Hall Render

JANUARY 29, 2025

The Centers for Medicare & Medicaid Services (CMS) is reinforcing its emphasis on hospice quality of care and identifying fraud. CMSs Focus on Surveys and Fraud Identification The CMS Memo highlights the dual purpose of hospice surveys: Ensuring Compliance : Evaluating whether hospice providers meet CoPs.

Fraud 80

Fraud Medicare Medicare Compliance 80

Healthcare IT News - Telehealth

SEPTEMBER 20, 2021

Department of Justice announced this past week that it was bringing criminal charges against 138 total defendants for their alleged participation in various healthcare fraud schemes, resulting in about $1.4 billion in alleged losses. More than $1.1 billion of that loss involved allegedly fraudulent claims related to telemedicine.

Fraud 209

Fraud Telemedicine Medicare Medicare 209

Electronic Health Reporter

FEBRUARY 27, 2025

The firm stated that its investigation identified […] The article Bias Capital Withdraws $25 Million Investment from Parker Health Amid Fraud Concerns appeared first on electronichealthreporter.com.

Fraud 91

Fraud Due Diligence 91

Healthcare Dive

DECEMBER 4, 2023

The HHS’ Office of the Inspector General’s report tallied 707 criminal enforcement actions and 746 civil actions for fraud and misspent funds in programs like Medicare and Medicaid.

Fraud 246

Fraud Governance Medicaid Medicaid 246

Healthcare IT News - Telehealth

FEBRUARY 22, 2021

Department of Justice announced earlier this month that an Indian Rocks Beach, Florida-based woman has pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return. The DOJ describes the case as involving one of the largest healthcare fraud schemes in U.S. Kelly Wolfe and her company, Regency, Inc.,

Fraud 199

Fraud Telemedicine US Department of Health and Human Services COVID-19 199

Healthcare Dive

JULY 6, 2022

Cases ranged from improper psychiatric treatment to providing false Medicare claims and illegal kickback schemes.

Fraud 332

Fraud Medicare Medicare 332

Healthcare Dive

JULY 25, 2022

The special alert to healthcare providers describes how fraudsters recruit and reward practitioners in schemes to exploit the growth of telemedicine.

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Fraud Telemedicine 344

Healthcare Dive

AUGUST 20, 2024

The insurer, which did not admit wrongdoing, agreed to the settlement on the eve of a jury trial.

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Fraud Medicare Medicare 322

Healthcare IT News - Telehealth

DECEMBER 17, 2021

Department of Justice announced this past Friday that it had charged four people, one of whom is a licensed physician, in an international telehealth fraud and kickback scheme. million in a case the DOJ described as one of the "largest healthcare fraud schemes in United States history. WHY IT MATTERS. " ON THE RECORD.

Fraud 178

Fraud Telemedicine Nurses Licensing 178

Healthcare Dive

JULY 17, 2024

A Pennsylvania pension fund had argued Centene board members failed in their oversight responsibilities and ignored red flags about a Medicaid overbilling scheme.

Medicaid 265

Medicaid Medicaid Fraud 265

Healthcare IT News - Telehealth

JANUARY 27, 2021

Department of Justice announced Monday that four people and one company have recently pleaded guilty in a telemedicine pharmacy healthcare-fraud conspiracy that allegedly lasted for years. "Telemarketing fraud is a major threat to the integrity of government and commercial insurance programs," said Derrick L. ON THE RECORD.

Fraud 180

Fraud Telemedicine Ransomware COVID-19 180

Healthcare IT News - Telehealth

APRIL 21, 2022

Attorney's Office for the Eastern District of New York announced Thursday that an orthopedic surgeon had been arrested and charged with healthcare fraud. Federal law enforcement has brought the hammer down on alleged telehealth fraud in several highly publicized cases. " ON THE RECORD.

Fraud 176

Fraud Telemedicine Medicare Medicare 176

Compliancy Group

FEBRUARY 25, 2025

Details of the healthcare fraud plea are provided below. The elaborate healthcare fraud conspiracy involved a multi-step process: First, Schreck would offer to connect pharmacies, durable medical equipment (DME) suppliers, and marketers with telemedicine companies. A healthcare fraud conspiracy fee, essentially.

Fraud 52

Fraud Medicare Medicare Doctors 52

Healthcare IT News - Telehealth

JULY 22, 2022

billion in alleged fraud involving telehealth, phony genetic testing and durable medical equipment. "The Department of Justice is committed to prosecuting people who abuse our healthcare system and exploit telemedicine technologies in fraud and bribery schemes," said Assistant Attorney General Kenneth A. WHY IT MATTERS.

Fraud 167

Fraud Telemedicine Medicare Medicare 167

AIHC

FEBRUARY 17, 2025

When Audit Managers Knowingly Skew Audit Results Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) Fraud cannot be eliminated. No system is completely fraud-proof, as any system can be bypassed or manipulated. on fraud detection and prevention in healthcare. median loss.

Fraud 52

Fraud Compliance Overpayments Overpayment 52

Healthcare Dive

JULY 12, 2024

The Department of Justice investigation follows a multi-year international probe into Steward's deal to improve three hospitals in Malta.

Fraud 240

Fraud Hospitals 240

Healthcare Dive

SEPTEMBER 25, 2024

Regulators say Medicare needs more data and oversight to avoid fraud and misuse. Digital health advocates argue the service is still crucial for managing chronic conditions.

Medicare 322

Medicare Medicare Fraud 322

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. This disparity highlights the difficulty in accurately assessing the risks and potential penalties associated with health care fraud violations.

