Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Fraud

DOJ Nabs 601 Defendants in Biggest Healthcare Fraud Takedown Yet

July 3, 2018 - HHS Secretary Alex Azar and Attorney General Jeff Sessions have announced the largest healthcare fraud takedown yet after HHS, the Department of Justice (DOJ), and other law enforcement agencies charged 601 healthcare professionals for $2 billion in fraudulent activities. Nearly 165 providers and co-conspirators have been charged with billing Medicare, Medicaid, TRICARE, and other...


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Commercial, Public Payer Healthcare Fraud Cases Total $21.6M

by Thomas Beaton

The latest string of commercial and public payer healthcare fraud cases totaled $21.6 million from providers launching various schemes such as patient kickback agreements and false claims submissions. Public payer programs are frequently...

Former CMS Employee Found Guilty in Insider Trading Scheme

by Thomas Beaton

A former CMS employee leaked high-level information related to the agency’s rulemaking decisions and changes in provider reimbursement as part of an insider trading scheme, according to a guilty verdict in the Southern District of...

DoJ Settles $27.68M in Medicare Fraud, False Claims Act Violations

by Thomas Beaton

The Department of Justice continues its crackdown on Medicare fraud by settling various criminal cases related to $27.68 million of False Claims Act violations. Provider settlements remain the primary medium for healthcare fraud...

OIG: Medicaid Fraud Control Units Recovered $1.8B in 2017

by Thomas Beaton

Medicaid fraud control units (MFCUs) recovered $1.8 billion in 2017 through effective collaboration with state governments, according a new report released by the Office of the Inspector General (OIG). MFCUs recovered $6.52 for every...

OIG: Medicare Could Save $367M by Auditing Improper Payments

by Thomas Beaton

CMS auditing systems failed to recognize that 61 percent of Medicare payments for outpatient physical therapy claims in 2013 were improperly filed, which cost the Medicare program nearly $367 million, says a new report by the OIG. Only...

Latest Medicare Fraud Schemes Targeted $139.4M via Kickbacks

by Thomas Beaton

Three Medicare fraud schemes in recent weeks have targeted a total $139.4 million, which led the Department of Justice (DoJ) to seek multiple convictions and a combined 33 years in prison sentences. Each of the schemes involved the use of...

Medicare Fraud Cases Lead to Mix of Convictions, Settlements

by Thomas Beaton

The Department of Justice’s (DoJ) crackdown on Medicare fraud continued as new investigations led to one provider conviction and two multi-million dollar settlements with provider organizations. The conviction found a provider...

VA, HHS Announce Healthcare Fraud Prevention Partnership

by Thomas Beaton

The Department of Veterans Affairs (VA), HHS, and CMS agreed to participate in a healthcare fraud prevention partnership that leverages data sharing to identify fraud and abuse within healthcare programs they collectively oversee. The...

Provider Health Insurance Fraud Schemes, Settlements Top $310M

by Thomas Beaton

Law enforcement agencies and federal healthcare administrators including HHS, the Office of the Inspector General (OIG), the FBI, and US Attorney's Offices across the country investigated provider healthcare schemes that defrauded...

VA Union: Investigate $90M in Third-Party Contractor Payments

by Thomas Beaton

The American Federation of Government Employees (AFGE) has sent a letter to VA leadership proposing an investigation into $90 million of improper payments made to the third-party contractors of the Veteran’s Choice program. The...

DoJ Recovered $2.4B from Healthcare Fraud Schemes in 2017

by Thomas Beaton

The Department of Justice (DoJ) recovered $2.4 billion from federal healthcare fraud cases during 2017, the agency announced in a press release. Healthcare-related fraud recoveries accounted for 64 percent of the DoJ’s $3.7 billion...

Commercial Payer, Medicare, Medicaid Fraud Cases Top $49.1M

by Thomas Beaton

The Department of Justice (DoJ) recently detailed three cases of healthcare fraud targeting private payers, Medicaid, and Medicare that totaled $49.1 million. The schemes involved common fraud tactics such as illegal kickback operations...

Top 5 Most Common Healthcare Provider Fraud Activities

by Thomas Beaton

Healthcare provider fraud is extraordinarily common and can be conducted at a shockingly large scale.  The largest healthcare provider fraud takedown in US history was announced just recently, resulting charges against 400 defendants...

Providers Caught in Medicare Fraud Schemes Topping $200M

by Thomas Beaton

Law enforcement officials continue to crack down on Medicare fraud schemes that siphon millions of dollars from the programs, as individuals submit fraudulent claims or overcharge for unnecessary healthcare utilization. Federal law...

HFPP Provides New Resource for Payers to Combat Opioid Abuse

by Thomas Beaton

A new 64-page report from the Healthcare Fraud Prevention Partnership (HFPP), a public-private partnership which includes CMS, gives payers resources that treat, educate, and develop improvements for combating opioid harm to patients. CMS...

GAO: Erroneous Medicaid Claims Data Pose Fraud Risk at CMS

by Thomas Beaton

Millions of people rely on long-term personal care services under Medicaid coverage, but significant gaps and errors in two major CMS data systems are creating significant opportunities for fraud and abuse.   A new report from the...

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