Topic:
Fraud Prevention and Detection
Latest Headlines
Latest Headlines
Deputy AG clarifies changes to the United States Attorney's Manual
Two months after sending a memo to federal prosecutors across the country, the Department of Justice (DOJ) has finalized changes to the United States Attorney's Manual (USAM), which solidifies its new approach to prosecuting individuals involved in white collar crime.
Dallas officials arrest 28 linked to 'sprawling' workers compensation fraud scam
Twenty-eight people, including a federal claims examiner, have been arrested in Dallas for allegedly participating in what authorities are calling a "sprawling" healthcare fraud scheme involving workers compensation claims.
Fraud, waste, abuse dominate the OIG's top 10 challenges
Half of the top 10 management and performance challenges identified by the Office of Inspector General in fiscal year 2015 have fraud, waste and abuse implications, according to a report released Tuesday.
New West Virginia fraud task force to lean on data analytics
A new task force announced by the West Virginia U.S. Attorney's Office will rely on data analytics to uncover healthcare fraud schemes.
Predictive analytics helps fraud fighters detect sophisticated schemes [Special Report]
Predictive analytics is the hot new buzzword in healthcare. Now, it is changing the way payers to identify instances of fraud, waste and abuse. Increasingly, both public and private payers are turning to data analytics to identify high risk fraud trends, said Andrew Asher, senior fellow and director of data analytics at Mathematica in an exclusive interview with FierceHealthPayer: AntiFraud. However, payers like Aetna are gradually realizing the full impact of using healthcare claims data to accurately predict fraud schemes.
Virginia spent as much as $38M covering ineligible Medicaid recipients
The state of Virginia spent between $21 and $38 million covering ineligible Medicare recipients in 2014, according to a state watchdog agency.
Feds target compounding pharmacies as Tricare spending spikes
Federal and state investigators are targeting compounding pharmacies for fraudulently billing Tricare, leading four Florida pharmacies to pay a combined $12.8 million in settlments last month, according to the Wall Street Journal.
With a laundry list of fraud concerns, Part D payments are far from perfect
Medicare Part D has been in effect for nearly 10 years, but it has accumulated a staggering list of deficiencies when it comes to fraud, waste and abuse. Most notably, the Centers for Medicare & Medicaid Services does not require Part D sponsors to report fraud, making it difficult to determine how much waste exists within the program. In an editorial for Forbes last week, Merrill Matthews, a resident scholar with the Institute for Policy Innovation in Dallas, described how Medicare Part D should be the posterchild for efficiency because of its low improper payment rate. But Matthews fails to acknowledge the pervasive vulnerabilities the Office of Inspector General and others have identified within the Part D program that have made it a target for fraud and abuse.
Why Medicare should adopt the credit card industry's approach to fraud detection
In a recent Wall Street Journal editorial, attorney Hank B. Walther asks why Medicare can't take the same approach to fraudlent claims as credit card companies do to questionable charges.
Billing irregularities prompted UnitedHealth to cut off Philidor Rx last 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.
