Labs Settle With UnitedHealthcare For $56.2 Million

UnitedHealthcare Insurance Co. has agreed to settle a lawsuit it filed in 2016 against five toxicology laboratory companies for $56.2 million. The suit, filed in U.S. District Court for the Southern District of Florida, alleged that medical testing lab executives offered kickbacks in the form of partnership shares to treatment facilities and doctors in exchange […]

Report: Many High-Risk Medicaid Providers Not Undergoing Critical Background Checks

Eighteen states failed to properly screen high-risk providers before allowing them to receive Medicaid payments by the July 2018 deadline and 13 of those states had not yet complied by Jan. 1, 2019. Those are the findings from a recently released report by the U.S. Department of Health and Human Services Office of Inspector General. […]

Growth of Telemedicine Sees Increase in Healthcare Fraud

Earlier this month, a New York anesthesiologist was indicted on charges stemming from her role in an alleged telemedicine conspiracy to submit fraudulent claims to federal and private insurance plans. The indictment alleges that Anna Steiner, also known as Hanna Wasielewska, along with others, ordered and prescribed durable medical equipment (DME) and prescription drugs in […]

OIG Alert: Beware of Genetic Testing Scam

The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) recently sent out an alert about a fraud scheme involving genetic testing. The government watchdog agency said Medicare beneficiaries are being offered the chance to get tested for certain genetic conditions through the use of a simple cheek swab, but they […]

Clinical Lab Industry Ripe for Fraud and Abuse

A former account rep for a toxicology testing company in Texas is the latest to be sentenced for his role in a Medicare fraud scheme that has become more common in recent years. Last month, Ivar Cantu was handed a 56-month sentence, to be followed by three years of supervised release, after pleading guilty to […]

How Artificial Intelligence is Detecting Healthcare Fraud

Throughout 2018, we saw how the federal government cracked down on healthcare fraud using a variety of technological advances As we have written about over the years, data analytics is increasingly being used to identify inappropriate payments. Through data mining and the use of predictive analysis, thousands or even millions of transactions, can be searched […]

Healthcare exec pleads guilty to multimillion-dollar opioid scheme

A Michigan healthcare CEO recently pleaded guilty to taking part in a $300 million healthcare fraud scheme that, in the words of U.S. Attorney Jeff Sessions, “flooded the streets” with millions of doses of opioids and other controlled substances. Mashiyat Rashid was CEO of the Tri-County Wellness Group of medical providers which operated pain clinics […]

OIG Unveils Fraud Risk Indicator

The Health and Human Services Office of Inspector General has launched a new initiative designed to draw attention to those healthcare providers it considers to be high risk for committing healthcare fraud after having been charged under the False Claims Act. The OIG posted this Fraud Risk Indicator on its website after Gregory Demske, the […]

Medical Device Maker Settles False Claims Allegations, Agrees to Pay $12.5M

A New York-based medical device manufacturer has agreed to pay $12.5 million to settle allegations it caused healthcare providers to submit false claims to federal healthcare programs relating to the use of two of its medical devices. AngioDynamics Inc. was accused of causing false claims to be submitted to Medicare, Medicaid, TRICARE, and other federal […]

Common Healthcare Fraud Schemes

Last month’s indictment of more than 600 people nationwide in what the feds dubbed “the largest healthcare fraud takedown in history,” should serve as a warning that the government is serious about cracking down on those who abuse the system. As we wrote about in June, of the 601 defendants charged, 165 were medical professionals […]

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