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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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DOJ charges 18 in COVID healthcare frauds totaling $490M

Healthcare Dive

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

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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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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.

Fraud 337
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DOJ charges dozens in multiple states for $2.5 billion healthcare fraud

Healthcare Dive

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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Knowing Your Patient: Helping Healthcare Organizations Prevent Insurance Fraud

Healthcare IT Today

With those competing priorities, fraud prevention does not always make its way to the top of the list of considerations, even when it should. According to the National Health Care Anti-Fraud Association, fraud costs the U.S. healthcare industry more than $50 billion each year. What Exactly is KYP?

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Detecting Behavioral Health Fraud: How Health Plans Can Strengthen Their Approach

HIT Consultant

Erin Rutzler, VP of Fraud, Waste, and Abuse at Cotiviti As behavioral health claim volumes continue to increase, there’s a growing need for health plans to be vigilant in spotting fraud, waste and abuse. But not every plan has access to a large SIU to combat fraud, waste and abuse in behavioral health.

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