Topic:

Fraud Prevention and Detection

Latest Headlines

Latest Headlines

Former U.S. Attorney: Healthcare fraud isn't increasing--detection is just getting better

Over the course of five years as U.S. Attorney for the Eastern District of Tennessee, Bill Killian collected more than $200 million from healthcare fraud cases alone, and saw five-fold increase in civil claims. However, he argues that healthcare fraud isn't increasing--state and federal agencies are just getting better and detecting it. Following his resignation as U.S. Attorney, FierceHealthPayer: Antifraud spoke with Killian about some of the important healthcare fraud trends and where the government is directing most of its attention. 

Public-private partnerships critical in $390M Novartis settlement

A collaborative effort that included both public and private legal teams was a critical element in forcing Novartis into a $390 million settlement finalized last month, according to a  Bloomberg BNA  Q&A with one of the whistleblower attorneys involved in the case.  

Distributor charged in $100M counterfeit drug scheme

A Utah-based pharmaceutical wholesaler has been charged for his role in a complex fraud scheme in which he is accused of reselling medications purchased on the black market, triggering tens of millions of illegitimate charges Medicaid programs, according to the Department of Justice.

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.

Ten sentenced for Virginia mental health scheme

Ten former employees of a Virginia counseling provider have been sentenced to varying prison terms over the past year for submitting false claims to the state's Medicaid program.

Ties between nursing homes, home health raise kickback concerns

Partnerships between assisted living facilities and home health companies are a natural fit based on their respective roles within the post-acute care environment, but those partnerships can also lead anti-kickback violations, intentional or otherwise.

As OIG investigative recoveries decline, civil actions on the rise

The Office of Inspector General is recovering less money from fraud investigations, but the agency is clearly shifting its focus toward civil actions, according to information included in the OIG's Semiannual Report to Congress.

What happens to the money from fraud fines and settlements?

When a company pays millions to settle False Claims Act allegations, where does that money go? That answer might be more convoluted than you think, according to an article by  BioPharmaDive.

Survey: More than two-thirds of healthcare companies affected by fraud last year

Nearly 70 percent of healthcare, pharmaceutical, and biotechnology executives around the world said their company was affected by fraud during the past year, according to a report from Kroll. However, only 36 percent reported they would be investing in management controls in the coming year.