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

Medicaid Fraud

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

December 28, 2018 - 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 Act makes individuals and companies liable for defrauding government programs, including Medicare, Medicaid, and TRICARE, the Department of Defense Military Health System’s healthcare...


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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 Medical School. The study recently...

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 allegations. According to an announcement from the US...

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 recently released by the Department of...

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 General (OIG) released a new RFI on the...

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 physician-self referral law. The federal...

AHA: Create Stark Law Exception for Value-Based Reimbursement

by Jacqueline LaPointe

The American Hospital Association (AHA) recently urged CMS to modify the Stark Law by adding value-based reimbursement exceptions that enable providers to coordinate care and advance patient outcomes.   “To reach the full...

NY Health System Settles E&M Upcoding, Healthcare Fraud Case

by Jacqueline LaPointe

A New York-based health system will pay the federal government $14.7 million to settle healthcare fraud allegations that claim the system engaged in evaluation and management (E&M) upcoding. According to the Department of Justice...

Over 600 Individuals Charged in 2018 Healthcare Fraud Takedown

by Jacqueline LaPointe

The HHS Office of the Inspector General (OIG) and Department of Justice (DoJ) recently announced the largest healthcare fraud takedown to date, with over 600 defendants charged with participating in fraud schemes amounting to about $2...

CMS Boosting Audits to Combat Medicaid Fraud, Improper Payments

by Jacqueline LaPointe

In efforts to prevent Medicaid fraud and improper payments, CMS plans to increase the number of audits in the public healthcare program and optimize state-provided claims and provider data, according to a recent announcement from the...

Banner Health Pays $18M to Resolve Medicare Fraud Accusations

by Jacqueline LaPointe

Banner Health, one of the largest non-profit hospital systems in the country, recently agreed to pay $18 million to the federal government to resolve Medicare fraud allegations involving 12 of its hospitals in Arizona and Colorado, the...

HHS, DoJ Recovered $2.6B from Healthcare Fraud Schemes in 2017

by Jacqueline LaPointe

For every dollar the federal government spent on combatting healthcare fraud and abuse in the last three years, the government recovered $4, HHS recently reported. While federal healthcare fraud investigations returned a significant...

Healthcare Fraud Allegations Spur $3.2M Settlement for Providers

by Jacqueline LaPointe

A group of five provider organizations specializing in orthopedic surgeries or anesthesiology recently paid $3.2 million to the federal government to resolve healthcare fraud allegations involving kickbacks, the Department of Justice (DoJ)...

DoJ Memo Limiting Guidance Use to Impact Healthcare Fraud Cases

by Jacqueline LaPointe

A recent Department of Justice (DoJ) memo limiting the use of regulatory guidance to pursue affirmative civil enforcement cases could alter the federal government’s approach to healthcare fraud litigation. The document from...

Ex Lab Exec, Marketing Partners Liable For $51M in Medicare Fraud

by Jacqueline LaPointe

A federal jury in South Carolina recently found the former CEO of Health Diagnostic Laboratory and the owners of the healthcare organization’s marketing partner liable in a Medicare fraud case brought on by three whistleblowers, the...

CMS Extends Home Health Enrollment Suspension to Combat Fraud

by Jacqueline LaPointe

In an effort to reduce Medicare fraud, CMS announced in a new rule that it will extend a moratorium on enrollment of new Medicare home health agencies in Florida, Illinois, Michigan, and Texas. The federal agency also suspended enrollment...

VA Leverages CMS Data Analytics to Reduce Healthcare Fraud, Waste

by Jacqueline LaPointe

The country’s two largest public-private healthcare payment systems, the VA and CMS, recently announced that they will partner to reduce healthcare fraud, waste, and abuse for veterans using data analytics tools. “The VA-HHS...

Physician Groups Pay $33M To Settle Healthcare Fraud Claims

by Jacqueline LaPointe

Two physician groups will pay over $33 million to settle healthcare fraud allegations that the groups received illegal kickback payments for patient referrals to hospitals owned by former Health Management Associates (HMA), the Department...

GAO Offers Steps to Enhance Medicaid, Medicare Fraud Strategy

by Jacqueline LaPointe

CMS demonstrates a commitment to preventing and combating Medicaid and Medicare fraud, but the federal agency’s anti-fraud efforts only partially align with the Government Accountability Office’s (GAO) Framework for Managing...

Home Health Owners Face Charges for Medicare Fraud, Upcoding

by Jacqueline LaPointe

The federal government filed a lawsuit against the two owners of Gateway Health Systems in Chicago for their involvement in a Medicare fraud scheme that cost the federal healthcare program millions, the Department of Justice recently...

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