Medicaid Fraud

Back to the Basics, Other Payment Integrity Strategies Post-PHE

June 6, 2023 - After an unprecedented three years, it’s time to return to the basics, according to Jordan Kearney, partner at Hooper, Lundy, and Bookman and founder of the firm’s Medicare Audits and Appeals Practice Group. By that, she means healthcare fraud prevention and payment integrity basics. Compliance with healthcare fraud, waste, and abuse policies may not have been top of mind...

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Eye Specialists Pay $17M to Resolve False Claims Act Violations

by Victoria Bailey

SouthEast Eye Specialists, SouthEast Eye Surgery Center, and the Eye Surgery Center of Chattanooga (SEES) must pay $17 million to the United States and Tennessee to resolve allegations that they...

Lawmakers Ask CMS to Inspect ACO REACH Model to Prevent Fraud, Abuse

by Victoria Bailey

A group of lawmakers, spearheaded by US Senator Elizabeth Warren (D-Mass.) and Representative Pramila Jayapal (D-Wash.), has asked CMS to examine the ACO REACH model to prevent organizations with a...

CA Healthcare Organizations Settle False Claims Act Violations

by Victoria Bailey

A California county organized health system and three healthcare providers have reached a $70.7 million settlement to resolve allegations that they violated the False Claims Act by submitting...

Federal Govt Received $1.9B from FY21 Healthcare Fraud Settlements

by Victoria Bailey

The federal government received almost $1.9 billion in healthcare fraud settlements and judgments in fiscal year 2021, according to a report from the HHS Office of Inspector General (OIG). The latest...

Molina Healthcare Pays $4.6M to Settle False Claims Act Violations

by Victoria Bailey

Molina Healthcare (Molina) has reached a $4.6 million settlement to resolve allegations that it violated the False Claims Act after submitting improper claims for Medicaid reimbursement. In October...

Steward Health Care System Settles False Claims Act Violations

by Victoria Bailey

Steward Health Care System has reached a $4.7 million settlement to resolve allegations that it violated the False Claims Act by paying physicians for services they did not provide. The United States...

Florida Practice Pays $24.5M to Resolve False Claims Act Violations

by Victoria Bailey

Florida-based Physicians Partners of America (PPOA) has reached a $24.5 million settlement to resolve healthcare fraud allegations that it violated the False Claims Act and billed federal healthcare...

Providence Reaches $22.7M Settlement to Resolve Healthcare Fraud

by Victoria Bailey

Providence Health & Services Washington (Providence) has reached a $22.7 million settlement to resolve healthcare fraud allegations that it falsely billed Medicare and Medicaid for medically...

Telehealth, EHR Use Increases False Claims Act Violations, Fraud

by Victoria Bailey

Healthcare digitization, including increased use of telehealth and EHR has led to a higher volume of healthcare fraud and False Claims Act (FCA) cases, according to lawyers from Hogan Lovells. The...

Top Healthcare Fraud, Waste, and Abuse Takedowns of the Year

by Jacqueline LaPointe

Healthcare fraud, waste, and abuse continue to be a problem for public and private programs. Each year, the Department of Justice (DoJ) reports on the major cases and takedowns involving physicians, pharmacists, and other medical...

Missoula Surgeon Pays $3.7M to Settle Healthcare Fraud Allegations

by Sarai Rodriguez

David Bellamah, MD, a vascular surgeon in Missoula and Kalispell of Montana, reached a civil settlement and has agreed to pay the federal government $3.7 million to settle healthcare fraud...

DOJ Recovered $3.1B Following 2020 Healthcare Fraud Investigations

by Jill McKeon

In efforts led by the Department of Justice (DOJ), $3.1 billion was paid out to the federal government and private persons in 2020 as a result of healthcare fraud investigations, according to an annual...

$21M Settlement Resolves Healthcare Fraud Accusations for OH System

by Jill McKeon

Akron General Health System (AGHS), a hospital system in Ohio owned by the Cleveland Clinic Foundation, reached a civil settlement and agreed to pay $21 million for allegedly committing healthcare...

CARES Act Funding Will Lead to More Healthcare Fraud Accusations

by Jacqueline LaPointe

Large stimulus packages passed in response to the COVID-19 pandemic will create an opportunity for more False Claims Act (FCA) enforcement, especially in the healthcare sector, lawyers from Hogan...

Top Healthcare Fraud Takedowns of 2020

by Jacqueline LaPointe

2020 will not only go down in the history books as the year COVID-19 hit, but also as a historic year for healthcare fraud takedowns. The Department of Justice recently reported that it has charged...

HHS Overhauls Key Healthcare Fraud Laws to Advance Value-Based Care

by Jacqueline LaPointe

After years of debate, HHS agencies have made changes to two major healthcare fraud, waste, and abuse laws that providers have said get in the way of value-based care progress. Late last week, CMS and...

Beyond the Pandemic: Telemedicine Reimbursement and Health Policy

by Jacqueline LaPointe

In the wake of the first confirmed cases of COVID-19 in the US, policymakers quickly relaxed long-standing healthcare regulations, including telemedicine reimbursement and healthcare fraud prevention...

OIG Recovered Over $1.5B From Healthcare Fraud Schemes, So Far

by Jacqueline LaPointe

The Office of the Inspector General (OIG) at HHS expects to return over $1.5 billion to the federal government from healthcare fraud schemes investigated during the first half of the fiscal year,...

Hospitals Ask for Relief from Healthcare Fraud Laws During COVID-19

by Jacqueline LaPointe

Leading hospital groups are urging the Department of Justice to ease penalties from the Anti-Kickback Statute and other federal healthcare fraud laws during the COVID-19 public health emergency. For...

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