The Medicare claims review process is unfairly burdening healthcare providers and failing to improve program integrity, due in part to the payment system for certain auditors, Senate leaders said during a roundtable hearing Wednesday.
A husband and wife have pleaded guilty to masterminding a sprawling drug diversion scheme that involved reselling nursing home medications, according to federal and state authorities.
Two investment brokers and their associates are facing charges that they stole nursing home residents' personal information to perpetrate annuities fraud, the U.S. Securities and Exchange Commission announced Thursday. A $4.5 million settlement has been reached with some of the parties.
A New York company that provided psychiatry services to nursing home residents with dementia has settled a whistleblower Medicare fraud case for $1 million.
A South Carolina man will pay $1 million in restitution for his role in a nursing home Medicaid fraud scheme, the state's attorney general announced Thursday.
The battle against Medicare waste, fraud and abuse heated up on Capitol Hill this week. Lawmakers introduced a bill to make Medicare claims and payments publicly available and asked for provider input on post-acute care reforms.
As we've been predicting here for some time, allegations of mismanaged therapy care are starting to land nursing homes in some seriously hot water.
Long-term care providers who self-disclose potential Medicare and Medicaid fraud will likely benefit from lower repayment amounts, according to updated guidance released Wednesday. It is the first time HHS has explicitly acknowledged systematically imposing lower penalties for self-reported fraud.
Here's the good news for providers: new analytics are making it possible to understand and bill your care in ways that would have been impossible just a few years ago. Here's the bad news: The government is quite aware of these new options.
Two former nurses' complaints about alleged substandard care and inappropriate billing resulted in $28.1 million in penalties being levied against the former owner of an Illinois nursing home. A federal jury assessed the penalties.
A federal jury recently assessed penalties of $28.1 million against the former owner of an Illinois nursing home on charges that include Medicare and Medicaid fraud.
The Department of Justice has joined a whistleblower fraud lawsuit against a former nursing home operator in Mississippi. The lawsuit was originally filed by Academy Health Center, which says the operator of the Lumberton facility charged Medicare and Medicaid for services that were not provided.
In what has become a frequent event, the Inspector General at the Department of Health and Human Services has just issued yet another report that crows about heroic fraud-fighting efforts.
The projected recoveries to the federal government from fraud-related audits and investigations are expected to rise 33% — or by $1.7 billion — in fiscal 2012, the Department of Health and Human Services Office of the Inspector General said this week.
Two Republican Senators want to know why the Centers for Medicare & Medicaid Services is two weeks overdue in issuing a report on the agency's fraud prevention system (FPS).
The Medicare contractors keeping close tabs on long-term care facilities will be subject to oversight too, according to a federal working plan released this week.
Although Medicare's fraud detection tactics have been sharply criticized by lawmakers and provider groups, federal officials say efforts are paying off.
A new federal fraud-fighting initiative will apply increased scrutiny to provider health claims submitted to both government and private payers, government officials announced Thursday.
State Medicaid directors outlined several different strategies for streamlining collaboration between Medicare and Medicaid antifraud efforts in a June 29 letter to members of the Senate Finance Committee.
The federal program tasked with detecting Medicaid fraud costs more to operate than it has recovered in overpayments, a government investigation found.
Beneficiaries from nursing homes were a target of a group filing false claims in what authorities call the largest Community Mental Health Center services fraud case.
With healthcare waste taking up to a third of all healthcare costs, reducing waste and fraud remain primary goals of the Office of the Inspector General, the head of the agency said Monday.
Providers and suppliers who submit claims to Medicaid and Medicare must include an identification number on enrollment applications and payment claims, according to a final rule.
Medicare recipients soon will be reaping the benefits of simplified benefit statements and will see added protections against Medicare fraud, the Centers for Medicare & Medicaid Services announced Wednesday.
Eliminating Medicare and Medicaid fraud should be a priority for the Department of Health and Human Services as it works to implement healthcare reform programs, according to a new report.
The Centers for Medicare & Medicaid Services has clarified the terms under which states can terminate a provider's participation in state Medicaid programs.
Johnson & Johnson has agreed to pay $158 million to settle a Medicaid fraud lawsuit. The lawsuit accused J & J subsidiary Janssen Pharmaceuticals of giving state officials kickbacks in exchange for putting the antipsychotic Risperdal on an approved list for Medicaid recipients.
Hospice company AseraCare allegedly defrauded Medicare by cycling beneficiaries through nursing homes and hospice care, according to a whistle-blower suit announced this week.
A former nursing home administrator was found guilty of receiving illegal payments for referring residents for fraudulent ambulance transport services.
On the heels of his departure from the Centers for Medicare & Medicaid Services, Donald Berwick, M.D., said he came to Washington with an agenda to eliminate waste from the system.