Medicare and Medicaid

Latest Headlines

Latest Headlines

GAO: Majority of fraud cases include multiple schemes

Two of three fraud cases in 2010 involved more than one scheme, including fraudulent billing, falsified patient records and kickbacks, according to a new report released by the Government Accountability Office.  

CMS drafts new rules to limit home health fraud

The Centers for Medicare & Medicaid Services has proposed a rule that would allow the agency to collect baseline data on probable fraud payments in the home health industry and launch a preauthorization pilot project in five states.  

Nationwide cardiac device probe wraps up with $23M settlement

The final stage of a nationwide investigation into the billing practices of cardiac device implantations added more than 50 hospitals and millions in settlement dollars to an investigation that has implicated more than 500 hospitals to date.  

Texas leads the way in Medicaid fraud recoveries in 2015

According to new Medicaid Fraud Control Unit statistics and an interactive map released by the Office of Inspector General, the Texas MFCU netted more than $210 million in fraud recoveries in 2015, almost all of which came from criminal investigations.

CMS clarifies 60-day rule, lookback period for overpayments

The Centers for Medicare & Medicaid Services has finalized rules that specify when the 60-day clock begins ticking for providers to return overpayments, and shaves four years off of the overpayment lookback period, according to  FierceHealthFinance.  

Clinicians ensnared in multi-million dollar fraud schemes

Clinicians across the country are facing fraud charges for multimillion dollar schemes that run the gamut of medical specialties, from obstetrics and gynecology to pain medicine. 

Imagining how a 2-for-1 deal could combat healthcare fraud

Cees Klumpler, chief risk officer for the Global Fund to Fight AIDS, Tuberculosis and Malaria, is responsible for $4 billion in annual funding that is distributed to 130 different countries. Following years of fraud and abuse that plagued the organization, Klumper has developed a unique 2-for-1 approach to recovering fraudulent payments. It's a methodology that the healthcare industry could benefit from. 

OIG requests $419M to oversee federal health programs in 2017

Following President Barack Obama's $4.1 trillion dollar budget proposal for fiscal year 2017, the Office of Inspector General has requested more than $419 million to fight fraud, waste, and abuse within federal healthcare programs.

OIG sets sights on Part D fraud amid rise in drug spending

Part D fraud remains "a top area of concern" for the Office of Inspector General following a 136 percent increase in Part D spending between 2006 and 2014, according to a new enforcement video released by the agency.  

Massachusetts officials ask AG to investigate a dozen home health providers

Massachusetts state officials have referred a dozen home health agencies to the attorney general's Medicaid Fraud Division calling for an investigation of potentially fraudulent billing practices,  according to   The Boston Globe.