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 […]

Move quickly to abjure wrongdoing as biller gets prison time for fraud

Medicare Part B published an article on the sentencing of a biller indicted on charges stemming from a conspiracy to obtain payment on care plan oversight services for patients who were not receiving those services. The article notes that the federal government is using all of its resources to identify and prosecute individuals at all […]

CMS’ fraud crackdown relies on high-tech analytics

The government’s crackdown on Medicare fraud is paying off and healthcare providers that bill the government program would be well advised to know that the Centers for Medicare & Medicaid Services is using a high-tech analytics system to identify inappropriate payments. Aptly named the “Fraud Prevention System,” the program has identified or prevented $820 million […]

Medicare Part D fraud fastest growing component of program

When the Department of Justice earlier this month announced the arrest of 243 people for Medicare fraud, it noted that 50 of the defendants were charged with crimes related to the Medicare prescription drug benefit program known as Part D. Prescription drug fraud has become the fastest-growing component of the Medicare program overall, and is […]

Latest Medicare fraud sting should serve as wake-up call

This week’s takedown by the Medicare Fraud Strike Force of 243 people nationwide should serve as a wake-up call to everyone in the medical profession. The arrests, according to federal officials, were due in large part to the government’s increasing use of sophisticated computer programs designed to detect patterns of potential fraud – which in […]

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 […]

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