Fraud

OIG: Cutting Medicare and Medicaid fraud still a top concern

February 03, 2012

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

January 24, 2012

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

January 23, 2012

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

January 05, 2012

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

December 13, 2011

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

Berwick decries Medicare and Medicaid fraud and waste in parting interview

December 06, 2011

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.
 

Report: CMS should boost reporting of fraud, abuse

August 03, 2011

While the Centers for Medicare & Medicaid Services has made strides in reducing Medicare fraud and abuse, the agency's sheer size leaves it vulnerable, a new report shows.
 

OIG: Higher than average nursing home payments might indicate fraud

July 18, 2011

Nursing homes that collect daily Medicare Part B payments that are more than three times the national average should be closely monitored for possible fraud and abuse, according to a new Office of the Inspector General report that was issued Friday.
 

Feds target individuals, not just companies, in healthcare fraud cases

June 01, 2011

In an effort to crack down on healthcare fraud repeat offenders, the federal government is going after individuals at nursing home chains, drug companies, medical device manufacturers and other providers that receive Medicare and Medicaid funding, according to the Associated Press.
 

Feds recover record $4 billion from fraudulent healthcare claims

January 25, 2011

The U.S. departments of Justice and Health and Human Services recovered a total of $4 billion in fiscal 2010 from healthcare fraud cases prosecuted under the False Claims Act, according to a new report from the annual Health Care Fraud and Abuse Control Program. A record-breaking $2.5 billion came from fraud judgments backed by whistle-blowers and ramped up collection efforts, administration officials said. The balance was collected through administrative findings.
 

U.S. announces new Medicaid audit program aimed at preventing fraud

November 08, 2010

The Centers for Medicare & Medicaid Services announced late Friday new rules aimed at stopping improper Medicaid payments to providers. Taking a page from the Medicare program, regulators have proposed using Medicaid Recovery Audit Contractors (RACs).
 

CMS doubles funding for Senior Medicare Patrol program activities

October 04, 2010

The Centers for Medicare & Medicaid Services on Friday disclosed the availability of $9 million in grants to expand Senior Medicare Patrol (SMP) programs across the country. The purpose of the programs is to educate seniors about ways to prevent fraud.
 

CMS may require more stringent provider screening for Medicare, Medicaid enrollment, participation

September 22, 2010

Some healthcare providers would be subject to criminal background checks and fingerprinting under a new fraud-prevention plan from the Centers for Medicare & Medicaid Services.
 

Providers to need NPI for Medicare, Medicaid enrollment and reimbursement

May 05, 2010

In an effort to crack down on healthcare fraud, the Centers for Medicare & Medicaid Services this summer will require all providers and suppliers who qualify for a National Provider Identifier (NPI) to include that on all enrollment applications, as well as payment claims.
 

Report: Nursing home therapy reimbursement under review as reform law toughens up

March 30, 2010

Healthcare analysts at the Department of Health and Human Services are re-evaluating Medicare's "ultra-high" billing category for therapy services in skilled nursing facilities as a potential way to reduce wasteful spending, according to a Washington Post report.
 

Obama targets Medicare, Medicaid waste

March 12, 2010

President Obama on Wednesday instructed the heads of all executive departments and agencies to increase their use of "Payment Recapture Audits" to reduce the amount of improper Medicare, Medicaid and other similar payments.
 

Obama's FY 2011 budget to extend FMAP increase, ramp up anti-fraud efforts

February 01, 2010

President Obama is scheduled to unveil his FY 2011 federal budget proposal today. The blueprint would provide states with some additional Medicaid funding and crack down on Medicare and Medicaid fraud.
 

HHS: Anti-fraud summit could help reduce wasteful Medicare, Medicaid spending

November 02, 2009

The Department of Health and Human Services is considering convening a Medicare and Medicaid anti-fraud summit meeting. It would be one way to reduce wasteful spending and combat fraud, a representative from the agency said last week.
 

State privacy laws could be slowing electronic medical record adoption

July 14, 2009

The call for widespread adoption of electronic medical records has prompted some states to pass stringent privacy laws to protect their residents against fraud or identity theft. But a new analysis finds these laws seem to significantly diminish the effectiveness of the new technology.
 
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