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.
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.
Richard Fu details the company's approach to nutrition therapy and strategy for patients using GLP-1s.
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.
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.
Across the nation, state-based health insurance exchanges are searching for ways to better serve their communities while making enrollment easier, more personal, and more accessible for everyone.
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.
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.
Sheila Bond, MD, talked about the latest trends regarding integration of AI in healthcare.
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.
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.