Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicaid Fraud

DOJ Recovers $2.5B in Healthcare Fraud, False Claims in 2018

January 3, 2019 - 2018 was a bad year to be a healthcare fraudster.  The Department of Justice (DOJ) has announced that $2.5 billion of the total $2.8 billion recovered under the False Claims Act can be attributed to fraud and improper claims from healthcare providers during the fiscal year. This was the ninth consecutive year that civil healthcare fraud settlements and judgments have topped $2...

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DOJ Nabs 601 Defendants in Biggest Healthcare Fraud Takedown Yet

by Thomas Beaton

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...

CMS to Develop New Medicaid Program Integrity Initiatives

by Thomas Beaton

CMS has announced a new set of Medicaid program integrity initiatives that leverage enhanced data sharing, claims auditing, and provider education to reduce the incidence of improper payments and help secure program finances. In 2016,...

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...

GAO: Medicaid Home, Community Care Create Financial Conflicts

by Thomas Beaton

Home and community-based services (HCBS) programs funded by Medicaid require additional protections from possible financial conflicts of interest, a new GAO report found. Program assessors, including HCBS providers, state and local...

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...

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...

NY Medicaid Inspector General Assists in $125M Fraud Takedown

by Thomas Beaton

The New York Office of the Medicaid Inspector General (OMIG) assisted the Medicaid Fraud Strike Force in uncovering Medicaid fraud totaled $125 million, the office announced in a press release. OMIG and the Strike Force helped other law...

MS Medicaid Recovers $8.6M in Fraud, Improper Payments

by Thomas Beaton

The Mississippi Division of Medicaid (DOM) recovered $8.6 million dollars from claims that were either directly fraudulent or improperly filed, the DOM announced in a press release. Through collaboration between Medicaid Fraud Control...

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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