Category : News Coverage

POLITICO Pulse: Medicare Fraud Proposal Takes Lumps From Defenders of Contractors

  POLITICO Pulse exposes the special interests driving RAC reform efforts in the House. FROM POLITICO PULSE:  It didn’t take long for the bipartisan harmony presented by the sponsors of the Medicare Audit Improvement Act to devolve into a mud fight. Primary sponsors, Rep. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), presented the bill as an effort to ease the administrative burden on small hospitals by restricting Medicare fraud contractors’ ability to make onerous document requests. But a chorus of […]

The Hill: Bill seeks to ease Medicare audit burden

  Reps. Sam Graves (R-Mo.) and Adman Schiff (D-Calif.) have introduced new legislation to limit auditing activities within a certain timeframe. FROM THE HILL’s HEALTHWATCH: The measure would limit the number of “additional document requests” to two percent of hospitals claims, with a maximum of 500 per 45 days. It would also penalize auditors that ignore basic audit requirements and courtesies. A non-profit anti-fraud group criticized the bill. “While we have not had an opportunity to review the legislation in […]

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FBI: Houston-Area Doctor Sentenced for Role in $17.3M Medicare Scheme

  From the FBI Website: Houston-Area Doctor Sentenced to 63 Months in Prison for Role in $17.3 Million Medicare Fraud Scheme WASHINGTON—A Texas doctor was sentenced today to serve 63 months in prison for conspiring to commit health care fraud by falsifying plans of care for Medicare beneficiaries, including patients whom he did not treat, as part of a $17.3 million Medicare fraud scheme. Today’s sentence was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney […]

POLITICO Pulse: Healthcare Group to Congress: Don’t Cut Fraud Programs

  POLITICO Pulse examined ACHCI’s effort to prevent Congress from restructuring vital healthcare auditing programs. FROM POLITICO PULSE:  The American Coalition for Healthcare Claims Integrity is asking Congress not to pass legislation that would hurt programs targeting health care fraud and waste — noting that provisions in the health care law have recovered $10.7 billion since 2009, mostly improper payments in Medicare and Medicaid. “Our coalition members have a proven track record of helping return significant funds to government health […]

Washington Post: Federal Government Continues to Lose Billions to Waste, Fraud and Abuse

  In this story, the Washington Post reports that the federal government lost $261 billion, or 7 percent of total spending, to fraud and waste in 2012. FROM THE WASHINGTON POST: “Despite progress in reducing improper payments, federal agencies continue to lose billions annually to waste, fraud and abuse. The federal government lost $261 billion, or 7 percent of total spending, to fraud and waste in 2012, said Rep. Darrell Issa (R-Calif.) during a February House committee hearing. Though improper […]

U.S. Department of Justice: Miami Health Care Clinic Director Pleads Guilty in $63 Million Health Care Fraud Scheme

  A healthcare clinic director and licensed therapist pleaded guilty to participation in a massive fraud scheme with defunct healthcare provider Health Care Solutions Network Inc. FROM THE U.S. DEPARTMENT OF JUSTICE: Health Care Clinic Director Pleads Guilty in Miami for Role in $63 Million Health Care Fraud Scheme A former health care clinic director and licensed therapist pleaded guilty today in connection with a health care fraud scheme involving defunct health provider Health Care Solutions Network Inc. (HCSN), announced […]

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U.S. Attorney’s Office: California Doctor Convicted in Multi-Million Dollar Medical Equipment Scam

A federal jury finds an Orange County doctor and nine other defendants guilty in a multi-million-dollar healthcare fraud case. FROM THE U.S. ATTORNEY’S OFFICE: Orange County Doctor Convicted Of Six Counts Of Health Care Fraud In Multi-Million Dollar Scam Involving Durable Medical Equipment FOR IMMEDIATE RELEASE March 7, 2013 LOS ANGELES – A federal jury has convicted a Buena Park doctor for participating in a health care fraud scheme involving unnecessary procedures and prescriptions that led to Medicare paying out nearly […]

Hospitals to pay millions for alleged overbilling in Florida, Texas

  This week, authorities pursued two major cases of hospital fraud in Texas and Florida, respectively. In both cases, providers overbilled the government by millions. FROM FIERCE HEALTHCARE:  According to federal prosecutors, Driscoll Children’s Hospital-owned Children’s Physician Services of South Texas and Radiology Associates each billed the government for the same procedure over five years, resulting in at least $12.3 million in wrongful reimbursement, according to the report. (…) Meanwhile, a whistleblower lawsuit filed against Florida Hospital continues in federal court […]

CBS News: Medicare Fraud in Mobile

  In this investigation, Medicare scammers find new ways to target the elderly. FROM CBS NEWS MOBILE, AL: Medicare scams aren’t new. What is, is the scammer’s approach. Sandy Reynolds gets emails from the office of the Inspector General detailing different scams. “But it was last week when a lady called me and said that someone had called her on the phone and said that they wanted to replace her Medicare card,” says Reynolds, with the Area Agency on Aging. […]

South Florida Business Journal: Big prison sentences handed down for $48M home health Medicare fraud

  In this story, two Miami men are sentenced to prison in a multi-million dollar false Medicare claims case. FROM THE SOUTH FLORIDA BUSINESS JOURNAL: Florida is considered the worst state for questionable Medicare billings by home health agencies – a problem so severe that regulators are considering a moratorium on new home health agencies in the state. Rogelio Rodriguez was sentenced to nine years while Raymond Aday was sentenced to four years and three months in prison. They were […]