Topic:
Fraud Prevention and Detection
Latest Headlines
Latest Headlines
Structural changes to Medicaid funding necessary to reduce fraud
Overhauling the way states recieve Medicaid funding from the federal govnernment could pave the way to improved state-based fraud and abuse prevention, according to one healthcare policy expert.
Choosing Wisely falls flat in reducing unnecessary tests
The Choosing Wisely campaign, developed to curb spending tied to unnecessary testing, hasn't done much to change the number of tests it identified as wasteful.
Pa. officials target doctor shopping to reduce opiate abuse
The increasing death toll tied to drug overdoses in Pennsylvania has prompted state senators and law enforcement officials to push for an alternate approach to prescribing pain medication in the state.
Nation's largest drug testing lab pays $256M to settle claims
After four months of negotiations with the federal government, Millennium Health LLC has agreed to pay $256 million to resolve claims that it billed Medicare for unnecessary tests, according to the Department of Justice.
Taylor Swift, Justin Bieber and the comprehensive nature of kickbacks
Kickback schemes run the gamut, from standard cash payments or physician compensation agreements above market value, to stranger bribes that include sporting events and tickets to Justin Bieber or Taylor Swift. These kickbacks often set the stage for multi-million dollar fraud schemes.
US takes less than one-third of original settlement with Tuomey
When Tuomey Healthcare System was hit with a $237.5 million judgment in 2013, the South Carolina provider said it would be forced to close its doors. Two years later, the feds are settling for less than one-third of that original judgment following a long, tumultuous legal battle.
Feds, states turning to predictive analytics to prevent fraud
The largest fraud bust in U.S. history probably wouldn't have happened without the assistance of data analytics, according to the Office of Inspector General.
Fee-for-service payments incentivize unnecessary cardiac surgeries
Lucrative reimbursement for cardiac procedures in Medicare's fee-for-service model is at the heart of an investigation involving three Indiana surgeons accused of performing unnecessary surgeries on hundreds of patients while the hospital turned a blind eye, according to The New York Times.
Second Miami physician charged in $20 million scheme
A Miami physician was indicted for his role in a $20 million fraud scheme in which he is accused of writing prescriptions for unnecessary services after taking kickbacks from home health agencies in the area, according to the Department of Justice.
Data analytics detect fraud schemes in Florida
Enforcement officials in Jacksonville, Florida, are relying on data analytics to uncover fraud, waste and abuse, a method that has already paved the way for several multi-million dollar settlements this year, according to the St. Augustine Record.
