Home health is still a prime target for business owners who want to bilk the government out of millions, as evidenced by several convictions and sentencings announced last week.
Federal and state enforcement agents raided compounding pharmacies in four states as part of a healthcare fraud investigation, seizing more than $15 million in assets, according to various news reports.
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.
Stark Law litigation is becoming a primary concern for healthcare providers following recent high-priced settlements involving physician compensation agreements, according to a report by Bloomberg BNA.
Big data and predictive analytics were supposed help Medicare prevent fraudulent payments the same way credit card companies deny suspicious charges. Fraud schemes still plague Medicare because the Centers for Medicare & Medicaid Services is too concerned about provider backlash to use the full force of claims data, according to an article published in Pacific Standard.
With fewer False Claims Act recoveries, some might say 2015 was a down year for federal fraud enforcement. But attorneys across the country say federal policy changes and FCA trends will keep fraud concerns high on the government's radar in the coming year.
Daniel Suarez, 24, will spend the rest of his twenties and early thirties in prison for stealing $21 million from Medicare Part D as part of pharmaceutical fraud scheme that began when he had barely turned 18. Suarez spent his money on luxury cars, while attempting to launder the stolen funds through FedEx trucks. His youthful exuberance conjures up comparisons the Martin Shkreli, now facing securities fraud charges after drawing in his own brand of attention.
State-of-the-art data analytics technology can edit claims to prevent fraudulent Medicare payments, but the human element found in initiatives like the Senior Medicare Patrol still play a crucial role in fraud detection, according to an article by FedTech.
While terrorism and national security are obvious priorities for the Federal Bureau of Investigation (FBI), the growing threat of healthcare fraud continues to be a focal point for the agency, according to FBI director James Coney.
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.