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

Medicare Fraud

Over 600 Individuals Charged in 2018 Healthcare Fraud Takedown

June 28, 2018 - 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 billion in losses to Medicare and Medicaid. Of the over 600 defendants charged, 165 were medical professionals, including 32 doctors who allegedly participated...


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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 Department...

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 amount of...

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) reported....

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 third-in-command...

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 of...

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 alliance...

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 of...

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 Fraud...

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 announced....

OK Physician Pays $580K to Settle Medicare Fraud Allegations

by Jacqueline LaPointe

A physician from Oklahoma recently agreed to pay $580,000 to settle a Medicare fraud case in which the federal government alleged that he submitted false claims to the federal healthcare program, the  Department of Justice (DoJ) announced....

New Medicare Fraud Audits to Ease Burden on Compliant Providers

by Jacqueline LaPointe

CMS recently updated its Medicare fraud and improper payment audit process to target providers and suppliers who continually demonstrate high medical billing error rates, according to the federal agency’s website. The new Targeted Probe...

LA Hospital Pays $42M to Settle Healthcare Fraud, Kickback Case

by Jacqueline LaPointe

Los Angeles-based Pacific Alliance Medical Center recently agreed to pay $42 million in order to settle an ongoing healthcare fraud case involving improper financial relationships between the acute care hospital and referring physicians. According...

Third MI Provider Convicted in $17.1M Healthcare Fraud Case

by Jacqueline LaPointe

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 LaPointe

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 LaPointe

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 LaPointe

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 LaPointe

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 LaPointe

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 LaPointe

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....

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