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

Medicaid Fraud

Third MI Provider Convicted in $17.1M Healthcare Fraud Case

May 22, 2017 - Healthcare fraud prevention and prosecution will continue to be a major area of focus for the Department of Justice (DoJ), Acting Assistant Attorney General Kenneth A. Blanco recently told the American Bar Association. With healthcare fraud draining the industry of up to $100 billion per year, he said, the federal agency has addressed “some of the most impactful healthcare fraud cases...


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Third MI Provider Convicted in $17.1M Healthcare Fraud Case

by Jacqueline Belliveau

Healthcare fraud prevention and prosecution will continue to be a major area of focus for the Department of Justice (DoJ), Acting Assistant Attorney General Kenneth A. Blanco recently told the American Bar Association. With healthcare fraud draining...

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,...

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...

GAO Finds $36B in Improper Medicaid Reimbursements in 2016

by Jacqueline Belliveau

Approximately $36 billion in Medicaid reimbursements made to providers and suppliers in 2016 were improper, a 9.8 percent increase from last year’s Medicaid improper payment amount, the Government Accountability Office (GAO) recently reported...

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...

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.*...

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...

GAO: Weak Medicare, Medicaid Provider Screening Allows Fraud

by Catherine Sampson

The Centers for Medicare & Medicaid Services’ (CMS) provider enrollment screening process is vulnerable to fraud because many ineligible providers are still being entered into the Provider Enrollment, Chain and Ownership System (PECOS),...

GAO: Millions Spent Yearly on Ineligible Medicaid Reimbursements

by Catherine Sampson

Ineligible managed care providers currently receive $3 million in Medicaid reimbursements annually, the Government Accountability Office (GAO) said in a report, due to the lack of effective screening processes. “The integrity of the Medicaid...

Sept. 18: Week That Was in Healthcare Fraud and Malpractice

by Sara Heath

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars...

July 24: Week That Was in Healthcare Fraud and Malpractice

by Jacqueline DiChiara

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars...

March 6: Week That Was in Healthcare Fraud and Malpractice

by Jacqueline DiChiara

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility...

Feb. 27: Week That Was in Healthcare Fraud and Malpractice

by Jacqueline DiChiara

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility...

New York City, CSC Sued for Tens of Millions in Medicaid Fraud

by Jennifer Bresnick

New York City and a contracting company are accused of a massive Medicaid fraud scheme relying on automated software. Federal prosecutors are suing New York City and Computer Sciences Corporation (CSC) for tens of millions of dollars in alleged...

Texas HHSC Failing at Medicaid Fraud Prevention

by Ryan Mcaskill

Last week, the Texas Sunset Advisory Commission issued a less than positive report of the Texas Health and Human Services Commission (HHSC). The main takeaway is that the organization needs to undergo a massive overhaul of its operations to be...

Nursing Facility Pays $38M in Largest Settlement in History

by Ryan Mcaskill

On October 10, the Justice Department and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) jointly announced the largest failure of care settlement with a chain-wide skilled nursing facility in the department’s...

OIG: Connecticut MFCU Recovers $84 Million and 20 Convictions

by Ryan Mcaskill

Last week, the Office of Inspector General (OIG) released the results of a comprehensive review of the Connecticut State Medicaid Fraud Control Unit (MFCU) between the fiscal years of 2010 and 2012. The report found that over this three year...

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