Medicare 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...

CMS Announces Start Date for IRF Claims Review Demo

by Jacqueline LaPointe

Inpatient rehabilitation facilities (IRFs) will have their Medicare claims reviewed either before or after payment as part of a demonstration CMS intends to take nationwide. CMS recently announced on...

CMS Proposes 2.8% Medicare Hospice Payment Bump

by Jacqueline LaPointe

Medicare hospice payments could grow by as much as 2.8 percent, or $720 million, next year under a rule recently proposed by CMS. The federal agency released the proposed rule on Friday. It seeks to...

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...

OIG: Labs Billed Medicare Part B for High Levels of Diagnostic Tests

by Victoria Bailey

More than 370 labs submitted Medicare Part B claims that included questionably high billing for COVID-19 and additional diagnostic tests, a report from the Office of Inspector General (OIG)...

US Rep. Urges HHS to Investigate Medicare Fraud Scheme by HCA

by Victoria Bailey

US Representative Bill Pascrell, Jr. (D-NJ-09), Chairman of the House Ways and Means Subcommittee on Oversight, has asked HHS to investigate a possible billion-dollar Medicare fraud scheme committed by...

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...

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...

Home Healthcare Company Settles False Claims Act Violations

by Victoria Bailey

Signature HomeNow, a home healthcare company operating in Florida, has reached a $2.1 million settlement to resolve allegations that it violated the False Claims Act and fraudulently billed Medicare...

CA Doctor Sentenced in Medicare Fraud Scheme Involving Upcoding

by Victoria Bailey

A California doctor has been sentenced to prison for nearly eight years after his involvement in a $12 million Medicare fraud scheme in which he upcoded and billed Medicare for unnecessary...

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...

DOJ Alleges Methodist Violated False Claims Act, Anti-Kickback Laws

by Victoria Bailey

The US Department of Justice (DOJ) has filed a lawsuit against Methodist Le Bonheur Healthcare and Methodist Healthcare Memphis Hospitals, alleging that the health systems violated the False Claims Act...

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...

Geisinger to Pay $18M Settlement Over Medicare Billing Violations

by Sarai Rodriguez

The US Attorney’s Office for the Middle District of Pennsylvania announced that Geisinger Community Health Service (GCHS) reached an agreement to pay more than $18.5 million for...

AHA Asks CMS to Retract Plans for Inpatient Rehab Facilities Review

by Victoria Bailey

The American Hospital Association (AHA) has asked CMS to withdraw the proposed review choice demonstration (RCD) that would implement program integrity audits at inpatient rehabilitation facilities...

Medical Coding Slip at TX Hospital Led to COVID-19 Billing Error

by Jacqueline LaPointe

Midland Memorial Hospital agreed to pay over $555,000 for a medical coding error that resulted in claims being sent out for reimbursement from the government even though patients did not have a primary...

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