Fraud

Nursing home psychiatrist in federal custody on 52 counts of fraud, including upcoding

Authorities have arrested a nursing home psychiatrist and charged him with 52 counts of healthcare fraud, the U.S. Attorney for the Northern District of Texas announced Thursday.

Senators blast Medicare audits, say RAC payments should be changed

Senators blast Medicare audits, say RAC payments should be changed

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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.

Fraudsters admit they bought nursing home drugs as part of $60 million scheme, feds announce

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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.

Brokers stole dying nursing home residents' identities to carry out a lucrative fraud, SEC charges

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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.

Psychiatry company settles Medicare fraud allegations for $1 million

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A New York company that provided psychiatry services to nursing home residents with dementia has settled a whistleblower Medicare fraud case for $1 million.

Nursing home operator to repay $1 million in Medicaid fraud case

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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.

Lawmakers call for public disclosure of Medicare payments, ask for input on post-acute reforms

Lawmakers call for public disclosure of Medicare payments, ask for input on post-acute reforms

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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.

Latest Medicare fraud allegations just an appetizer

Latest Medicare fraud allegations just an appetizer

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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.

HHS: Self-disclosure saves providers money in cases of Medicare and Medicaid fraud

HHS: Self-disclosure saves providers money in cases of Medicare and Medicaid fraud

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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.

Shamelessly invoice at your own risk

Shamelessly invoice at your own risk

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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.

IL whistleblower suit draws $28M fines

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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.

Jury in nursing home whistleblower suit hands down $28M in fines

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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.

Feds join lawsuit against nursing home operator

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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.

Fraud-fighting efforts not much to brag about

Fraud-fighting efforts not much to brag about

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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.

Fraud investigations, audits bring dramatically rising 'savings,' OIG reports

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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.

CMS is two weeks late issuing report on fraud prevention efforts

CMS is two weeks late issuing report on fraud prevention efforts

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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).

OIG: Medicare contractors, antipsychotics in SNFs to get a closer look

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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.

Medicare antifraud efforts paying off, experts say

Medicare antifraud efforts paying off, experts say

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Although Medicare's fraud detection tactics have been sharply criticized by lawmakers and provider groups, federal officials say efforts are paying off.

Federal healthcare fraud initiative will vigorously scrutinize provider claims

Federal healthcare fraud initiative will vigorously scrutinize provider claims

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.

Medicaid directors propose reforms for fraud-detection programs

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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.

Medicaid claims audits come up short, report suggests

Medicaid claims audits come up short, report suggests

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The federal program tasked with detecting Medicaid fraud costs more to operate than it has recovered in overpayments, a government investigation found.

Nursing home residents targeted as part of massive Medicare scheme

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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.

Healthcare waste accounts for a third of all spending, government official says

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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.

CMS issues final rule on provider identification number

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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 enhances readability and fraud protections with streamlined benefit statements

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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.

OIG: Cutting Medicare and Medicaid fraud still a top concern

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.

CMS clarifies provider termination criteria

CMS clarifies provider termination criteria

The Centers for Medicare & Medicaid Services has clarified the terms under which states can terminate a provider's participation in state Medicaid programs.

J & J pays $158 million to settle Texas Medicaid fraud lawsuit

J & J pays $158 million to settle Texas Medicaid fraud lawsuit

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 provider fraudulently cycled patients through nursing homes, hospices, whistle-blower suit claims

Hospice provider fraudulently cycled patients through nursing homes, hospices, whistle-blower suit claims

Hospice company AseraCare allegedly defrauded Medicare by cycling beneficiaries through nursing homes and hospice care, according to a whistle-blower suit announced this week.

Former TX administrator convicted of healthcare fraud, anti-kickback violations

A former nursing home administrator was found guilty of receiving illegal payments for referring residents for fraudulent ambulance transport services.

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