Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Healthcare Fraud

OIG Releases Healthcare Fraud Compliance Program Guidelines

March 28, 2017 - The Office of the Inspector General (OIG) recently published guidelines on how healthcare organizations can measure the effectiveness of their healthcare fraud compliance programs. The resource guide explains how healthcare organizations of all sizes can measure different components of their compliance program. The guide covers how organizations can evaluate standards and policies, administration,...


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OIG Releases Healthcare Fraud Compliance Program Guidelines

by Jacqueline Belliveau

The Office of the Inspector General (OIG) recently published guidelines on how healthcare organizations can measure the effectiveness of their healthcare fraud compliance programs. The resource guide explains how healthcare organizations of all...

GA Dentist Sentenced to Prison for $1M Medicaid Fraud Scheme

by Jacqueline Belliveau

A dentist from Georgia faces one and a half years in federal prison after she reportedly participated in a Medicaid fraud scheme totaling almost $1 million, the Department of Justice (DoJ) recently announced. From 2009 to 2013, Oluwatoyin Solarin,...

HHS: Physician Self-Referral Law Hinders Value-Based Care

by Jacqueline Belliveau

Some healthcare fraud prevention regulations many impede value-based care models that use financial incentives to encourage providers to improve care quality and reduce healthcare costs, the Department of Health and Human Services (HHS) recently...

NY Clinic Manager Pleads Guilty in $70M Medicare Fraud Scheme

by Jacqueline Belliveau

A New York-based healthcare clinic manager recently pled guilty for his role in a Medicaid and Medicare fraud ring involving three clinics across New York City. The scheme to defraud federal healthcare programs resulted in $70 million in fraudulent...

Former Tenet Exec Charged in $400M Healthcare Fraud Scheme

by Jacqueline Belliveau

The Department of Justice (DoJ) recently announced the indictment of Tenet Healthcare Corporation’s former senior vice president of operations for his alleged participation in a healthcare fraud scheme totaling over $400 million in inappropriate...

HHS, DoJ Recovered $3.3B From Healthcare Fraud Cases in 2016

by Jacqueline Belliveau

Through healthcare fraud cases and settlements in 2016, Department of Health and Human Services (HHS) and Department of Justice (DoJ) initiatives returned over $3.3 billion to the federal government and individuals, including $1.7 billion to...

OIG Identifies Top HHS Financial, Medicare Fraud Challenges

by Jacqueline Belliveau

The Office of the Inspector General (OIG) recently found the most significant management and performance challenges facing the Department of Health and Human Services (HHS), including financial management and Medicare fraud prevention inefficiencies....

GA Provider Receives Jail Time for a Healthcare Fraud Scheme

by Jacqueline Belliveau

A Georgia-area provider has recently been sentenced to three years and two months in prison stemming from a healthcare fraud case, the Department of Justice (DoJ) reported. Robert E. Windsor of Georgia was charged with fraudulent medical billing...

Former Hospital Exec Pays $1M to Settle Medicare Fraud Case

by Jacqueline Belliveau

The former chief executive officer of a South Carolina-based healthcare system agreed to pay $1 million and be excluded from federal healthcare programs for four years to resolve a 2013 Medicare fraud case, according to the Department of Justice...

Provider Org Pays $3M for Violating Medicare Fraud Resolution

by Jacqueline Belliveau

Kindred Healthcare, Inc., the country’s largest provider of post-acute care, recently paid more than $3 million for failing to comply with a Medicare fraud resolution agreement. It represents the largest penalty ever doled out by the Office...

CMS Proposes to Expand Medicaid Fraud Control Unit Authority

by Jacqueline Belliveau

A recently proposed rule would codify several statutory changes involving Medicaid Fraud Control Units, including the authority to investigate patient and abuse cases at healthcare facilities regardless of if they receive Medicaid payments.*...

DoJ Charges Providers in Medicare Fraud Cases, Settles Others

by Jacqueline Belliveau

Medicare fraud cases have the potential to drain the federal healthcare program of millions of dollars while also putting beneficiaries at risk of receiving unnecessary or low-quality care. In response, the federal government has ramped up its...

Patients Led to Private Plans to Boost Claims Reimbursement?

by Jacqueline Belliveau

The federal agency is investigating whether some healthcare providers or provider-affiliated organizations are encouraging individuals eligible for Medicare and/or Medicaid to enroll in individual market plans under the Affordable Care Act in...

Strong Compliance Programs Key to Avoiding Healthcare Fraud

by Jacqueline Belliveau

Preventing and catching healthcare fraud schemes has recently jumped to the forefront of many public and private payer programs that are designed to reduce unnecessary healthcare spending. The Department of Health and Human Services (HHS) announced...

Provider Enrollment Restrictions Target Medicare Fraud in 6 States

by Jacqueline Belliveau

To further prevent Medicare fraud, CMS has extended temporary provider enrollment restrictions in six states and expanded the prohibition’s reach statewide, the federal agency reported on its website. “CMS is continuing its efforts...

DOJ Charges 3 Individuals in $1B Medicare Fraud Scheme

by Jacqueline Belliveau

Healthcare fraud, waste, and abuse is known to drain the industry of essential funds, but three individuals have allegedly participated in Medicare fraud and money laundering schemes that have cost the program more than $1 billion. According...

CMS Saves $42B Through Healthcare Fraud Prevention Activities

by Jacqueline Belliveau

By using a more proactive approach to healthcare fraud protection, CMS has saved the Medicaid and Medicare programs nearly $42 billion in fiscal years 2013 and 2014. In a post on its official blog, CMS attributed the savings to an increase in...

Providers Pay Millions to Resolve Medicare Fraud Cases

by Jacqueline Belliveau

Healthcare fraud, abuse, and waste can cost the government millions, but recently, federal agencies have made catching and preventing Medicare fraud a top priority. Last month, the Department of Justice partnered with the Department of Health...

HHS, DoJ Announce Largest Healthcare Fraud Takedown

by Jacqueline Belliveau

The Department of Health and Human Services (HHS) has recently partnered with the Department of Justice (DoJ) to charge 301 individuals, including 61 physicians and licensed medical professionals, with reportedly participating in healthcare fraud...

CMS Proposes Revisions to Medicaid Improper Payment Programs

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) is calling on healthcare stakeholders to comment on a proposed rule that would change how states identify improper payments stemming from Medicaid and Children’s Health Insurance Program...

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