Some necessary conversations tend to be awkward and uncomfortable. They include talking to our children about baby making. Or convincing our parents to give up the car keys. Or talking to government investigators about those astronomical therapy billings.
The owner of more than 30 Miami-area nursing homes and assisted living facilities has been charged with leading a national record $1 billion-plus Medicare fraud scheme.
The healthcare world currently ranks as the fourth most victimized industry when it comes to fraud, falling prey to roughly 6.6% of all fraud incidents. In the long-term care sector, experts recently shared, one area gets hit harder than others: resident trust funds.
The Kansas woman who authorities say worked with her husband to steal more than $1.2 million from an assisted living company has pleaded guilty to one federal count of mail fraud.
With Medicare and Medicaid costs soaring, federal and state agencies are looking at various avenues to rein in costs. Fraudulent billings from healthcare providers costs taxpayers millions of dollars each year and is an area of focus for government agencies.
A San Diego man will serve 2½ years in custody after being ordered to repay the government nearly $1 million for what prosecutors say were phony Medicare claims for medically unnecessary and unsupervised tests on unsuspecting seniors, the FBI reported.
A 44-year-old licensed speech therapist faces 10 years in prison and a $250,000 fine after admitting she and a colleague submitted $3.7 million in fraudulent insurance claims for services either unnecessary or not provided at all. It serves as another stark reminder that providers need to know how their contractors are conducting business.
A 31-year bookkeeper for a Wisconsin nursing home received a 2½-year prison sentence and was ordered to repay $296,000 for siphoning funds from residents' insurance proceeds in a decade-long spree.
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A New York hospice provider Wednesday agreed to pay approximately $6.5 million in fines to settle alleged false Medicare and Medicaid claims over a 16-month period.
Healthcare payments linked to the quality of care are causing challenges to existing fraud and abuse laws, a government official said Wednesday.
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.
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.