Press Room

Orlando Sentinel: Halifax Hospital whistleblower at forefront of $200M alleged fraud

  State and federal law enforcement are jointly prosecuting a hospital in Daytona Beach after an employee-whistleblower uncovered a decade of fraudulent billing and nearly $200 million in improper payments pocketed by the hospital. FROM THE ORLANDO SENTINEL: Most of the bills defrauded federally funded programs such as Medicare and Medicaid. “I kept hoping someone else would do it,” said Baklid-Kunz, who has worked in compliance and revenue services for the hospital, “but sometimes you have to be that someone.” In a […]

VEGAS INC: Scamming The System – The Rising Cost of Health Care Fraud

  A Las Vegas Air Force Base contractor billed the health care system for numerous cosmetic procedures claiming they were part of breast cancer treatments. FROM VEGAS INC: “Thirty-one-year-old Las Vegas resident Shanita Flax pleaded guilty to two counts of felony theft in August 2012 for a scheme in which she received money from women undergoing cosmetic breast implant procedures but ordered their implants as though they were part of breast cancer treatments. Flax, a civilian contractor at O’Callaghan Federal […]

NBC NEWS: NYC Cardiologist Admits Faking Diagnoses to Collect Medicare Money

  A New York City Cardiologist admits he intentionally misdiagnosed up to 80 percent of his patients to collect fraudulent Medicare funds. FROM NBC NEWS NEW YORK: “Dr. Jose Katz, 68, pleaded guilty to falsifying charts diagnosing patients with angina and other heart ailments so he could prescribe extra tests and treatments when hundreds of patients did not need them. Prosecutors said it was the largest fraud ever executed by a single doctor in New York or New Jersey. “After […]

Becker’s Hospital Review: Medicare RACs, Hospitals Spar Over New Fraud Legislation

  A bill that would reform Medicare recovery auditing practices has spurred tensions between hospitals and RACs. FROM BECKER’S HOSPITAL REVIEW: “Last month, House Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) reintroduced the Medicare Audit Improvement Act. Under this bill, Medicare RAC record requests would be capped to 2 percent of hospital claims, with a maximum of 500 medical record requests every 45 days, among other measures. The American Coalition for Healthcare Claims Integrity, a non-profit RAC supporter group, argued […]

Fierce Healthcare: Hospitals, Auditors Clash Over RAC Reform

  Medicare recovery auditors (RACs) are fighting a house bill that would cut into billions of dollars in Medicare fraud recoveries.   FROM FIERCE HEALTHCARE: “If you want to send Medicare crashing to the ground, letting improper payments run rampant is a surefire way to do that,” Amanda Keating, a spokeswoman for the American Coalition for Healthcare Claims Integrity, told The Hill’s Healthwatch. She noted RACs recovered more than $2 billion in improper payments in 2012 alone, Healthwatch reported.   Read the full […]

Bloomberg: Pacific Health Corp. Closes 3 Hospitals Due to Fraud Allegations

  Pacific Health Corporation officials said they will close their three remaining hospitals this week after allegations that the facilities recruited homeless people to fraudulently bill Medicare. FROM BLOOMBERG: “Department of Justice officials announced in August that Pacific Health agreed to pay a $16.5 million for allegedly engaging in an illegal kickback scheme in which homeless people were recruited from Los Angeles’ Skid Row to become patients and bilk the system. As part of the settlement, PHC’s Los Angeles Doctors […]

The Hill: Feud between hospitals, Medicare contractors explodes over fraud bill

  Recovery audit contractors are pushing back on new legislation that weakens oversight of Medicare payments. FROM THE HILL:  RACs charge that the new bill from Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) will severely undercut their efforts to secure Medicare’s finances at a time when improper payments are rife within the program. A spokeswoman for the American Coalition for Healthcare Claims Integrity, a nonprofit coalition, pointed to more than $2 billion recovered for Medicare by RACs in 2012. […]

CBS: U.S. Attorney’s Office Sees Uptick in Health Care Fraud Cases

  In this video, the U.S. Attorney’s Office reports that healthcare schemes previously uncovered in Miami are now on the rise in West Michigan. FROM CBS NEWS GRAND RAPIDS, MI: “In fiscal year 2012, the Department of Justice recovered $3 billion of taxpayer money by cracking down on health care fraud. “Taxpayers are definitely the ultimate victim here, and that means everyone is suffering when people are abusing the system,” said U.S. Attorney Pat Miles. We’re told that schemes that […]

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FBI: Medical Equipment Company Owner Arrested in 21-Count Health Care Fraud Indictment

  Authorities arrested Andrea Michelle Tellison, owner of Texas Durable Medical Company, following a 21-count indictment charging her with healthcare fraud and aggravated identity theft. From the FBI Website: Durable Medical Equipment Company Owner Arrested in 21-Count Health Care Fraud Indictment HOUSTON—Andrea Michelle Tellison, 46, has been arrested following the return of a 21-count indictment charging her with health care fraud and aggravated identity theft, United States Attorney Kenneth Magidson announced today. The indictment was returned under seal Wednesday, March 20, […]

RACMonitor: Fallout Continues over Audit Reform Bill

  The Medicare audit reform bill, introduced by Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), will weaken the federal government’s flagship healthcare program. FROM RACMonitor:  “Every year, more than $65 billion in improper payments are made to healthcare providers due to fraud, waste, abuse, and billing errors,” Amanda Keating, a spokesperson for the American Coalition for Healthcare Claims Integrity, said in a written statement to RACmonitor. “This puts a tremendous burden on a Medicare system already struggling to remain […]