Topic:
Fraud Prevention and Detection
Latest Headlines
Latest Headlines
DOJ's new compliance counsel to provide 'reality check'
There's a new face at the Department of Justice this week, and it's one that the agency hopes will provide a "reality check" for corporate compliance programs throughout the country.
California pharmacist accuses Philidor Rx Services of 'massive fraud'
A California pharmacist that agreed to sell his small pharmacy for $350,000 to Philidor Rx Services is now suing the company, alleging Philidor committed "widespread fraud," according to the Los Angeles Times.
OIG's 2016 Work Plan targets Part D, med equipment fraud concerns
Medicare Part D pharmacy enrollment, drug reimbursement and durable medical equipment are among the new fraud and abuse focus areas targeted by the Office of Inspector General, according to agency's 2016 Work Plan.
Pharma exec's arrest proves Yates memo isn't just an empty threat
Pharmaceutical executives have a long history of avoiding individual charges, even when the company they work for settles for billions to wipe away kickback claims. But the arrest of a pharmaceutical exec last week is one indication that the Yates memo released in September is more than just an empty threat from the feds.
New RAC directive solidifies tension between providers, fraud fighters
A new federal directive will decrease the amount of hospital claims that Recovery Audit Contractors can review, effectively handcuffing the program's ability to root out improper payments.
Pharma exec faces fraud charges after company's $125M plea deal
Less than two months after outlining its intent to target executives entwined in corporate fraud schemes, the Department of Justice arrested a pharmaceutical executive and charged him with paying kickbacks to physicians.
Civil monetary penalties, exclusion cases on the rise
The government resolved 110 cases involving civil monetary penalties and program exclusions in the past fiscal year, according to a senior official at the Office of Inspector General, and even more cases are expected in the coming year.
Self-policing could stem the heartbreaking wave of unnecessary cardiac procedures
The issue of unnecessary cardiac procedures has been building momentum for years, and fraud investigators are certainly well aware of the amount of federal dollars that circle the drain thanks to the trend. The problem, however, is that unnecessary procedures are difficult to identify based on claims data alone. Cardiologists may be the key to self-policing a specialty that is quickly spiraling out of control.
Fierce Exclusive: As telemedicine grows, so do underlying fraud and abuse considerations
Touting accessibility and affordability, telemedicine is poised to make a huge splash in the healthcare industry in the coming years. The global telemedicine market is expected to reach 7 million patients worldwide by 2018, fueling an 18 percent growth rate by 2020. Although most telehealth arrangements are exempt from anti-kickback laws, broader coverage, particularly at the federal level, could push fraud and abuse considerations to the forefront of a burgeoning industry.
Citing fraud concerns, Texas investigators subpoena Planned Parenthood records
After spending the last several months embroiled in national controversy, Planned Parenthood is facing Medicaid fraud allegations that has resulted in an investigation by Texas state officials, according to The Houston Chronicle.
