Medicare and Medicaid

Latest Headlines

Latest Headlines

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.  

Minnesota audit finds state spent as much as $271M on ineligible beneficiaries

Minnesota overpaid as much as $271 million over a five-month period on ineligible beneficiaries within the state's health insurance exchange program, according to a recently released audit.  

Dallas woman sentenced to five years for submitting fraudulent psychotherapy claims

A Dallas woman has been sentenced to 57 months in prison after using the Medicaid provider numbers of four different licensed counselors to submit fraudulent psychotherapy services.

N.Y. long-term care plan pays $47M for enrolling ineligible beneficiaries

A managed care organization that specializes in long term care in New York City has agreed to pay $47 million for enrolling ineligible beneficiaries in the plan, according to the New York Attorney General's Office.  

Consultant pleads guilty in $63M mental health scam

A consultant that served as a Medicare biller for the now-defunct Greater Miami Behavioral Healthcare Center, Inc. pleaded guilty to her involvement in a $63 million fraud scheme.  

Florida AG steps in against bill that would disrupt fraud litigation

Florida lawmakers delayed a vote on a Medicaid reimbursement bill after Attorney General Pam Bondi argued the legislation would disrupt the state's case against two medical labs and could have broad implications for fraud litigation in other states, according to  WCGU Public Media.  

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

Kindred Healthcare pays $125M to settle claims against subsidiary

The nation's largest rehab provider, which specializes in caring for skilled nursing facility residents, will pay $125 million to settle claims the company provided medically unnecessary therapy services, according to the Department of Justice.

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.