Medicare and Medicaid

Latest Headlines

Latest Headlines

Cancer care company reaches $20M settlement for unnecessary tests

One of the largest cancer care providers in the country agreed to pay nearly $20 million to resolve claims that it incentivized physicians to order unnecessary urine screening tests used to detect bladder cancer, according to the Department of Justice.. 

South Carolina ambulance providers criticize preauthorization program

Patients and ambulance operators in South Carolina are echoing concerns made in other states that a prior authorization program aimed at preventing fraud is doing more harm than good.

Youthful exuberance adds a unique twist to fraud schemes

Daniel Suarez, 24, will spend the rest of his twenties and early thirties in prison for stealing $21 million from Medicare Part D as part of pharmaceutical fraud scheme that began when he had barely turned 18. Suarez spent his money on luxury cars, while attempting to launder the stolen funds through FedEx trucks. His youthful exuberance conjures up comparisons the Martin Shkreli, now facing securities fraud charges after drawing in his own brand of attention. 

CMS held back on audits, leading to billions in Medicare Advantage overpayments

The Centers for Medicare & Medicaid Services knew as far back as 2008 that certain Medicare Advantage plans were pocketing billions in overpayments, but officials still held back on auditing the plans and recouping payments tied to inflated risk scores, according to government records obtained by the Center for Public Integrity.  

Healthcare fraud among the FBI's top focus areas

While terrorism and national security are obvious priorities for the Federal Bureau of Investigation (FBI), the growing threat of healthcare fraud continues to be a focal point for the agency, according to FBI director James Coney.  

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.

Supreme Court to hear FCA case on 'implied certification'

The U.S. Supreme Court has agreed to hear a case that will determine whether Medicaid claims can be considered false if a provider does not adhere to "implied" program requirements, according to  Courthouse News Services.  

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.

False Claims Act recoveries drop nearly 40 percent in 2015

Following a record-setting 2014, civil False Claims Act recoveries saw a 39 percent decline in 2015, dropping to $3.5 billion overall, according to figures released by the Department of Justice

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.