Health Insurance Fraud

Latest Headlines

Latest Headlines

Seeing the whole problem: An elephant story for fraud fighters

Six blind men lived in a village visited by an elephant. They had no idea what an elephant was, and so they--being curious and bold--decided to touch the animal to find out. (Note to readers: Do not...

Commit, play hard and fly: Bobby Orr as a fraud fighting role model

Robert Gordon Orr is a retired professional ice hockey player who led the Boston Bruins and Chicago Black Hawks. He's a sports legend. What set him apart was the completeness of his game, his...

Massive fraud scheme linked to baby's death

Fifteen California medical professionals were indicted last week in a $25 million dollar workers' compensation scam that prosecutors associate with a child's death, the Associated Press reported.

4 recent scams exploit patients

Offering further proof that health insurance fraud and abuse aren't victimless crimes, recent scams share a theme of patient exploitation and endangerment. Here are four prominent cons worth noting.

DOJ's Rebecca Pyne on fighting fraud by organized crime

Health insurance programs have lost hundreds of millions of dollars due to fraud by organized crime rings. To learn how payers can recognize and respond effectively to this threat, FierceHealthPayer: Anti-Fraud spoke to Rebecca Kettelle Pyne, a trial attorney in the organized crime and gang section of the criminal division of the U.S. Department of Justice (DoJ).

A tribute to good medical directors and veterans

As Memorial Day nears, I remember the saddest day of my professional life. That was when the medical director at my former company died. I don't know old he was, but his life ended early as a...

Jack Price on building a top-notch SIU

FierceHealthPayer:Anti-Fraud recently spoke to Jack Price (pictured) about how payers can create high-performance special investigations units (SIUs) to control fraud, waste and abuse. A former law enforcement officer, Price is a consultant with more than 20 years of experience developing, managing and leading SIUs in the life and health insurance industries.

OIG moves to expand sanction authorities

The Office of Inspector General proposed a new rule to strengthen its authority to exclude providers from federal healthcare programs.   

Home care, hospice fraud trends to watch

Monitoring home healthcare and hospice claims is a program integrity priority due to continuing fraud, abuse and general noncompliance involving such benefits. How can payers fight these trends? FierceHealthPayer: Anti-Fraud spoke to Sean McKenna, J.D., to find out.

Diamonds from Barbados: The possibility of real-time fraud prevention

My credit card company called me awhile back asking if I had just bought diamond jewelry in Barbados. With powerful analytic subtlety, the bank's anti-fraud unit flagged this purchase as a tad...