Report: HHS OIG fraud recoveries on the rise

The Department of Health and Human Services Office of the Inspector General recently released its semi-annual Report to Congress outlining its anti-fraud activities. The report highlights OIG’s accomplishments for the six-month period ending March 31, 2016. The agency noted that during that period it reported expected recoveries of more than $2.77 billion consisting of nearly […]

Healthcare Fraud and Abuse Crackdown Not Slowing as Evidenced by Recent Cases

The federal government has been busy since the beginning of the year announcing arrests, convictions and settlements relating to healthcare fraud and abuse. The activities relate to violations of the Stark Law, anti-kickback law and federal False Claims Act, and there appears to be no end in sight. Whether it’s home health, transportation, durable medical […]

Government recovers $1.9 billion in healthcare fraud judgments and settlements in FY 2015

A newly released report by the Health Care Fraud and Abuse Control Program (HCFAC) shows that the federal government won or negotiated more than $1.9 billion in healthcare fraud judgments and settlements in fiscal year 2015. As a result of these efforts, as well as those of preceding years, in fiscal year 2015, approximately $2.4 […]

Lessons learned from whistleblower FCA case against cancer treatment company

Earlier this month, the U.S. Department of Justice announced that 21st Century Oncology and its wholly owned subsidiary, South Florida Radiation Oncology LLC, agreed to settle False Claims Act allegations relating to billing for procedures that were medically unnecessary. Specifically, the Fort Myers, Florida-based company was alleged to have billed for performing the Gamma function […]

GAO: Smart cards not a viable weapon in battle against healthcare fraud

There’s been a lot of debate in the last few years over the value of smart cards in the war on healthcare fraud. Some have argued that their use would go a long way toward preventing beneficiaries’ IDs from being used to perpetuate fraud in the healthcare system. Others have suggested that their use would […]

Social media posts can be used to detect healthcare fraud

In George Orwell’s novel Nineteen Eighty-Four, citizens of Oceania, a totalitarian state, are under surveillance at all times and constantly reminded that Big Brother is watching them. Today, with the advancement of digital technologies – from cameras on the street and in stores, to cookies gathered from the Internet – most of us are being watched […]

How data mining is uncovering healthcare fraud

What does your data say about your healthcare practice? Does it show that you bill considerably more than your colleagues for certain types of procedures? What about your facility? Is it performing more of a particular procedure than nearby competitors? These days, healthcare fraud investigators increasingly rely on data to root out healthcare fraud. They […]

Finalized DME rule targets fraud, abuse

The Centers for Medicare and Medicaid Services has finalized a rule that creates a prior authorization process for some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that it has determined are often subject to unnecessary utilization – i.e. healthcare fraud. The rule was first proposed in May 2014 and included a Master List of […]

Government cracks down on pharmacies, home health agencies, medical directors for medically unnecessary services

It’s no secret that in recent years the number of healthcare fraud investigations and prosecutions in the U.S. has rocketed. Clearly, the amount of taxpayer dollars being lost to fraud and abuse, coupled with the potential for big payoffs when fraud is detected, is a great motivator. Every year that the government racks up successful […]

Feds to increase exclusion and civil monetary penalty enforcement cases

When it comes to exclusion and civil monetary penalty cases, the federal government is preparing to take an even harder line than in the past. During the recent Health Care Compliance Association’s Healthcare Enforcement Compliance Institute, Gregory Demske, chief counsel at the Health and Human Services Office of Inspector General, told an audience his agency […]