Topic:
Fraud Prevention and Detection
Latest Headlines
Latest Headlines
New preauthorization rule targets DME fraud, improper payments
Responding to "longstanding concerns" about improper payments tied to durable medical equipment (DME), the federal government issued a finale rule Tuesday aimed at reducing fraud, waste and abuse within an industry known for questionable billing practices.
Ohio cardiologist sentenced to 20 years for fraud blames Obamacare
An Ohio cardiologist sentenced last week to 20 years in prison for convincing patients to undergo unnecessary tests and procedures says the government used the Affordable Care Act to target him, according to The Guardian.
Memorial Health pays $9.8 million in record False Claims Act lawsuit
Memorial Health, Inc. will pay $9.8 million to settle False Claims Act allegations in the largest civil healthcare fraud recovery ever recorded by the U.S. Attorney's Office for the Southern District of Georgia.
Michigan-Illinois partnership moves Medicaid provider screening to the cloud
A multi-million dollar project between Michigan and Illinois has moved each state's Medicaid system to the cloud, which could offer better fraud detection mechanisms.
South Carolina ambulance providers criticize preauthorization program
Patients and ambulance operators in South Carolina are echoing concerns made in other states that a prior authorization program aimed at preventing fraud is doing more harm than good.
Feds dole out stiff penalties for home health fraud
Home health clinicians and executives embroiled in fraud schemes are facing as much as 80 months in prison after billing Medicare for medically unnecessary care.
CMS held back on audits, leading to billions in Medicare Advantage overpayments
The Centers for Medicare & Medicaid Services knew as far back as 2008 that certain Medicare Advantage plans were pocketing billions in overpayments, but officials still held back on auditing the plans and recouping payments tied to inflated risk scores, according to government records obtained by the Center for Public Integrity.
Data analytics can spot fraud patterns, but humans offer a 'gut instinct'
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.
Healthcare fraud among the FBI's top focus areas
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.
In the choppy waters of FCA recoveries, whistleblowers still steer the ship
Last week, the Department of Justice released its annual report on False Claims Act recoveries in fiscal year 2015. Considering last year's historic $5.7 billion total, it was a little surprising--at least initially--to see FCA recoveries had dropped 40 percent. But there are a few explanations for the decline. Most importantly, it appears the government is struggling to keep pace with the flood of whistleblower claims, but recent announcements indicate the feds are in the middle of regrouping and could be joining up with whistleblowers with even more ferocity.
