improper payments

Latest Headlines

Latest Headlines

Payers are ramping up addiction treatment audits

Health payers are intensifying investigations into addiction treatment services with more comprehensive records requests, according to one healthcare attorney.

Louisiana state senator's personal care business investigated 27 times

While juggling a number of other scandals, newly sworn-in Louisiana state Sen. Troy Brown is now answering questions about his long history of Medicaid fraud investigations that have led to more than $90,000 in fines, according to  WWLTV.com.

New preauthorization rule targets DME fraud, improper payments

Responding to "longstanding concerns" about improper payments tied to durable medical equipment (DME), the federal government issued a finale rule Tuesday aimed at reducing fraud, waste and abuse within an industry known for questionable billing practices.  

Michigan-Illinois partnership moves Medicaid provider screening to the cloud

A multi-million dollar project between Michigan and Illinois has moved each state's Medicaid system to the cloud, which could offer better fraud detection mechanisms.

Unnecessary spinal procedures remain in the national spotlight

The Department of Justice has secured $28 million in False Claims Act settlements from 32 hospitals for improperly billing a minimially invasive spinal procedure, adding to a long history of previous settlements with more than 100 hospitals and a manufacturer.  

NJ man arrested in genetic testing fraud scheme

A New Jersey man has been charged with using a non-profit company to gain entrance to community centers across the state, where he convinced elderly residents to get unnecessary genetic tests that were billed to Medicare.

Power wheelchair provider nets more than $27 million in improper payments

The second-highest biller for power wheelchairs received nearly $27 million in improper Medicare payments in 2010, according to a report from the Office of Inspector General.

Plenty of blame to go around for Medicaid's growing improper payment rate

Last month, the Department of Health and Human Services released its Fiscal Year 2015 Agency Financial Report, and one often-criticized program stuck out like a sore thumb: Medicaid. The program's improper payment rate now sits at 9.8 percent, a significant leap from 6.7 percent in 2014, and nearly double the 5.8 percent rate in 2013. Although CMS continues to deflect blame onto the five-year-old regulation and the states, the agency is conveniently ignoring its own critical role in the transition. 

NHCAA conference focuses on the future of fraud enforcement

As improper payment rates increase across the board, federal officials are targeting areas of healthcare that are particularly vulnerable to fraud, including prescription drug schemes involving non-controlled drugs and high-priced specialty drugs, according to reports from the National Health Care Anti-Fraud Association's annual conference.

In Georgia, strict fraud enforcement raises concerns about access to care

​Providers in Atlanta are raising concerns about the state's approach to fraud enforcement, citing multiple cases in which the state has levied heavy fines against facilities for making small clerical errors, according to  WSB-TV   2  in Atlanta.