While basic medical coding errors and Covid care upcoding are much more common, the grim reality that in 2021 alone, the Department of Justice (DOJ) recovered more than $5 billion from civil fraud and false claims.
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.
Patient expectations continue to evolve, and healthcare practices that fail to adapt risk more than just revenue—they risk losing trust.
Spearheaded by the Departments of Justice, and Health and Human Services, efforts to investigate and prosecute healthcare fraud resulted in the government recovering billions, including about $2.1 billion for the Medicare Trust Funds.
Covid-19 may have hampered investigations and led authorities to shift resources to more obvious frauds, attorneys said. But the pandemic also created new targets to investigate, including telemedicine and CARES Act funding.
At the last minute, President Donald Trump granted pardons to several individuals convicted in huge Medicare swindles that prosecutors alleged often harmed or endangered elderly and infirm patients while fleecing taxpayers.
A Berlin-based anti-fraud consulting group found several concerning issues when it surveyed 58 countries around the world in April to understand fraud in healthcare services that negatively affected Covid-19 response in those countries.
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While prescriptions for durable medical equipment, such as orthotic braces or wheelchairs, have long been a staple of Medicare fraud schemes, the manipulation of telemedicine is relatively new.
The $270 million settlement by HealthCare Partners Holdings LLC, part of giant dialysis company DaVita Inc., is believed to be the largest to date involving allegations that some Medicare Advantage plans exaggerate how sick their patients are to inflate government payments.
The OIG report describes a range of rip-offs, some of which involve caretakers caught up in the nation’s opioid epidemic.
Payers are increasingly being vigilant of fraudulent claims, but a data analytics approach is needed to go beyond just the tip of the problem.
Transitioning to PDPM models significantly shifted the healthcare industry. By replacing the RUG system, healthcare providers cut waste and more accurately reflect the care each patient received.
Spending on these medications in Medicare’s Part D program, for example, rose 56 percent last year, with some of the costliest products, including topical pain creams, priced at hundreds or thousands of dollars per tube.
Both Pfizer and Allergan have paid some $4.5 billion to settle government healthcare fraud allegations in the U.S. Shouldn't we just expect more at this point?