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 […]

OIG Cracks Down on Home Health Questionable Billing Practices

A few years back, as part of its Work Plan, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) announced it was seeking to identify home health agencies, supervising physicians, and geographic areas whose Medicare claims had characteristics similar to those observed by the agency in cases of home health […]

Incident-to Billing Investigation Ends in $118,000 Fine

A physician in Texarkana, Texas recently agreed to pay $118,000 to settle allegations he engaged in improper billing practices for his Medicare patients at three of his clinics. According to the allegations, Dr. Donald S. Douglas’ advanced practice nurses (APNs) were hired to assist him with seeing patients in his clinics. By law, if the […]

Medicare Improper Payments Fall to Lowest Level in Eight Years

The Centers for Medicare & Medicaid Services (CMS) announced last week that its efforts to reduce improper payments is working. CMS noted that it paid out an estimated $31 billion in improper payments during fiscal year 2018, down from $36.2 billion a year earlier. That’s the lowest level since 2010. CMS noted this is the […]

Obstructing Medicare Audit Can Get You Jail Time

A 73-year-old Port Charlotte, Florida endocrinologist was recently sentenced to five months in prison, to be followed by three years of supervised release, for obstructing a Medicare audit. In addition, Dr. John Janick will have to pay $118,831.62 in restitution to the Medicare program. Janick, who reached a plea agreement, is alleged to have lied […]

Doctors, Nurses, Other Healthcare Pros Rounded up in Opioid and Medicare Fraud Sweep

Doctors, nurses, addiction treatment professionals, pharmacists and hundreds of others are among the 601 people across 58 federal districts charged this week in what the Justice Department is calling “the largest national healthcare fraud enforcement action” in its history. The fraud resulted in more than $2 billion in losses. Of those 601, more than 162 […]

Second FCA Whistleblower Case Dismissed – What’s a Lawyer to Do?

For the second time in the last few weeks, a Florida district court judge has dismissed a whistleblower lawsuit filed against a healthcare company alleging fraud. The most recent dismissal, which took place on February 6, was of a lawsuit against electronic software company Epic that alleged it had overbilled for anesthesia procedures. In dismissing […]

June a busy month for healthcare fraud enforcement

Individual physicians, medical billers, DME manufacturers, healthcare executives and even entire healthcare systems were on the receiving end of the U.S. Department of Health and Human Services Office of the Inspector General’s (OIG) enforcement efforts last month. In fact, there were 39 actions announced by the IG’s office in June, up from 35 in May […]

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 […]

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 […]

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