Medicare and Medicaid

Latest Headlines

Latest Headlines

Study identifies $11M in Medicaid waste, fraud and abuse in Delaware

A much-anticipated review of the Delaware's Medicaid program revealed $11 million in potential fraud, waste, and abuse over the last three years, according to the Associated Press.

Senate hearing addresses Medicare and Medicaid overpayments

The federal government spent an estimated $124.7 billion in 2014 inimproper payments across 22 government agencies, most of which came from Medicare and Medicaid programs, according to expert testimony from a senior GAO official.  

Salomon Melgen, plus payment data, put ophthalmologists in the hot seat

Two multi-million dollar cases against two ophthalmologists, including the headline-grabbing Salomon Melgen, have thrown the specialty into the regulatory hot seat. Add Melgen's high-profile case to payment data that lists Medicare payments to ophthalmologists that reach eight figures and an OIG report that identified $171 million in questionable claims, and you've got a recipe for additional federal scrutiny, plus potentially more fraud cases involving ophthalmologists.

OIG identifies $76 million in questionable chiropractic claims

The government isn't doing enough to prevent improper chiropractic payments, particularly claims involving "maintenance therapy," according to a new OIG report, particularly claims involving "maintenance therapy."   

OIG: Medicare paid $30 million for untraceable ambulance rides

Medicare spent more than $30 million during the first half of 2012 on ambulance transports for patients that appear to be ghosts on paper, according to a new report released by the Office of Inspector General Tuesday.

After claiming providers committed $823M in dental fraud, Texas settles for just $20M

Lingering problems from the previous Texas Health and Human Services Commission administration have forced the state to offer reduced settlement packages to nearly 100 dental providers accused off overbilling Medicaid, according to  The Houston Chronicle.

California sees an increase in balance billing among Medi-Cal recipients

Although medical providers are prohibited from billing patients for costs that aren't covered by Medi-Cal, California's low income insurance plan, patient advocates say they are receiving an increasing number of complaints regarding the practice known  as balance billing.

OIG identifies $171 million in questionable billing tied to ophthalmology services

Four percent of ophthalmologists demonstrated questionable billing habits in 2012, leading to $171 in potentially inappropriate Medicare payments, according to a report released by the Office of Inspector General.  

AHA raises concerns about Stark Law interfering with bundled payments

In comments submitted to the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association (AHA) has raised concerns regarding how the Stark Law self-referral rules will interact with the proposed bundled payment program for joint replacements.

State audit: Nebraska failed to act on overpayment referrals

More than 12,000 overpayment referrals are sitting untouched in the Nebraska Department of Health and Human Services' "overpayments mailbox," according to a state audit released last week.