The scheme started in New York but became a complex international endeavor as the two men attempted to launder money received from fraudulent Medicare claims for cancer drugs during the pandemic.
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.
As technology advances, AI-powered tools will increasingly reduce the administrative burdens on healthcare providers.
The lawsuit alleges that UPMC and the chair of its cardiothoracic surgery department knowing submitted false claims for concurrent surgeries that violated regulations. But, according to UPMC, there is no regulation that prohibits overlapping surgeries or billing for them.
The Justice Department has sued Walmart for fanning the flames of the opioid crisis through its network of pharmacies, claiming that the retailer knowingly filled thousands of illegitimate opioid prescriptions. But Walmart says the lawsuit is "misguided."