From Detection to Defense: Building Fraud-Resilient Healthcare Payment Systems
Prevention requires more than faster detection. Organizations need payment programs with end-to-end visibility and controls that intervene before losses occur.
The 5 Areas Where Dr. Oz Says CMS Can Make Healthcare More Affordable
CMS Administrator Dr. Mehmet Oz outlined the agency's strategy for making healthcare more affordable during a Tuesday address at the HFMA Annual Conference, touching on everything from Medicare fraud to drug pricing to nutrition.
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The Power of Real World Data to Study Women’s Health at Scale
Veradigm examines key clinical trends, comorbidity profiles, and treatment trends across adolescence, reproductive years, and peri-/post-menopause. Download it today!
Massachusetts Attorney General Sues UnitedHealthcare, Alleges $100M MassHealth Fraud
The Massachusetts attorney general sued UnitedHealthcare, alleging the insurer improperly inflated MassHealth members’ health risk scores to secure at least $100 million in excess payments.
CMS Halts New Medicare Enrollment for Hospice, Home Care Amid Fraud Crackdown
CMS imposed a six-month nationwide freeze on new Medicare enrollments for hospices and home health agencies as part of a broader crackdown on fraud in the sectors.
DOJ Doubles Down on Healthcare Fraud Enforcement with New West Coast Strike Force
The Department of Justice’s new “West Coast” strike force targets Arizona, Nevada and Northern California — regions flagged for rising Medicaid, hospice and tech-enabled fraud risks. Legal experts say the effort signals a broader shift toward data-driven enforcement, as regulators ramp up their scrutiny of telehealth companies and billing automation software.
How the DOJ Is Tackling Fraud in the ACA Marketplace
At the Medicarians Conference, Ricardo Carcas, assistant special agent in charge of the Office of Investigations, discussed cases of fraud in the ACA and how the DOJ is combatting it.
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Inside an Automated Healthcare Practice: Redesigning Care Around People, Not Paperwork
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Healthcare’s Paper Check Problem
By adopting a modern digital payment solution, payers can streamline operations, improve provider relationships and reduce fraud exposure. Most importantly, they gain a flexible, scalable foundation built to meet today’s demands and tomorrow’s challenges.
Kaiser Permanente to Pay $556M to Settle Medicare Advantage Fraud Allegations
Five Kaiser Permanente affiliates agreed to pay $556 million to settle allegations from the Department of Justice that they improperly inflated Medicare Advantage payments through inaccurate diagnosis coding. The case is one of the largest risk-adjustment settlements to date — and it signals continued federal scrutiny of the program.
Ex-Cano Health CEO Faces $72M Fraud Claims
Marlow Hernandez, the founder and former CEO of Cano Health, was set to face a trial over allegations that he fraudulently enriched himself and his family while managing the senior-focused primary care company. Cano filed for bankruptcy last year — an event many industry experts attributed to Hernandez’ poor governance.
Dr. Oz Says the Medicaid Program is Complicit in ‘Legalized Money Laundering’
CMS Administrator Dr. Mehmet Oz said that Medicaid’s rapid spending growth is unsustainable and criticized state financing tactics that let providers and governments “game” the system for extra federal funds. He said CMS is shifting its fraud strategy to follow the flow of money rather than just individual offenders in an effort to ensure health dollars are used for legitimate care.
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Top 7 Modern AI-Powered EAP Providers for Global Workforces in 2026
Discover the top AI-powered EAP providers for 2026. Compare platforms like Kyan Health and Spring Health on triage speed, global reach, and clinical quality to transform workforce wellbeing.
Credit Monitoring Won’t Save You: The True Fallout of the Change Healthcare Hack is Just Beginning
The attack has given detailed dossiers on millions of lives to criminals, employers, enemies and anyone with the means and motivation to exploit them. This isn't just another data breach, it's a healthcare catastrophe — and it's being inexplicably downplayed.
Former Outcome Health Execs Found Guilty of 47 Counts of Fraud
A federal jury found three former Outcome Health executives guilty of 47 counts of fraud. The convictions come after a 10-week trial that investigated the former leaders’ role in a billion-dollar scheme in which the company lied to its customers about how many physicians' offices their advertisements would appear in.
What do GCs need to know to advise clients to avoid telehealth fraud?
What's interesting in this special fraud alert and what was somewhat new is the dual emphasis on marketing and clinical decision making.
DOJ charges dozens for $1.2B in telemedicine fraud scheme
The charges involve some of the first cases in the country involving fraudulent cardiovascular genetic testing, a “burgeoning scheme,” according to a news release from the DOJ.
DOJ accuses Kaiser Permanente of Medicare Advantage fraud in new complaint
The California-based health system and insurer has bilked CMS out of "hundreds of millions of dollars" by submitting claims that were altered to make patients appear sicker than they were, a new complaint filed by the DOJ alleges. Kaiser denied these allegations saying it is confident in its compliance with Medicare Advantage program requirements.