Fraud, Waste & Oversight
Expert articles and analysis related to fraud, waste & oversight.
AI Summary — Last 7 Days
Synthesis:
In the past week, scrutiny of Medicare Advantage fraud and data integrity has intensified, exemplified by Aetna’s $117.7 million settlement over false claims and Elevance’s $935 million expense provision for potential CMS liabilities tied to inaccurate MA data reporting. Congressional hearings and bipartisan legislative action signal mounting pressure to reform Medicare Advantage oversight and strengthen fraud prevention, with direct implications for ACOs and value-based payment contracts reliant on accurate risk adjustment and robust compliance infrastructure. Concurrently, CMS remains focused on tightening program integrity across at-home and hospice care, broadening the enforcement net for providers engaged in alternative payment models.
Related Articles
“Fraud Pays”: Congressional Hearing Exposes Deep Cracks in Medicare’s Defenses
AG Murrill's Medicaid Fraud Control Unit Arrests Shreveport Woman For Medicaid Fraud After Providing Medical Services To Patients Without A License Since At Least 2019 - Office of Inspector General (.gov)
AG Murrill's Medicaid Fraud Control Unit Arrests Shreveport Woman For Medicaid Fraud After Providing Medical Services To Patients Without A License Since At Least 2019 Office of Inspector General (.g...
Memphis Woman Arrested Following TennCare Fraud Investigation - Office of Inspector General (.gov)
Memphis Woman Arrested Following TennCare Fraud Investigation Office of Inspector General (.gov)
Lehigh County Man Sentenced to Prison for Posing as a Medical Professional - Office of Inspector General (.gov)
Lehigh County Man Sentenced to Prison for Posing as a Medical Professional Office of Inspector General (.gov)
Columbia, Missouri Doctor Arrested, Accused of Health Care Fraud, Illegally Prescribing Drugs - Office of Inspector General (.gov)
Columbia, Missouri Doctor Arrested, Accused of Health Care Fraud, Illegally Prescribing Drugs Office of Inspector General (.gov)
Eye Practice and Physician Owner Agree to Pay $415,000 to Resolve Allegations of False Claims Act to Medicare - Office of Inspector General (.gov)
Eye Practice and Physician Owner Agree to Pay $415,000 to Resolve Allegations of False Claims Act to Medicare Office of Inspector General (.gov)
STAT+: CMS to ask every state for new audits of health care providers
The Trump administration has been heavily focused on combating purported fraud in federal health care programs.
Former Pharmacy President Sentenced to 24 Months in Prison for Health Care Fraud and Kickback Scheme Involving Compounded Medications - Office of Inspector General (.gov)
Former Pharmacy President Sentenced to 24 Months in Prison for Health Care Fraud and Kickback Scheme Involving Compounded Medications Office of Inspector General (.gov)
New Federal Focus on Fraud, Waste and Abuse May Signal Changes for the Health Care Industry
Metro Detroit Surgeon Was Sentenced to a Year in Prison in $7 Million Dollar Medicare Fraud Scheme - Office of Inspector General (.gov)
Metro Detroit Surgeon Was Sentenced to a Year in Prison in $7 Million Dollar Medicare Fraud Scheme Office of Inspector General (.gov)