Medicare and Medicaid

Latest Headlines

Latest Headlines

Hearing highlights troubling gaps in Medicaid fraud prevention

Legislators and government officials met Friday for a hearing to discuss fraud, waste and abuse gaps that still exist within Medicaid, and review six bills that aim to improve the way federal and state entities address improper payments.  

OIG report: Washington needs better policies for suspending providers with credible allegations of fraud

From March 2011 through September 2013, Washington failed to suspend Medicaid payments to 48 providers being investigated for credible allegations of fraud, according to a report from the Office of Inspector General.  

Obama budget director wants more aggressive approach to improper medical payments

The Obama administration is zeroing in on fraud, waste and abuse, as evidenced by a letter from a White House official calling for "a more aggressive strategy" to combat improper payments within government healthcare programs.  

Seven indicted for home health fraud scheme in Chicago

Two owners of a home health company in Chicago, along with four nurses and a marketer, were indicted for paying kickbacks for patient referrals and altering patient records in order to carry out a $6 million Medicare fraud scam.

Iowa governor defends companies selected to manage Medicaid program

Iowa Gov. Terry Branstad is defending the companies selected to manage the state's $4.2 billion Medicaid program, despite reports that all four have been involved in high-priced fraud settlements, according to the  Des Moines Register.  

OIG: New Jersey billed $32.2M in improper personal care services

Between 2008 and 2011, New Jersey submitted at least $32.2 million in unallowable Medicaid claims for personal care services, according to a new report from the Office of Inspector General.

Citing fraud concerns, Florida governor orders regulators to audit 129 hospitals

Rising Medicaid costs and concerns surrounding potential Medicaid fraud among healthcare providers has led Florida Gov. Rick Scott (R) to call on state regulators to audit 129 hospitals within the state. 

When does the 60-day stop watch start ticking? It all depends on one word

Words matter, especially when it comes to interpreting healthcare legislation. Just as we saw with the Supreme Court decision to uphold Affordable Care Act, the interpretation of even a few words can be crucial. In the case of reverse false claims through the False Claims Act, it's just one word that holds the key to interpreting when the 60-day stopwatch begins for returning overpayments. 

$6M home health settlement reopens fraud hotspot in New York City

A $6 million fraud settlement by a Brooklyn home health provider offers a window into larger concerns surrounding potential abuse throughout New York, according to the  Wall Street Journal.  

Healthcare fraud outside the U.S. borders underscores recovery challenges

A busted fraud scheme that billed Medicare for patients in Nicaragua and the Dominican Republic offers an inside look at how criminals manage to steal millions from the government program by using fake United States addresses, adding to a growing concern about fraud that takes place outside of U.S. borders.