Genetic testing brings with it a tremendous amount of hype, along with the influential support of the president. Following Barack Obama's $215 million Precision Medicine Initiative last year, payers have been cautious about covering genetic tests. However, a recent announcement by Independence Blue Cross just raised the bar. As more payers consider when and how to cover genetic tests that could offer a personalized approach to medical care, they should also consider the significant fraud concerns that go along with new, expensive tests.
James Slattery, CEO of Millennium Laboratories, who was once awarded a regional entrepreneur of the year award from Ernst & Young, prided himself on his fast-growing company's culture. But behind the scenes, court documents show that company attorneys warned employees not to be "weasels," and company executives pushed an agenda that ultimately led to a $256 million fraud settlement with the federal government. Through a series of financial tricks, however, Slattery stands to walk away with his pockets lined.
Minnesota overpaid as much as $271 million over a five-month period on ineligible beneficiaries within the state's health insurance exchange program, according to a recently released audit.
A prominent physician and former CEO of an Oregon health system says he was fired by the governing board last year for suggesting the provider self-report $10 million in improper Medicare claims, according to The Oregonian,
The push for healthcare providers to adopt electronic health records has been fueled by promises of improved efficiency and usability, greater accessibility to health information, and in some cases, better patient care. Despite multiple warnings from experts, researchers and government agencies, fraud vulnerabilities still exist within current EHR systems, leading to improper billing, and in some cases, brazenly fraudulent records.
By building a well-respected and insulated cancer practice, Detroit cancer doctor Farid Fata, convicted of fraud last year, protected himself from scrutiny and used patients as part of a horrifying moneymaking scam, according to Dateline NBC. It wasn't until one patient broke her leg that suspicions gave way to an investigation.
A popular ridesharing app that has emerged as a 21st Century alternative to taxis is getting into the medical transportation business, and it could help stem the tide of ambulance fraud.
The recent merger between Pfizer and Allergan is getting plenty of attention for its $160 billion pricetag, but one healthcare attorney wonders if fraud and corruption are part of each company's "corporate DNA."
Nearly 70 percent of healthcare, pharmaceutical, and biotechnology executives around the world said their company was affected by fraud during the past year, according to a report from Kroll. However, only 36 percent reported they would be investing in management controls in the coming year.
The shakeup continues for Philidor Rx Services LLC, which has dominated headlines over the last several weeks for its questionable relationship with pharmaceutical giant Valeant.