Latest Headlines

Latest Headlines

More whistleblower lawsuits target Medicare Advantage plans

At least six whistleblower lawsuits have been filed in states across the country alleging overpayments linked to privately run Medicare Advantage plans, and more are expected to emerge.

The story of a wealthy doctor, a powerful senator and a friendship put to the test

Corruption charges filed against New Jersey Sen. Robert Menendez (D) aim to unveil whether his friendship with Salomon Melgen, M.D., was genuine or used to try and influence an $8.9 million overbilling investigation against the physician.

Horizon New Jersey CEO: Out-of-network providers cost us millions

Out-of-network providers are taking advantage of Horizon Blue Cross Blue Shield of New Jersey.

N.J. Sen. Robert Menendez faces corruption charges stemming from ties to Florida ophthalmologist

The Department of Justice (DOJ) is expected to bring criminal corruption charges against Sen. Robert Menendez (D-N.J.) based on his relationship with Florida ophthalmologist Salomon Melgen.

DOJ investigating Humana's Medicare Advantage billing process

The Department of Justice has requested information from Humana regarding risk adjustments assigned to Medicare Advantage beneficiaries, according to an annual report the insurance company filed to the Securities and Exchange Commission.

Florida fraud case highlights concerns surrounding Medicare Advantage upcoding

In what is believed to be the first case of its kind in South Florida, prosecutors are pursuing criminal fraud charges against a physician that overcharged Medicare Advantage plans. The case has pulled the health plan into the spotlight as it attempts to stave off spending cuts.

Medtronic settles two false claims cases totaling more than $4 million

The third-largest medical device company in the world has agreed to pay $4 million to settle two separate lawsuits stemming from allegations tied to overbilling and off-label promotion of a neurostimulation product.

As retirees move to warmer regions, concerns emerge over unnecessary tests and procedures

Winter destinations like Florida and Arizona that attract retirees from other parts of hte country have higher medical costs due to potentially unnecessary medical testing and exams, according to an investigation by the  New York Times.

What happens when false claims intersect with state peer review protections?

State peer review statutes offer protections to providers, ensuring the process in which medical professionals review the quality of medical services of their peers is shielded from discovery in legal proceedings. However, federal courts are not apt to apply a state statute to a federal case, and that can make things messy.  

Healthcare overbilling is systemic fraud, Nader says

Political activist Ralph Nader recently drew attention to the problem of doctors and hospitals overcharging patients for healthcare services, a practice that costs at least $270 billion a year, counterpunch reported.