Tag:

Fraud Investigations

Latest Headlines

Latest Headlines

Public-private healthcare fraud partnerships aim at prevention

For decades, fighting healthcare fraud has involved a "pay-and-chase" mentality. Recently, though, the focus has started to shift to prevention.

Politicians getting involved in Medicare fraud investigations

Even Medicare fraud investigations are not immune to political pressure, according to an investigative article from the  Wall Street Journal. The newspaper details instances in which governors and state representatives have interjected themselves into fraud investigations, blocked payments, and prepayment reviews.

Fraud investigation tips from Deloitte's Mike Little

FierceHealthPayer: Anti-Fraud talked to Michael E. Little for expert advice on how special investigations units can improve their anti-fraud casework. Little is a senior manager in the forensic practice of Deloitte Financial Advisory Services, LLP in Philadelphia.

How to spot liars in fraud investigations

Though it's often hard to say with certainty if someone is lying or telling the truth, recent news describes questioning strategies and clues fraud investigators can use to improve their chances of exposing lies in investigative interviews.

Fraud prompts some to do donuts around insurance

Growing numbers of providers are choosing to run cash-only practices to subvert health insurance middlemen, and fraud and abuse concerns contribute to the attractiveness of this business model.

How to prepare for a government fraud investigation

Whether or not they've committed wrongdoing, payers are increasingly becoming the targets of significant fraud investigations. So it pays to prepare financially and operationally for this possibility. FierceHealthPayer: Anti-Fraud interviewed Kirk J. Nahra, J.D., a partner in the Washington, D.C. law firm WileyRein, to bring readers expert advice on this topic.

Feds recover record $2.5B from healthcare fraud

The Obama Administration's crackdown on healthcare fraud has led to a record $2.5 billion being recovered from industry-related wrongdoing during the most recent fiscal year, reports USA Today. "Our

BCBS companies take aggregate 41 percent loss for 2008

It looks like last year was a serious downer for the Blue Cross and Blue Shield plans, which lost a collective 40.9 percent in income for 2008, as compared with the previous year, struggling with