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Healthcare Dive
DECEMBER 20, 2022
The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program.
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Healthcare Dive
SEPTEMBER 9, 2022
A small proportion of providers that billed for telehealth — 1,714 out of 742,000 — posed a high risk of fraud or abuse to Medicare in COVID-19’s first year, regulators found.
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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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Healthcare Dive
DECEMBER 12, 2022
At least 10 organizations with records of healthcare fraud and abuse prior to 2021 participated in the direct contracting program last year despite CMS screening requirements, the letter said.
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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.
325 
Healthcare Dive
JULY 6, 2022
Cases ranged from improper psychiatric treatment to providing false Medicare claims and illegal kickback schemes.
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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.
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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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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.,
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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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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.
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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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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.
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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.
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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 The agency said it is still litigating Medicare Advantage cases against major insurers.
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Fierce Healthcare
DECEMBER 15, 2022
Genetic testing lab owner convicted in $463M Medicare fraud case. Thu, 12/15/2022 - 14:14.
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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.
164 
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.
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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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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 (..)
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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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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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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.
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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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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.
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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.
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Fierce Healthcare
JULY 31, 2023
Portland, Maine-based Martin’s Point Health Care will pay $22.48
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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.
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Healthcare IT Today
OCTOBER 23, 2024
The following is a guest article by David Lareau, CEO at Medicomp Systems A couple of years ago, we predicted an impending “explosion” of Medicare Advantage (MA) fraud and penalties. The Failure of Reactive Approaches The current approach to combating Medicare fraud is woefully inadequate.
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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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Health Law Checkup
JANUARY 20, 2022
Can a whistleblower successfully allege Medicaid/Medicare fraud if the whistleblower lacked direct access to records related to the alleged fraud? While the appellate circuits are still split on this issue, we look at recent decisions that indicate a possible shift in the Seventh Circuit’s pleading standard.
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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.
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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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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.
98 
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.
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Healthcare IT Today
MAY 5, 2023
The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.
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Fierce Healthcare
JULY 1, 2024
Accountable care organizations concerned they would be held responsible for bad actors exploiting the Medicare system can breathe a sigh of relief. 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.
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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 (..)
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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.
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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.
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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.
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Healthcare IT News - Telehealth
AUGUST 11, 2021
Grimm: "It is important that new policies and technologies with potential to improve care and enhance convenience achieve these goals and are not compromised by fraud, abuse or misuse." They're not submitting a telehealth claim to Medicare. billion, with a B, of alleged fraud. "One scheme went for $1.6
Innovaare Compliance
JULY 19, 2024
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%).
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