Fraud 40

Fraud Compliance Medicaid Medicaid 40

Healthcare Dive

JANUARY 17, 2025

Healthcare fraud investigations accounted for more than half of the Department of Justice’s settlements and judgments in 2024, which totaled north of $2.9

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Fraud 317

American Medical Compliance

MARCH 6, 2025

Fraud, Waste, and Abuse (FWA) remain critical challenges in the healthcare industry, impacting patient care, financial integrity, and regulatory compliance. These safe harbors help distinguish lawful financial arrangements from those that could lead to fraud, waste, or abuse.

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare Dive

JULY 20, 2022

Regulators are primarily targeting laboratory owners and operators who paid illegal kickbacks and bribes in exchange for patient referrals from doctors working with fraudulent companies.

Fraud 258

Fraud Doctors 258

Healthcare Dive

SEPTEMBER 26, 2024

But Republicans argue the subsidies are costly and create opportunities for fraud. If the enhanced tax credits expire, healthcare costs for millions of Americans will suddenly increase, and some could become uninsured, Democrats say.

ACA 307

ACA Fraud 307

Hall Render

MARCH 24, 2025

Under federal law, the public disclosure bar prohibits a relator from bringing an FCA lawsuit based on fraud that has already been disclosed through certain public channels. Court of Appeals Shuts Down Recycled Fraud Claims Under Public Disclosure Bar appeared first on Law Firm | Health Care Law Firm in the USA | Hall Render.

Fraud 52

Fraud Governance 52

Fierce Healthcare

JUNE 13, 2024

The CEO and clinical president of telehealth startup Done have been arrested and charged with fraud, accused by federal authorities of participating in a scheme to distribute Adderall online.

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Fraud 128

American Medical Compliance

JUNE 21, 2024

Fraud, waste, and abuse (FWA) in healthcare present significant challenges, causing substantial financial losses, eroding public trust, and compromising the quality of patient care. Unlike fraud, waste is not necessarily intentional but results from inefficiencies.

Fraud 105

Fraud Compliance Medicaid Medicaid 105

Fierce Healthcare

OCTOBER 27, 2023

The Department of Justice (DOJ) has filed charges against a former HealthSun Health Plans executive as part of an alleged multimillion-dollar Medicare fraud scheme. | The Department of Justice has filed charges against a former HealthSun Health Plans executive as part of an alleged multimillion-dollar Medicare fraud scheme.

Fraud 128

Fraud Medicare Medicare 128

Healthcare Dive

APRIL 21, 2025

During a ceremony at the Oval Office, Dr. Mehmet Oz said he would focus on reducing chronic disease, “modernizing” Medicare and Medicaid, and targeting fraud, waste and abuse in government insurance offerings.

Fraud 251

Fraud Medicaid Medicaid Medicare 251

Fierce Healthcare

DECEMBER 12, 2022

House and Senate Dems want CMS to drop ACO REACH members due to fraud concerns. Mon, 12/12/2022 - 16:08.

Fraud 139

Fraud 139

Healthcare Dive

JUNE 29, 2023

The multi-state bust that targeted 78 individuals represents “one of the largest healthcare fraud schemes ever prosecuted by the Justice Department,” Attorney General Merrick Garland said.

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Fraud 130

Fierce Healthcare

DECEMBER 15, 2022

Genetic testing lab owner convicted in $463M Medicare fraud case. Thu, 12/15/2022 - 14:14.

Fraud 124

Fraud Medicare Medicare 124

Compliancy Group

JANUARY 23, 2025

A classic example is Medicare fraud. Providers who bill Medicare for services they did not actually provide and who present the bill with the knowledge that the service was not performed have committed Medicare fraud. The DOJ has focused much of its anti-fraud efforts on pursuing these cases, litigating several of them in 2024.

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

Healthcare Dive

OCTOBER 10, 2024

Here are the legal issues providers need to know as litigation increases around healthcare fraud and abuse, according to two experts.

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Fraud 260

HIT Consultant

JUNE 6, 2024

Healthcare fraud is a significant issue in the U.S. the cost of healthcare fraud in the country is close to $100 billion a year. Recent advances in technology are now enabling government agencies to be more effective in their efforts to detect and prevent healthcare fraud. According to the U.S. Department of Justice (D.O.J.),

Fraud 94

Fraud Medicare Medicare Governance 94

Fierce Healthcare

FEBRUARY 23, 2024

billion in settlements and judgments was related to health-related matters in the last fiscal year, about two-thirds of the monetary fraud recoveries by t | Health fraud settlements under the False Claims Act exceeded $1.8 Under the False Claims Act, more than $1.8 billion last year, according to the Department of Justice.

Fraud 122

Fraud Medicare Medicare 122

Fierce Healthcare

FEBRUARY 15, 2024

ACOs could face lasting financial difficulties because of a recent, alleged $2 billion Medicare catheter fraud scheme. Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months.

Fraud 127

Fraud Medicare Medicare Governance 127

Healthcare Dive

JUNE 29, 2022

Lawmakers on both sides of the aisle are taking a harder look at coverage denials, fraud and waste in the popular MA program.

Medicare 261

Medicare Medicare Fraud 261

MedTrainer

MAY 3, 2024

Healthcare fraud, waste, and abuse is a costly problem for both public and private payers. The National Health Care Anti-Fraud Association estimates financial losses due to healthcare fraud could be as much as $300 billion annually. Keep in mind that these are just examples of provider fraud!

Fraud 94

Fraud Compliance Compliance Officers Licensing 94