRUARY 25, 2025

billion in false and fraudulent claims to Medicare and other government insurers for orthotic braces, prescription skin creams, and other items that were medically unnecessary and ineligible for Medicare reimbursement. Details of the healthcare fraud plea are provided below. A healthcare fraud conspiracy fee, essentially.

Fraud 52

Fraud Medicare Medicare Doctors 52

Fierce Healthcare

DECEMBER 15, 2022

Genetic testing lab owner convicted in $463M Medicare fraud case. Thu, 12/15/2022 - 14:14.

Fraud 124

Fraud Medicare Medicare 124

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 166

Fraud Telemedicine Medicare Medicare 166

Compliancy Group

JANUARY 23, 2025

A classic example is Medicare fraud. Providers who bill Medicare for services they did not actually provide and who present the bill with the knowledge that the service was not performed have committed Medicare fraud. Medicare Advantage Matters Medicare Part C is the largest part of Medicare.

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

Healthcare IT News - Telehealth

APRIL 10, 2019

Hundreds of thousands patients were lured into worldwide criminal healthcare fraud schemes involving telemedicine and durable medical equipment (DME) executives, according to the FBI and Department of Justice. WHY IT MATTERS. billion in losses. ON THE RECORD. WHAT ELSE TO KNOW. billion in claims and were paid over $900 million.

Fraud 167

Fraud Telemedicine Medicare Medicare 167

Fierce Healthcare

FEBRUARY 15, 2024

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. ACOs could face lasting financial difficulties because of a recent, alleged $2 billion Medicare catheter fraud scheme.

Fraud 127

Fraud Medicare Medicare Governance 127

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.

Fraud 175

Fraud Telemedicine Nurses Licensing 175

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 The agency said it is still litigating Medicare Advantage cases against major insurers.

Fraud 122

Fraud Medicare Medicare 122

HIT Consultant

JANUARY 5, 2025

government alleged that between January 2017 and November 2022, Meditelecare submitted claims to Medicare for telehealth psychotherapy sessions that did not meet the minimum time requirements for reimbursement. Attorney Michael A. Bennett of the Western District of Kentucky. – The U.S. Attorney Bennett.

Medicare 52

Medicare Medicare Fraud Governance 52

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. By staying vigilant, you help protect Medicare enrollees, preserve the integrity of the Medicare Program, and safeguard the Medicare Trust Fund.

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Fraud Medicare Medicare Compliance 52

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 40

Fraud Compliance Medicaid Medicaid 40

Fierce Healthcare

MARCH 7, 2024

Leading Republicans in the House are demanding answers regarding a recently uncovered catheter billing scheme that has critical implications for Medicare and accountable care organizations. | In light of a recent Medicare fraud scheme impacting providers and ACOs across the country, Republicans are looking for answers from the feds.

Fraud 97

Fraud Medicare Medicare 97

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.

Fraud 52

Fraud Compliance Overpayment Overpayments 52

Fierce Healthcare

AUGUST 27, 2024

A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars—only to abruptly back off amid an “uproar” fr | Filings and testimonies in a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group outline industry pressure that led the (..)

Medicare 132

Medicare Medicare Fraud Governance 132

Verisys

APRIL 8, 2025

At a minimum, FACIS Level 1M satisfies the requirements of the OIG and CMS (Centers for Medicare & Medicaid Services) by screening providers for exclusions, debarments, disciplinary actions , and related issues. A Guide to the Fraud Abuse Control Information System appeared first on Verisys. The post What is FACIS?

Fraud 52

Fraud Medicaid Medicaid Compliance 52

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.),

Fraud 94

Fraud Medicare Medicare Governance 94

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 105

Fraud Compliance Medicaid Medicaid 105

Healthcare Blog

JANUARY 19, 2025

CMS Medicare Swing Bed Rules and Regulations for Critical Access Hospitals (CAHs) Critical Access Hospitals (CAHs) are the backbone of rural healthcare, providing essential services to underserved communities. Why Are Medicare Swing Bed Rules So Important to Follow? Prevent fraud and abuse of Medicare funds.

Medicare 52

Medicare Medicare Compliance Nurses 52

Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

Fraud 98

Fraud Nurses Medicare Medicare 98

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.

Fraud 98

Fraud COVID-19 Public Health Medicare 98

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 59

Fraud Medicare Medicare Compliance 59

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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Fraud Compliance Compliance Officers Licensing 94

Fierce Healthcare

JULY 18, 2023

Two Florida brothers are staring down lengthy prison sentences after pleading guilty to playing a role in a fraud scheme that raked in $67 million from Medicare. | Two brothers pleaded guilty last week to defrauding Medicare of $67 million by selling beneficiaries genetic tests and durable medical equipment that they didn’t need.

Fraud 71

Fraud Medicare Medicare 71

Healthcare IT News - Telehealth

SEPTEMBER 27, 2021

"CMS and state efforts to evaluate and oversee telehealth are critical to meeting Medicaid enrollees' behavioral health needs and to safeguarding the Medicaid program from potential fraud, waste and abuse," wrote OIG officials. Fraud is a concern for many stakeholders when it comes to the future of telehealth.

COVID-19 214

COVID-19 Fraud Medicaid Medicaid 214

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 102

Medicare Medicare Fraud Medicaid 102

Fierce Healthcare

JULY 31, 2023

Portland, Maine-based Martin’s Point Health Care will pay $22.48

Medicare 94

Medicare Medicare Fraud 94

Healthcare IT News - Telehealth

MARCH 2, 2021

Policymakers and stakeholders emphasized the importance of balancing access to care with addressing concerns around fraud and overutilization. Mahoney said the restrictions inadvertently create a "donut hole" for Medicare Fee for Service patients, allowing the health system to offer care to everyone but them.

Fraud 217

Fraud Telemedicine COVID-19 Medicare 217

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 93

Medicare Medicare Compliance Medicaid 93

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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Medicare Medicare Medicaid Medicaid 111