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Government watchdog warns of Medicare fraud after relaxing provider requirements

Healthcare Dive

The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program

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Progressive lawmakers call on CMS to cull companies with history of Medicare fraud from ACO REACH

Healthcare Dive

At least 10 organizations with records of healthcare fraud and abuse prior to 2021 participated in the direct contracting program last year despite CMS screening requirements, the letter said

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OIG report suggests telehealth fraud rare in Medicare

Healthcare Dive

A small proportion of providers that billed for telehealth — 1,714 out of 742,000 — posed a high risk of fraud or abuse to Medicare in COVID-19’s first year, regulators found

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Verisys- Healthcare Fraud and Abuse

Verisys

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important.

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Feds brokered record $5B in healthcare fraud cases last year

Healthcare Dive

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

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Dozens of Defendants Charged with Healthcare Fraud

American Medical Compliance

The United States Department of Justice charged 36 defendants for healthcare fraud that amounted to over $1 Billion. Healthcare organizations must take all possible steps to prevent instances of fraud. Billion in Health Care Fraud. General Health Fraud prevention Scams training

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Genetic testing lab owner convicted in $463M Medicare fraud case

Fierce Healthcare

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

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Customization vs. Configuration in Healthcare Fraud Detection

Fierce Healthcare

Customization vs. Configuration in Healthcare Fraud Detection. mteefey. Wed, 11/09/2022 - 16:55

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Florida Surgeon Gets 7 Years for Committing $28 Million in Health Care Fraud

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. By George F. Indest III, J.D., M.P.A.,

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Florida Surgeon Handed Seven Years in Prison for $28 Million Health Care Fraud Scheme

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. By George F. Indest III, J.D., M.P.A.,

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18 Former NBA Players Indicted For Alleged $4 Million Health Care Fraud Scheme

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league's benefit plan, according to an indictment filed in the Southern District [.] By George F.

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Florida Pharmacy Owner Pleads Guilty For Role in $8.3 Million Medicare Fraud Scheme

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On September 27, 2022, a Florida pharmacy owner pled guilty to conspiring to commit healthcare fraud in an $8.3 By George F. Indest III, J.D., M.P.A.,

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Massive Telehealth Fraud Charges May Be First Of Many

Healthcare IT Today

The US Department of Justice has filed charges against 345 defendants, including more than 100 medical professionals, accusing them of engaging in healthcare fraud schemes.

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Fraud Detection with Machine Learning For e-Commerce and Retailers

Electronic Health Reporter

There is interesting research in Forbes’ recent article named “How E-Commerce’s Explosive Growth Is Attracting Fraud”. The article Fraud Detection with Machine Learning For e-Commerce and Retailers appeared first on electronichealthreporter.com.

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Fraud-Proofing Your Telehealth Strategy

HIT Consultant

Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud. Julia Twaddle, Sr.

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Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks

Healthcare Compliance Blog

The post Three Clinical Labs and Their Owner Charged with Medicaid Fraud and Kickbacks appeared first on Med-Net. Client Alerts client alerts Fraud Kickbacks Medicaid

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OIG warns of telehealth fraud risks in wake of DOJ crackdown

Healthcare Dive

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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Michigan Podiatrist Convicted of $1.8 Million Healthcare Fraud Scheme

Healthcare Compliance Blog

The defendant was also convicted for falsification of records designed to prevent detection of this fraud and aggravated identity theft for falsely corresponding with Medicare under the name of another physician. Million Healthcare Fraud Scheme appeared first on Med-Net.

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Does Expanding Healthcare Coverage = an Increasing Risk of Fraud for Healthcare Payers?

Healthcare IT Today

New types of fraud are continually emerging, and it’s also become harder to uncover with traditional approaches. The telehealth market is growing at a significant rate, and fraud is continuing to grow with it. Is Telehealth Fraud Getting Harder to Identify?

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Nursing Home Psychologist Convicted of Healthcare Fraud Scheme

Healthcare Compliance Blog

The psychologist was convicted of four counts of healthcare fraud. The FBI and HHS-OIG investigated the case, which was brought as part of the Chicago Strike Force, supervised by the Criminal Division’s Fraud Section and the US Attorney’s Office for the Northern District of Illinois.

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House and Senate Dems want CMS to drop ACO REACH members due to fraud concerns

Fierce Healthcare

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

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Healthcare Fraud and Abuse Control Program Fiscal Year 2021 Report

Healthcare Compliance Blog

The report says that in FY 2021 the DOJ opened 831 new criminal healthcare fraud investigations. Federal prosecutors filed criminal charges in 462 cases involving 741 defendants, and a total of 312 defendants were convicted of healthcare fraud related crimes during the year.

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Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges

The Health Law Firm Blog

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D., M.P.A., Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3

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Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., M.P.A.,

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Foreign Medical Student Found Guilty in Home Health Fraud Scheme

Healthcare Compliance Blog

A federal jury in Texas convicted a 65-year-old foreign medical student for conspiracy to commit healthcare fraud. At the trial, the defendant attempted to convince the jury he had no knowledge of fraud and did not have the intent to defraud Medicare. Client Alerts client alerts Fraud

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HIPAA Seal of Compliance = Consumer Fraud

Healthcare IT Today

The Federal Trade Commission (FTC) announced a consumer fraud settlement against a company that displayed a ‘HIPAA Compliant’ seal on its website.

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Two Men Charged in $39M Personal Protective Equipment Fraud Scheme

Healthcare Compliance Blog

Two Texas men have been charged with conspiracy to commit and committing wire fraud during the COVID-19 pandemic involving medical-grade nitrile gloves. The two men were both charged with conspiracy to commit wire fraud, and defendant 1 also faces an additional five counts of wire fraud.

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Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., M.P.A.,

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Be Vigilant: A Look at Supply Chain Fraud in Healthcare

Healthcare IT Today

According to a survey by Proofpoint, the average healthcare organization received about 200,000 emails from over 10,000 different 3rd party domains. When you consider the thousands of vendors and suppliers that work with a healthcare organization, this isn’t a big surprise.

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Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme

Healthcare Compliance Blog

He was convicted of one count of healthcare fraud and one count of making a false claim. The post Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme appeared first on Med-Net. Client Alerts client alerts Fraud Medicaid Medicare

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2 DOJ Cyber Fraud Initiative Cases Net Almost $10 Million

Compliancy Group

Department of Justice’s (DOJ) Civil Cyber Fraud Initiative (CCFI). Details of DOJ Cyber Fraud Initiative Settlements. DOJ Cyber Fraud Initiative and the HIPAA Connection. Whistleblower Incentives Within the DOJ Cyber Fraud Initiative.

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DOJ collected nearly $2B in health fraud False Claims Act cases in fiscal year 2022

Fierce Healthcare

DOJ collected nearly $2B in health fraud False Claims Act cases in fiscal year 2022 rking Wed, 02/08/2023 - 16:01

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DOJ cracks down on 'largest and most wide-ranging' COVID-19 fraud

Healthcare Dive

Defendants — including doctors, medical business executives and fake vaccination card manufacturers — caused nearly $150 million in false billings to federal programs, the DOJ alleged

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Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. By George F. Indest III, J.D., M.P.A.,

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Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000

The Health Law Firm Blog

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By George F. Indest III, J.D., M.P.A.,