Commercial Insurance 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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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...

American Renal, Former Execs Charged with Healthcare Fraud Scheme

by Sarai Rodriguez

The Securities and Exchange Commission (SEC) has charged the nationwide dialysis service provider American Renal Associates Holdings of engaging in a healthcare fraud scheme involving revenue...

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...

Hospital Exec, Others Charged in $1.4B Rural Hospital Fraud Scheme

by Jacqueline LaPointe

The Justice Department has charged ten individuals, including a hospital executive, for their participation in a rural hospital fraud scheme that cheated $1.4 billion out of private insurance companies...

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...

25% of Total Healthcare Spending Attributed to Waste, Study Finds

by Jacqueline LaPointe

Despite initiatives to reduce spending and promote value over volume, a new study showed that the US healthcare system still wasted between $760 billion to $935 billion, representing approximately...

Dozens of Providers Charged in September Healthcare Fraud Busts

by Jacqueline LaPointe

Late last week, the Department of Justice (DoJ) charged 35 individuals, including ten medical professionals, for their involvement in a national healthcare fraud scheme that cost Medicare more than...

DoJ Probes Swedish Health Services About Joint Ventures, Other Deals

by Jacqueline LaPointe

The US Department of Justice (DoJ) is investigating Providence St. Joseph’s Swedish Health Services over a civil issue, the non-profit disclosed in its recent quarterly earnings report. The DoJ...

Feds Dismantle $1.2B Healthcare Fraud Scheme Involving DME

by Jacqueline LaPointe

Federal authorities recently took down a massive international healthcare fraud scheme involving telemedicine and durable medical equipment (DME) companies, the Department of Justice (DoJ) announced on...

MedStar Health Pays $35M to Settle 2 Healthcare Fraud Cases

by Jacqueline LaPointe

MedStar Health Inc. and two affiliated hospitals recently agreed to pay $35 million to the federal government to resolve healthcare fraud cases that alleged the health system paid kickbacks in exchange...

Justice Dept Recovered $2.5B from Healthcare False Claims in 2018

by Jacqueline LaPointe

The Department of Justice recovered over $2.8 billion from False Claims Act cases in the 2018 fiscal year, and the majority of the recoveries stemmed from healthcare fraud schemes. The False Claims...

Medicare, Medicaid Exclude 200% More Docs for Healthcare Fraud

by Jacqueline LaPointe

Efforts to combat healthcare fraud, waste, abuse by Medicare, Medicaid, and public insurance programs may be paying off, according to a new study from the University of Southern California and Harvard...

Aurora Health Care Pays $12M to Settle Healthcare Fraud Claims

by Jacqueline LaPointe

An integrated health system that services patients in Wisconsin, Illinois, and Michigan recently agreed to pay $12 million to federal and state governments to settle healthcare fraud...

OIG: Healthcare Fraud Exceptions for 2 Value-Based Payment Models

by Jacqueline LaPointe

Two recent advisory opinions from the Office of the Inspector General (OIG) at HHS are demonstrating why current healthcare fraud and abuse laws are not aligned with value-based payment and care...

Telemedicine at Center of Billion-Dollar Healthcare Fraud Scheme

by Jacqueline LaPointe

Law enforcement officials in Tennessee recently charged four individuals and seven companies involved in a $1 billion healthcare fraud scheme involving telemedicine services, according to details...

OIG Mulls Anti-Kickback Statute Changes to Boost Value-Based Care

by Jacqueline LaPointe

HHS is looking to make sweeping changes to healthcare fraud and abuse laws. As the comment period for a CMS Request for Information (RFI) on the Stark Law closed, the HHS Office of the Inspector...

MI Hospital System Pays $84.5M to Resolve Healthcare Fraud Claims

by Jacqueline LaPointe

A regional hospital system in the Detroit, Michigan area agreed to pay the federal government over $84 million to resolve allegations that the system violated the Anti-Kickback Statute and the...

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