Medicare and Medicaid

Latest Headlines

Latest Headlines

How proposed bills would help Medicare, Medicaid close mental healthcare gap

Bills currently being considered in both the House and Senate mark a "meaningful attempt" at reducing mental health coverage gaps in Medicare and Medicaid, according to a new perspective piece published in the  Journal of the American Medical Association.

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.

Plenty of blame to go around for Medicaid's growing improper payment rate

Last month, the Department of Health and Human Services released its Fiscal Year 2015 Agency Financial Report, and one often-criticized program stuck out like a sore thumb: Medicaid. The program's improper payment rate now sits at 9.8 percent, a significant leap from 6.7 percent in 2014, and nearly double the 5.8 percent rate in 2013. Although CMS continues to deflect blame onto the five-year-old regulation and the states, the agency is conveniently ignoring its own critical role in the transition. 

NHCAA conference focuses on the future of fraud enforcement

As improper payment rates increase across the board, federal officials are targeting areas of healthcare that are particularly vulnerable to fraud, including prescription drug schemes involving non-controlled drugs and high-priced specialty drugs, according to reports from the National Health Care Anti-Fraud Association's annual conference.

In Georgia, strict fraud enforcement raises concerns about access to care

​Providers in Atlanta are raising concerns about the state's approach to fraud enforcement, citing multiple cases in which the state has levied heavy fines against facilities for making small clerical errors, according to  WSB-TV   2  in Atlanta.

As much as 20 percent of mental health funds lost to fraud, waste, abuse

Mental health fraud, waste and abuse cost Medicare and Medicaid as much as $8 billion annually, which translates to a 20 percent improper payment rate, according to estimates from mental health researchers.

Home health owners found guilty for largest fraud scheme in DC's history

Husband and wife owners of a home care agency in Washington D.C. were convicted for their role in the largest fraud scheme recorded in the nation's capital.

Fraud, waste, abuse dominate the OIG's top 10 challenges

Half of the top 10 management and performance challenges identified by the Office of Inspector General in fiscal year 2015 have fraud, waste and abuse implications, according to a report released Tuesday.  

Four ways to protect yourself from Medicare Advantage fraud liability

Medicare Advantage plan sponsors could be facing a greater level of scrutiny, and potentially more legal costs, but legal experts say four simple steps could potentially mitigate liability.

Virginia spent as much as $38M covering ineligible Medicaid recipients

The state of Virginia spent between $21 and $38 million covering ineligible Medicare recipients in 2014, according to a state watchdog agency.