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

Medicare 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...

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...

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...

AHA: Delay Site-Neutral Rule to Address Medicare Fraud Risks

by Jacqueline Belliveau

The American Hospital Association (AHA) has asked CMS to delay the implementation of proposed site-neutral payments for another year because the payment reform rule could increase a hospital’s Medicare fraud and abuse risks. Site-neutral...

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...

CMS Announces Pre-Claims Reimbursement Review for Home Health

by Jacqueline Belliveau

In efforts to combat Medicare fraud and provide more timely care to beneficiaries, the Centers for Medicare and Medicaid Services (CMS) has issued a rule that requires some home health agencies to undergo a pre-claim review to qualify for full...

Big Data Tool Saves CMS $1.5B by Preventing Medicare Fraud

by Jacqueline Belliveau

Using big data tools and predictive analytics, the Centers for Medicare and Medicaid Services (CMS) has saved approximately $1.5 billion by preventing Medicare fraud in the traditional fee-for-service program, according to the official CMS blog....

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),...

OIG: CMS Not Reducing Medicare, Medicaid Improper Payments

by Catherine Sampson

In testimony submitted to House of Representatives Subcommittee on Oversight and Investigations, the Office of Inspector General (OIG) urged the Centers for Medicare & Medicaid Services to work with states to correct gaps in their...

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