Weeks after posting $18 million in bonds to secure his release from prison, Salomon Melgen, M.D., was officially suspended from participation in the Medicaid program in July, according to a press release from Florida's Agency for Health Care Administration. Melgen, who operated out of Palm Beach, faces 76 counts of healthcare fraud for allegedly performing unnecessary tests, procedures and surgeries totaling $105 million.
More lawsuits targeting Medicare Advantage are rolling in, and the latest calls into question the practices of one company that performed in-home health assessments on elderly patients for 30 health plans in more than 15 states across the country, according to a report from the Center for Public Integrity.
Fresh off a House Subcommittee hearing in which legislators grilled the Centers for Medicare & Medicaid Services regarding Part D fraud controls, the Government Accountability Office (GAO) released a report this week noting that four state Medicaid programs spent $33 million in 2011 on prescription drugs tied to doctor shopping.
Nearly 300 providers who were terminated for cause from one state in 2011 continued billing Medicaid in other states for as many as three years, according to a report released by the Office of Inspector General. Those 300 physicians represented 12 percent of providers studied by the watchdog agency.
Preventing improper payments, which comprised $17.5 billion of Medicaid spending in 2014, represents a specific concern for the long-term health of the government-run health program, according to a report released last week by the Government Accountability Office.
Andy Slavitt, nominated by President Obama in July to replace Marilyn Tavenner as the CMS administrator, was a key player in one of the largest fraud settlements by a health insurance company.
Medicare and Medicaid turned 50 last month, and looking back over the last five decades, it's impressive to see how fraud prevention has evolved from virtually nothing in 1965 to 2015, when CMS is transitioning away from a pay-and-chase model with the use of predicitve analytics. A look back at the last 50 years shows that heatlhcare fraud prevention is constantly evolving in an effort to protect the governments health programs.
Thousands of doctors in the Centers for Medicare & Medicaid Services' (CMS) Provider Enrollment, Chain and Ownership System (PECOS) list medical degrees from universities that no longer exist, all of which went unnoticed by CMS, and often the physicians themselves.
The transition from a reactive approach to relying on claims data to better predict and prevent fraudulent payments has led to significant progress in fighting Medicare and Medicaid fraud, former Centers for Medicare and Medicaid Services Administrator Don Berwick told the Journal for the American Medical Association.
Medicare contractors in 13 jurisdictions across the country overpaid for outpatient drugs to the tune of $35.8 million between July 2009 and June 2012, according to a report released by the Office of Inspector General.