Compliance, Fraud & Oversight
Expert articles and analysis related to compliance, fraud & oversight.
AI Summary â Last 7 Days
Synthesis:
The past week saw intensified scrutiny and reform in Medicare Advantage and Medicaid oversight, with CMS announcing the 2027 MA capitation rates and payment policy changes aimed at tightening compliance and payment accuracy, as well as a substantial $117.7 million settlement from Aetna over MA false claimsâunderscoring ongoing efforts to combat overbilling and fraud (AAPC, Aetna settlement).
Related Articles
Macomb County Dentist Charged with Racketeering in Massive Alleged Medicaid Fraud Scheme - Office of Inspector General (.gov)
Macomb County Dentist Charged with Racketeering in Massive Alleged Medicaid Fraud Scheme  Office of Inspector General (.gov)
Attorney General Bonta Dismantles Los Angeles Hospice Fraud Ring Responsible for $267 Million in Fraud, 21 Charged - Office of Inspector General (.gov)
Attorney General Bonta Dismantles Los Angeles Hospice Fraud Ring Responsible for $267 Million in Fraud, 21 Charged  Office of Inspector General (.gov)
The DOJ continues to come for healthcare fraud: What ASCs, physicians need to know
Acting U.S. Attorney General Todd Blanche launched the National Fraud Enforcement Division on April 7, consolidating the Justice Departmentâs fragmented fraud units into a single, centralized division...
Structuring Discounts Arrangements in Compliance with Federal Anti-Kickback Law: OIGâs Advisory Opinion 25-11
San Fernando Valley Clinic Operator Sentenced to 18 Years in Federal Prison for Role in Ring that Sold Illegal Opioid Prescriptions for Cash - Office of Inspector General (.gov)
San Fernando Valley Clinic Operator Sentenced to 18 Years in Federal Prison for Role in Ring that Sold Illegal Opioid Prescriptions for Cash  Office of Inspector General (.gov)
Business Owner Convicted of $1.9M Medicare, Medicaid, and Private Insurer Fraud Scheme - Office of Inspector General (.gov)
Business Owner Convicted of $1.9M Medicare, Medicaid, and Private Insurer Fraud Scheme  Office of Inspector General (.gov)
National Partnership of Insurance Brokers and its Former Subsidiary Agree to Pay Over $160 Million For Affordable Care Act Enrollment Fraud Scheme - Office of Inspector General (.gov)
National Partnership of Insurance Brokers and its Former Subsidiary Agree to Pay Over $160 Million For Affordable Care Act Enrollment Fraud Scheme  Office of Inspector General (.gov)
Florida Man Pleads Guilty in Health Care Fraud and Kickback Scheme Involving âFoot Bathsâ - Office of Inspector General (.gov)
Florida Man Pleads Guilty in Health Care Fraud and Kickback Scheme Involving âFoot Bathsâ  Office of Inspector General (.gov)
What SNFs should do now to protect themselves in a new era of CMS validation and OIG enforcement
What SNFs should do now to protect themselves in a new era of CMS validation and OIG enforcement  McKnight's Long-Term Care News
States' lawsuit against HHS cuts moves forward after court win
A federal judge has dismissed an attempt by Health and Human Services Secretary Robert F. Kennedy Jr. to dismiss a lawsuit brought by 19 states and the District of Columbia over the restructuring and ...