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Medicare 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...

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...

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...

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...

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...

Claims Analytics Help Medicare Identify, Prevent Provider Fraud

by Thomas Beaton

Close to a quarter of new Medicare fraud investigations started with the use of a claims analytics platform that has helped to save approximately $6.7 million in incorrect billings, a new GAO report found.   After reviewing fraud...

DoJ Charges 412 in Medicare Fraud Schemes Totaling $1.3B

by Thomas Beaton

The Department of Justice (DoJ) announced the largest ever healthcare enforcement action in the history of the federal agency took place when the Medicare Fraud Strike Force (MFSF) charged 412 defendants for Medicare fraud losses totaling...

GAO: CMS Erroneously Paid $16B to Medicare Advantage Orgs

by Thomas Beaton

CMS incorrectly paid $16 billion to Medicare Advantage organizations (MAOs) as a result of insufficient oversight and mismanagement of data, says the Government Accountability Office (GAO) in a new report. Almost 10 percent of all MA...

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

by Jesse Migneault

Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill Medicare for expensive...

Two Payers Liable for $32.5M in Medicare Advantage Fraud Suit

by Jesse Migneault

Insurers Freedom Health and Optimum Healthcare have agreed to pay $32.5 million to avoid further litigation in a whistleblower lawsuit which alleges systemic Medicare Advantage fraud.    The insurers will pay the federal...

DOJ Sues UnitedHealth over Alleged $1B Medicare Fraud

by Jesse Migneault

The Department of Justice is suing UnitedHealth  for alleged Medicare Advantage fraud in a civil case.  The complaint, filed in the Western District court, is “for monies unlawfully obtained or retained from the insurers...

Senator Calls for Scrutiny of Health Payers, Medicare Fraud

by Jesse Migneault

Senator Chuck Grassley (R-Iowa) is asking federal officials to investigate charges that Medicare Advantage plans were overcharged by health payers. In a letter to CMS Acting Administrator Seema Verma, Grassely cited an...

Are Skilled Nursing Facilities Fraudulently Billing Medicare?

by Vera Gruessner

Skilled nursing facilities are an essential part of improving the health among the elderly and the disabled. However, some skilled nursing facilities and rehabilitation centers have taken advantage of Medicare beneficiaries by fraudulently...

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