Fraud

Overflow crowd sees former American Senior Communities CEO get 9½ years for $19 million fraud, kickback schemes

Overflow crowd sees former American Senior Communities CEO get 9½ years for $19 million fraud, kickback schemes

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A U.S. District Court judge leaned closer to prosecuting attorneys' recommendations than defense attorneys' on Friday and sentenced former nursing home executive James Burkhart to 9½-years in prison before an overflow crowd in Indianapolis.

CMS should intensify Medicaid eligibility checks at certain facilities, government asserts

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The Centers for Medicare & Medicaid Services should prioritize fingerprint-based criminal background checks and conduct site visits to high-risk providers to mitigate Medicaid fraud, a government watchdog official said Wednesday.

Hospice provider settles massive case for $2.5 million, claiming documentation errors

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Once accused of defrauding Medicare of $14 million in false claims in a single year, a Florida hospice provider has agreed to pay $2.5 million to resolve the allegations.

Also in the News for Monday, April 23

Nurse accused of covering up patient's fatal fall fails to surrender license, may still be practicing ... Miami man gets 97 months in $10 million home health fraud case ... Strong winds partially destroy Arkansas nursing home, scatter residents — possibly for good

Lawmakers target SNFs' big payer for fraud, waste cuts

Lawmakers target SNFs' big payer for fraud, waste cuts

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A pair of Congressional subcommittees focused on oversight have banded together to examine ways to reduce Medicaid fraud and waste.

Lawsuit claims nursing home managers scammed resident, sold her house, gave her only $2k for it

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An Illinois woman is suing a nursing home and two former employees for allegedly selling her house against her wishes — then paying her only $2,000 for it.

OIG: Medicare needs to do more to prevent fraud and waste related to chiropractic care

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Previous controls have not done enough to reduce fraud and waste in connection to chiropractic care for Medicare patients, according to a review issued by a federal watchdog Friday.

Veterans Affairs plans to borrow from the CMS fraud-prevention playbook

Veterans Affairs plans to borrow from the CMS fraud-prevention playbook

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The Centers for Medicare & Medicaid Services will share its best fraud prevention tactics used against nursing homes and other providers with the U.S. Department of Veterans Affairs, the agencies said Tuesday in announcing a joint effort to sniff out waste and abuse.

Hospice director, also the town mayor, charged in $150M federal fraud case

Hospice director, also the town mayor, charged in $150M federal fraud case

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A Texas mayor and three others were indicted Wednesday for their alleged roles in a $150 million healthcare fraud and money laundering scheme, prosecutors said.

Pharmacist sentenced to probation in nursing home drug reuse scheme

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A former employee of a Pennsylvania pharmacy was sentenced to probation and community service on Tuesday for her role in a scheme to repackage drugs that went unused by area nursing homes.

DOJ's review of fraud prosecution process may have healthcare implications

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Healthcare fraud policies may undergo changes following a recently announced review of prosecution methods by the Department of Justice, according to some observers.

SNF biller charged in $600,000 Medicaid fraud scheme after facility alerts authorities

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A former biller for a Michigan nursing home has been charged with multiple fraud-related charges after authorities say she pocketed residents' cash payments to the facility.

OIG wants $30M refund from rehab in NJ

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Fox Rehabilitation received at least $29.9 million in Medicare Part B payments for services that did not meet Medicare requirements, according to an August report by the Office of the Inspector General of the U.S. Department of Health and Human Services.

CEO in nursing home podiatry scheme given 1 year in prison

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The former CEO of a healthcare company caught billing Medicare for unnecessary podiatry services for nursing home residents was sentenced last week to serve a year in prison and pay $1.8 million in restitution.

It's time for 'the talk' about healthcare fraud

It's time for 'the talk' about healthcare fraud

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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.

SNF owner led record $1 billion Medicare fraud ring, authorities say

SNF owner led record $1 billion Medicare fraud ring, authorities say

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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.

Tales you might never expect from the frontlines of fraud

Tales you might never expect from the frontlines of fraud

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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.

Husband and wife plead guilty to stealing $1.2 from assisted living company

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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.

Avoiding fraud claims

Avoiding fraud claims

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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.

CA man gets 30 months in prison, hefty fine in clinic 'fraud' case

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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.

Speech therapist faces 10 years for $3.7M in bogus claims

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.

Embezzlement scheme nets nursing home bookkeeper 2½-year prison term

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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.

Also in the News for Thursday, February 26

AHCA members testify on Capitol Hill on health IT....DME vendor pleads guilty in $5M scheme ... Doc who illegally prescribed Oxycodone sentenced ... FBI moves closer to nailing Anthem hackers

Hospice pays $6.5 million fine to settle fraud case

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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.

New payment models clash with fraud laws; waivers might not be the answer, official says

New payment models clash with fraud laws; waivers might not be the answer, official says

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Healthcare payments linked to the quality of care are causing challenges to existing fraud and abuse laws, a government official said Wednesday.

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.