The intersection of private insurers and government-sponsored programs often gives rise to unique challenges. One such challenge is insurance providers taking advantage of the federal government’s Medicare Advantage program through adjustment fraud. Medicare...
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Medicare / Medicaid Fraud
When to speak up: identifying and reporting Medicaid fraud
As a Medicaid recipient, you have the right to receive necessary medical care and services that help improve your health and well-being. However, sometimes, health care providers may bill for services that are not medically necessary or may upcode (bill for more...
What signs of Medicaid fraud should providers look out for?
Medicaid fraud is a severe issue in New York, costing the state valuable resources that could have been allocated for other urgent needs. This type of fraud can involve one or more parties, including patients, health care providers and practitioners. If left...
Maintaining integrity through the Anti-Kickback statute
Under the Anti-Kickback Statute, health care providers cannot exchange anything of value to reward or induce referrals for federal programs like Medicare or Medicaid. Meaning, doctors cannot give or accept gifts or rewards to get more patient referrals for services...
What are examples of provider and recipient Medicaid fraud?
Committing Medicaid fraud is a severe crime that can impact the usage of public funds. This type of fraud can divert financial resources from vulnerable residents who rely on Medicaid for healthcare. Because of its significant impact on the community, authorities have...
Who suffers in Medicaid fraud incidents?
Fraud is a serious crime that could negatively impact innocent people's lives. It is also true for health care fraud involving funds used to cover the medical needs of unsuspecting citizens. The New York State Office of the Medicaid Inspector General (OMIG) considers...
Detroit health system to pay $29.7 million for kickbacks
VHS of Michigan Inc. (doing business as, The Detroit Medical Center Inc. (DMC)), Vanguard Health Systems Inc. (Vanguard), and Tenet Healthcare Corporation (Tenet) all agreed to pay a total of $29,744,065 to the federal government for providing kickbacks some referring...
Supreme Court overturns circuit court ruling of pharmacies billing Medicare and Medicaid
The Supreme Court Justices of the United States ruled 9-0 to throw out a 7th Circuit Court of Appeals ruling that said that pharmacies for Safeway and SuperValu cannot be held accountable for fraudulent drug billing. Whistleblowers are seeking monetary damages for a...
Bronx nursing home and staff to pay $3.46 million
A U.S. District Attorney for the Southern District of New York and Special Agent in Charge of the New York Regional Office of the U.S. Department of Health and Human Services announced that it settled a fraud lawsuit that alleges that Morris Park Nursing Home engaged...
Podiatrist sentenced for fraudulent Medicare billing
A federal judge sentenced a Michigan podiatrist to seven years in prison for orchestrating a scheme that fraudulently billed Medicare for nearly $2 million. He is also guilty of falsifying records and identity theft. The doctor operated a practice specializing in...