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.
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.
Greenway Health blends smart technology with human expertise to elevate revenue cycle.
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's interesting in this special fraud alert and what was somewhat new is the dual emphasis on marketing and clinical decision making.
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.
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.
In this episode hear how improving benefit verification, prior authorizations, and patient affordability with smart integrations and real-time eligibility can streamline healthcare workflows.
A previous investigation by MedCity News found that ElectrifAi was touting an improperly-developed algorithm during the earliest phase of the Covid-19 pandemic, with both the company and CEO defendants in an employment discrimination lawsuit. A year later, lawsuits are piling up as more former employees complain that the company and CEO lied about its AI capabilities and business.
The California-based health system will pay a hefty price to resolve allegations that it knowingly submitted inflated diagnosis codes for certain Medicare Advantage beneficiaries to receive higher payments. Sutter Health does not admit any liability in the matter.
The government has intervened in complaints alleging Kaiser Permanente entities defrauded Medicare out of "tens of millions of dollars" by knowingly submitting false diagnoses for Medicare Advantage beneficiaries. Kaiser denies the allegations, saying it is in compliance with program requirements.
The agency charged the co-founders of the failed fecal microbiome startup with defrauding investors. The SEC is seeking a court order that would bar uBiome’s co-founders from serving as officers or directors, and require them to give up any ill-gotten gains.
Employee assistance programs have become essential tools for organizations aiming to address mental health challenges, reduce burnout and foster healthier workplaces.
The investigation resulted in charges against more than 345 defendants for more than $6 billion in alleged fraud losses. Roughly $4.5 billion of that was connected to telemedicine, the Department of Justice said.
The U.S. filed a lawsuit against Anthem alleging the insurer knowingly failed to correct inaccurate diagnosis codes for patients enrolled in its Medicare Advantage plans.
The Department of Justice sued Omnicare for allegedly dispensing drugs without valid prescriptions.
Various news outlets reported that attorneys for Holmes successfully convinced a federal judge to delay setting a trial date in order to get more time to review some 20 million pages of documents.
After an eight-week trial, Philip Esformes was found guilty for his role in a fraud scheme that involved more than $1.3 billion in fraudulent claims to Medicare and Medicaid for services that weren't provided, weren't medically necessary or were procured through the payment of kickbacks.