Healthcare Dive

SEPTEMBER 9, 2022

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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Fraud Medicare Medicare COVID-19 271

Healthcare Dive

APRIL 24, 2023

It's the largest enforcement action against COVID-19 healthcare fraud schemes to date, according to regulators.

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Fraud COVID-19 260

Center for Health Insurance Reform

JUNE 10, 2025

The proposed Marketplace Integrity rule and House-passed budget bill purportedly aim to curb ACA fraud but overlook basic steps to address broker misconduct. CHIR experts explain how these policies increase barriers for eligible enrollees without improving oversight of unethical brokers or implementing common-sense reforms.

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Fraud ACA Health Insurance 106

Healthcare IT News - Telehealth

MARCH 1, 2021

Department of Health and Human Services' Office of Inspector General recognized telehealth's potential while cautioning that steps must be taken to ensure virtual care will not be compromised by fraud. Grimm in her statement also differentiated between telehealth fraud and "telefraud" schemes. THE LARGER TREND.

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Fraud Telemedicine Department of Veterans Affairs COVID-19 212

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.

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Fraud Medicare Medicare Compliance 80

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.

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Fraud Due Diligence 91

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.

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Fraud Telemedicine Medicare Medicare 202

HIPAA Journal

JUNE 30, 2025

The Federal Bureau of Investigation (FBI), its Internet Crime Complaint Center (IC3), and the HHS Centers for Medicare & Medicaid Services (CMS) have issued warnings to the healthcare and public health (HPH) sector about ongoing fraud schemes.

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Fraud Overpayment Overpayments Medicare 63

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.

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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.,

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Fraud Telemedicine US Department of Health and Human Services COVID-19 200

HIPAA Journal

JUNE 18, 2025

The audit confirmed that effective controls had not been implemented for preventing fraud and communicating and acting on reports of fraudulent activity. The post HHS-OIG Audit Uncovers Fraud Control Failures Within HHS Grant Payment System appeared first on The HIPAA Journal.

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Payment Systems Fraud HIPAA Governance 62

Healthcare Dive

JULY 6, 2022

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

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Fraud Medicare Medicare 330

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 319

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 262

Medicaid Medicaid Fraud 262

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.

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Fraud Telemedicine Nurses Licensing 175

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.

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Fraud Telemedicine Medicare Medicare 178

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.

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Fraud Telemedicine Ransomware COVID-19 176

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.

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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.

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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.

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Fraud Compliance Overpayment Overpayments 52

AIHC

FEBRUARY 24, 2025

Part 2: When Criminal Behavior Infiltrates Your Audit Program Written by Carl J Byron , CCS, CHA, CIFHA, CMDP, CPC, CRAS, ICDCTCM/PCS, OHCC and CPT/03 USAR FA (Ret) We Recommend Reading Part 1 Fraud Indicators and Red Flags – When Audit Managers Knowingly Skew Audit Results as this article is Part 2, “the rest of the story.”

Fraud 52

Fraud Compliance Governance Compliance Officers 52

AIHC

FEBRUARY 17, 2025

Part 1: 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.

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Fraud Compliance Overpayment Overpayments 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.

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Fraud Hospitals 238

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.

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Fraud Compliance Medicaid Medicaid 40

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 319

Medicare Medicare Fraud 319

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 315

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.

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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.

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Fraud Doctors 256

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.

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Fraud Governance 52

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.

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ACA Fraud 304

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.

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Fraud Medicare Medicare 128

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.

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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

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.

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Fraud Medicare Medicare Regulatory Compliance 98

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.

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Fraud Compliance Medicaid Medicaid 105