Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Fraud

Provider Health Insurance Fraud Schemes, Settlements Top $310M

January 17, 2018 - 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 Medicare and Medicaid more than $310 million. The investigations led to criminal charges and one settlement to resolve False Claims Act allegations. Aggressive...


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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 inquiry...

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 total...

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 and the...

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 in...

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 enforcement...

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 has...

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 Government...

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