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What happens if you become the target of a healthcare fraud investigation?

No healthcare provider wants to become the target of a healthcare fraud investigation. But, as we have seen, it happens more often than we would like to think. Not only does a healthcare fraud investigation come with the potential for criminal penalties, but the state also can impose harsh consequences resulting in the loss of […]

Whistleblower lawsuits: How to avoid becoming a target

Earlier this month, three former managers of AIDS Healthcare Foundation Inc. (AHF) filed federal and state Whistleblower Act claims against their former employer. They allege that the nation’s largest supplier of HIV/AIDS medical care participated in patient referral kickbacks to the tune of at least $20 million since 2010. All three plaintiffs held management positions […]

Feds use data analytics to detect and investigate Medicare fraud

There have been countless stories in the news about how the federal government has gone about combating Medicare fraud. Still, every year the battle rages on. Between 2012 and 2014, the Office of the Inspector General’s investigations have resulted in $14.8 billion in investigative receivables (dollars ordered or agreed to be paid to government programs […]

Home health agency owner 20-year sentence for Medicare fraud upheld

The Eleventh Circuit Court of Appeal recently affirmed a 20-year prison sentence for the owner of a Miami home healthcare business who was found guilty of Medicare fraud. Dora Moreira, the owner and operator of Anna Nursing Services Corp., was accused of bilking Medicare out of $7 million. The appellate court found that Moreira, who […]

Now is the time to protect against cyberthieves

For the second time in as many months, a major healthcare insurer has become the target of cyberthieves. This week, Premera Blue Cross announced it had been the target of hackers who gained access to the financial and medical information of 11 million members. In February, Anthem, Inc., announced that personal information of around 80 […]

CMS announces next generation of ACO model

The Centers for Medicare & Medicaid this week launched a new Accountable Care Organization model that the agency says will “reward value over volume in care delivery.” The Next Generation ACO Model, as it has been named, is an initiative from CMS’ Innovation Center. ACOs are groups of providers that contract with the Medicare program […]

GAO: Government misspent billions on Medicare/Medicaid

Last year, Medicare financed health services for approximately 54 million elderly and disabled beneficiaries at a total cost of $603 billion. Of that, approximately $60 billion went toward improper payments, according to a report issued last week by the Government Accountability Office (GAO) Most of that misspent money, about $45.8 billion, went toward the Medicare […]

CMS says ICD-10 testing successful: Are you prepared?

The Centers for Medicare and Medicaid Services is reporting that it successfully completed the first week of end-to-end testing of the soon-to-be-implemented ICD-10 coding. The testing, which took place between Jan. 26 and Feb. 3, included 661 participants with about 1,400 National Provider Identifiers registered. They were split equally between direct submitters and clearing houses/billing […]

GAO: CMS ready for ICD-10, but are you?

There is good news for healthcare providers coming out of the Government Accountability Office: The Centers for Medicare and Medicaid Services is prepared for the switch to ICD-10 on Oct. 1, according to a newly released report. The 41-page report notes that CMS has undertaken “a number of efforts” to prepare for transition to the […]

Florida lawmakers introduce telemedicine legislation

Florida could see legislation later this year that would create statewide guidelines on the use of telemedicine. A bipartisan bill has been filed in Tallahassee that, if signed into law, would more clearly define what telehealth is, who is considered a telehealth provider and outlines what the standard of care is for those providers. HB […]

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It is not intended as professional advice and should not be construed as such.