The Department of Justice recovered over $3 billion from False Claims cases in the 2019 fiscal year, with $2.6 billion coming form healthcare fraud schemes.
In a recent announcement, the Justice...
CMS and the Department of Veterans Affairs (VA) recently announced a new data sharing initiative in which the departments will share provider enrollment data to prevent healthcare fraud, waste, and...
HHS recently made moves to update the Stark Law and Anti-Kickback Statute, two healthcare fraud rules created decades ago that have prevented physicians, hospitals, and other healthcare providers from...
A rule proposed by CMS earlier today aims to modernize Medicare’s physician self-referral law, which is also known as the Stark Law, in an effort to advance value-based care.
The Stark law...
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...
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...
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...
States are struggling to implement effective provider enrollment screening processes to prevent Medicaid fraud, including fingerprint-based criminal background checks, according to a recent HHS Office...
California Attorney General Xavier Becerra is leading a multi-state effort to upend a new final rule from CMS that bars states from diverting Medicaid payments to third parties on behalf of providers,...
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...
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...
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...
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...
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...
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...
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...
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....
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)...
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...
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...
