Posts Tagged ‘fraudulent billing’
Healthcare-Related False Claims Act Settlements Reach $1.8 Billion in FY 2023
The False Claims Act (FCA), the federal government’s primary tool for civil enforcement, is resulting in record returns. The U.S. Department of Justice reported 543 settlements and judgments, recovering $2.68 billion in the fiscal year ending Sept. 30, 2023. Of that, more than $1.8 billion related to matters involving the healthcare industry, including managed care…
Read MoreBilling Under Another’s Credentials Results in FCA Violation for Therapy Company
A Macon, Ga. rehab facility has been ordered to pay more than $9.6 million in damages after a district court judge ruled in favor of the government in a civil case alleging the fraudulent billing of hundreds of TRICARE and Medicaid claims. The order was the result of a judge’s recent ruling in which he…
Read MoreOIG Cracks Down on Home Health Questionable Billing Practices
A few years back, as part of its Work Plan, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) announced it was seeking to identify home health agencies, supervising physicians, and geographic areas whose Medicare claims had characteristics similar to those observed by the agency in cases of home health…
Read MoreHow can investigators predict healthcare fraud?
Predictive modeling is a term that has been used a great deal lately in the context of healthcare fraud. In a nutshell, predictive modeling is the area of data mining concerned with forecasting probabilities and trends. Here in South Florida, many of us are familiar with its use through the forecasting of hurricanes. In the…
Read MoreSCOTUS Hears Arguments on Implied Certification Theory
Last month, the United States Supreme Court took up the issue of whether False Claims Act (FCA) cases may be brought by whistleblowers and the government under the theory known as “implied certification.†And, if so, under what circumstances. On April 19, the high court heard oral arguments in Universal Health Services v. United States…
Read MoreTRICARE Billing Scandal Intensifies as Feds Target More Compounding Pharmacies
Allegations of fraudulent billing practices involving compounding pharmacies and specialty creams is rearing its ugly head again. Now, the U.S. Department of Justice is investigating what is suspected to be half a billion dollars in healthcare fraud linked to these creams used to treat pain. TRICARE, the health insurance program for members of the U.S.…
Read MoreHome health agency owner 20-year sentence for Medicare fraud upheld
The Eleventh Circuit Court of Appeal recently affirmed a 20-year prison sentence for the owner of a Miami home healthcare business who was found guilty of Medicare fraud. Dora Moreira, the owner and operator of Anna Nursing Services Corp., was accused of bilking Medicare out of $7 million. The appellate court found that Moreira, who…
Read More