Medicare Fraud

Long-term care providers would receive more education from auditors under draft Medicare bill

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Medicare auditors would boost outreach and education efforts to long-term care and other providers under the provisions of a draft bill introduced Thursday by Rep. Kevin Brady (R-TX), chairman of the Ways and Means health subcommittee.

Congressional lawmakers grill top ALJ on appeals backlog, say too many providers are being put out of business

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Efforts to root out Medicare fraud have put far too many above-board providers in auditors' crosshairs, leading to a staggering backlog of appeals that has no easy fix, Congressional lawmakers and a top government official said during a hearing Thursday.

CMS improperly measuring outcomes, report claims

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So far, some providers have been put through a wringer without enough verification that it's been worth it, according to a new Government Accountability Office report.

CMS fails to measure outcomes of the zone program integrity contractor program: government report

CMS fails to measure outcomes of the zone program integrity contractor program: government report

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The Centers for Medicare & Medicaid Services is not thoroughly assessing how well zone program integrity contractors are contributing to Medicare anti-fraud efforts, according to a new report from the Government Accountability Office.

Judge dismisses claims of 'nationwide' Medicare fraud in Omnicare antipsychotics case

Judge dismisses claims of 'nationwide' Medicare fraud in Omnicare antipsychotics case

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Long-term care pharmacy Omnicare will not face charges that it engaged in "nationwide" Medicare fraud for off-label antipsychotics prescriptions, a federal judge recently ruled. However, the pharmacy still faces more limited False Claims Act charges over billing for antipsychotic drugs allegedly used for dementia care.

Life Care Centers of America denies massive Medicare fraud charges; judge criticizes feds in secret whistleblower case

Life Care Centers of America denies massive Medicare fraud charges; judge criticizes feds in secret whistleblower case

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A U.S. District Judge has called federal prosecutors' years-long delay in announcing a Medicare fraud case involving one of the nation's largest nursing home companies "absurd."

OIG: Volunteer Medicare fraud patrols had declining recovery in 2011

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The success rate of Medicare's volunteer force of fraud-detecting beneficiaries is declining, a government report finds.

Senators: Recovery audit contractors might be doubling up tasks; campaign against fraud gears up

Senators: Recovery audit contractors might be doubling up tasks; campaign against fraud gears up

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Members of the Senate Finance Committee say they are concerned that the functions completed by independent contractors — known as recovery audit contractors (RACs) and Zone Program Integrity Contractors (PICs) — often overlap.

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.

Odyssey to pay $25 million in settlement

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Odyssey Hospice has agreed to pay the U.S. Department of Justice a cash settlement of $25 million. Odyssey, which was acquired in 2010 by Gentiva Health Services, was investigated by the DOJ for continuous care services given between Jan. 1, 2006 and Jan. 22, 2009.

Was it something she said? 'Speech therapist' sent to prison, fined

A North Carolina woman who posed as a licensed speech therapist in two assisted living facilities has been sentenced to 34 months in prison for committing Medicare fraud.

Berwick decries Medicare and Medicaid fraud and waste in parting interview

Berwick decries Medicare and Medicaid fraud and waste in parting interview

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.

CMS expands Medicare fraud patrol program

The Centers for Medicare & Medicaid Services is offering $9 million in grants to expand a program that trains retirees to spot Medicare fraud.

Government saved $17.6 billion in 2011 due to fraud prevention programs

Government saved $17.6 billion in 2011 due to fraud prevention programs

A government crackdown on improper payments in federal programs, such as Medicare and Medicaid, cut wasteful payments by $17.6 billion in 2011, the Office of Management and Budget reported Tuesday. The administration's Campaign to Cut Waste saved $7 billion in Medicare fee-for-service payment errors between 2010 and 2011, according to the OMB.

Medicare and Medicaid chief tells long-term care providers: CMS is on their side

Medicare and Medicaid chief tells long-term care providers: CMS is on their side

Improving the quality of care and targeting waste and fraud are priorities for the Centers for Medicare & Medicaid Services, chief Donald Berwick, M.D. told a large group of long-term care providers Tuesday.

OIG: Higher than average nursing home payments might indicate fraud

OIG: Higher than average nursing home payments might indicate fraud

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.

CMS announces Medicare fraud and abuse initiative

Those who commit Medicare fraud and abuse are facing a new foe: better technology.

Dozens arrested in multistate Medicare fraud ring

The Justice Department Wednesday arrested 52 people for their alleged role in a $163 million, 25-state Medicare fraud scheme, the agency said. Authorities say it is the "largest Medicare fraud scheme ever perpetrated by a single criminal enterprise."

Medicare fraud crackdown yields more than 30 arrests

Medicare fraud crackdown yields more than 30 arrests

An ongoing, multistate healthcare fraud investigation has led to more than 90 individuals being accused of defrauding Medicare of more than $251 million.

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