How can investigators predict healthcare fraud?

Predictive modeling is a term that has been used a great deal lately in the context of healthcare fraud. In a nutshell, predictive modeling is the area of data mining concerned with forecasting probabilities and trends. Here in South Florida, many of us are familiar with its use through the forecasting of hurricanes. In the […]

SCOTUS Hears Arguments on Implied Certification Theory

Last month, the United States Supreme Court took up the issue of whether False Claims Act (FCA) cases may be brought by whistleblowers and the government under the theory known as “implied certification.” And, if so, under what circumstances. On April 19, the high court heard oral arguments in Universal Health Services v. United States […]

TRICARE billing scandal intensifies as feds target more compounding pharmacies

Allegations of fraudulent billing practices involving compounding pharmacies and specialty creams is rearing its ugly head again. Now, the U.S. Department of Justice is investigating what is suspected to be half a billion dollars in healthcare fraud linked to these creams used to treat pain. TRICARE, the health insurance program for members of the U.S. […]

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 […]