May 10, 2013
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.
April 18, 2013
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.
March 22, 2013
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.
November 30, 2012
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.
October 17, 2012
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.
August 21, 2012
Although Medicare's fraud detection tactics have been sharply criticized by lawmakers and provider groups, federal officials say efforts are paying off.
July 27, 2012
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.
June 14, 2012
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.
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.
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.
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.
A former nursing home administrator was found guilty of receiving illegal payments for referring residents for fraudulent ambulance transport services.
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.
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.
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.
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.
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.
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).
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.
