Payment integrity & fraud, waste, abuse

Improper payments, fraud enforcement, False Claims Act, OIG audits and work plan, RAC/UPIC, payer payment-integrity programs

Latest

Last 14 days · as of Nov 10

Quest Diagnostics pays $13M for physician kickback scheme

Becker's ASCNov 9Topic alignment 92

New CMS rule ties Medicare billing privileges to owners’ misconduct

Healthcare DiveNov 6Topic alignment 88

Regulators have expanded powers to revoke providers’ Medicare certification, including for parent companies that violate federal rules.

The Perfect Child Sued by Elevance Health over $800M in Fraudulent Billing

Behavioral Health BusinessNov 6Topic alignment 90

California Laboratory and Its Owner Pay $1.25M to Settle Allegations of Kickbacks to Marketers - Department of Justice (.gov)

DOJ Health Care FraudNov 6Topic alignment 95

Behind the Scenes: How CMS Combats Hospice Fraud

Hospice NewsNov 4Topic alignment 95

The U.S. Centers for Medicare & Medicaid Service (CMS) is locking horns with scammers, and hospices need a transparent view into the agency’s methods. CMS routinely monitors billing activity, beneficiary complaints and other indicators that may signal…

Chicago-area lab owner pleads guilty in $227M Medicare fraud scheme

Becker's Payer IssuesNov 5Topic alignment 95

A Limited Window and Lower Multiplier: DOJ and HHS Launch New FCA Self-Disclosure Pilot Program

Hall RenderNov 3Topic alignment 95

Elevance sues autism therapy group, alleging $160M in payments to shell companies

Becker's Payer IssuesNov 6Topic alignment 88

Also covered by Becker's Behavioral Health

DOJ’s Fraud Division and the U.S. Attorney’s Office for the District Minnesota Uncover Nearly $30M in Benefits Fraud in Enforcement Surge - Department of Justice (.gov)

DOJ Health Care FraudOct 30Topic alignment 95

Crushing Fraud, Waste, & Abuse - Centers for Medicare & Medicaid Services | CMS (.gov)

MLN Connects NewsletterNov 2Topic alignment 95

Force Multiplier: HHS Grants CMS Permissive Exclusion Authority

Hall RenderNov 5Topic alignment 90

Recent Decision Examines the Boundaries of Anti-Kickback Statute Liability for Marketing Arrangements

Hall RenderNov 6Topic alignment 85

CMS COO: Moratorium Has Blocked 250 Home Health Agencies From Medicare Enrollment

Home Health Care NewsOct 29Topic alignment 92

Louisiana Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees - Office of Inspector General (.gov)

OIG HHSOct 29Topic alignment 92

CMS Moves To Expand Home Health Review Choice Demonstration To California

Home Health Care NewsOct 30Topic alignment 90

CMS COO: Hospice, Home Health Moratoria a Successful Approach

Hospice NewsOct 29Topic alignment 90

The U.S. Centers for Medicare & Medicaid Services’ (CMS) temporary moratoria on hospice and home health provider enrollment in Medicare has been working, according to Kimberly Brandt, the agency’s deputy administrator and COO. To date, during the six-month…

HRSA Made $658 Million in Potential Overpayments to Selected Providers Under Phase 3 of the Provider Relief Fund Program - Office of Inspector General (.gov)

OIG HHSNov 2Topic alignment 92

Independence Blue Cross Agrees to Pay $22.5 Million to Resolve Medicare Advantage Risk Adjustment False Claims Act Case: “Additions” Without “Deletions”

Frier LevittOct 29Topic alignment 88

Independence Blue Cross (IBX) has agreed to pay $22.5 million to the United States to resolve a whistleblower lawsuit, United States ex rel. Crawford v. Independence Blue Cross, No. 20-cv-5818 (E.D. Pa.), concerning the risk adjustment data it submitted to…

Potential Vulnerabilities in CMS’s Oversight of Medicare Providers’ Billing of Selected Outpatient Drugs, OAS-25-09-090 - Office of Inspector General (.gov)

OIG HHSOct 28Topic alignment 90

Office of Public Affairs | Virginia Mental Health Professional Charged in $49M Medicaid Fraud Scheme - Department of Justice (.gov)

DOJ Health Care FraudOct 28Topic alignment 95

Multiple Individuals Arrested for Health Care Fraud Conspiracy following Homeland Security Task Force Investigation - Department of Justice (.gov)

DOJ Health Care FraudOct 27Topic alignment 92

District of Kansas | U.S. Attorney’s Office announces $23 million civil recovery for health care fraud victims - Department of Justice (.gov)

DOJ Health Care FraudOct 28Topic alignment 92