Oversight, Fraud & Compliance
Expert articles and analysis related to oversight, fraud & compliance.
AI Summary â Last 30 Days
In the past 30 days, federal oversight of Medicare Advantage and ACO payment has intensified, with CMS under the Trump administration implementing measures to combat suspect billing and reinforce program integrity. Major settlementsâincluding $556 million from Kaiser affiliates and $117.7 million from Aetnaâunderscore escalating enforcement on risk adjustment upcoding and fraud, reflecting a multi-year trend toward heightened scrutiny and obligating plans to address audit findings proactively (Kaiser settlement, Aetna settlement). In parallel, CMS launched new pilotsâsuch as the Substance Access Beneficiary Engagement Incentive, which greenlights hemp product use.
Related Articles
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)
Former Intensive Care Nurse Indicted, Charged with Prescription Drug Fraud - oig.hhs.gov
Former Intensive Care Nurse Indicted, Charged with Prescription Drug Fraud  oig.hhs.gov
Former Greeneville Caregiver Indicted, Charged in Vulnerable Adult Abuse Investigation - oig.hhs.gov
Former Greeneville Caregiver Indicted, Charged in Vulnerable Adult Abuse Investigation  oig.hhs.gov
Advanced Urology and Jitesh Patel will pay $14 million to settle False Claims Act case involving allegations of fraudulent billing and unnecessary medical procedures - oig.hhs.gov
Advanced Urology and Jitesh Patel will pay $14 million to settle False Claims Act case involving allegations of fraudulent billing and unnecessary medical procedures  oig.hhs.gov
Trinity Hospital Agrees to Pay $1.7M to Resolve Alleged Stark Law Violations - oig.hhs.gov
Trinity Hospital Agrees to Pay $1.7M to Resolve Alleged Stark Law Violations  oig.hhs.gov
Vibrent Health Claimed Unallowable Costs Under a National Institutes of Health Other Transaction Award - oig.hhs.gov
Vibrent Health Claimed Unallowable Costs Under a National Institutes of Health Other Transaction Award  oig.hhs.gov
Georgia practice, physician owner to pay $14M to settle fraud allegations
An Atlanta-based urology practice and its physician owner have agreed to pay $14 million to resolve False Claims Act allegations of billing federal healthcare programs for medically unnecessary and un...
8 Arrested in Health Care Fraud Takedown, Including Owners of Hospices that Billed Taxpayers Millions of Dollars to Serve the âDyingâ - Office of Inspector General (.gov)
8 Arrested in Health Care Fraud Takedown, Including Owners of Hospices that Billed Taxpayers Millions of Dollars to Serve the âDyingâ  Office of Inspector General (.gov)
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Priority Health (Contract H2320) Submitted to CMS - Office of Inspector General (.gov)
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Priority Health (Contract H2320) Submitted to CMSÂ Â Office of Inspector General (.gov)