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Medicare/Medicaid Fraud Archives

Progressive units agree to $2 million False Claims Act settlement

A whistleblower will receive more than $600,000 after federal authorities obtained a $2 million+ settlement from Progressive Insurance in relation to alleged Medicare and Medicaid fraud. Progressive Casualty Insurance Co., of Cleveland, Ohio, and Progressive Garden State Insurance Co., of West Trenton, New Jersey, improperly submitted claims under the company's "health first" auto insurance policies.

Whistleblower: Clinics billed Medicaid for unlicensed treatment

A whistleblower has filed suit against a chain of Massachusetts mental health care centers, claiming the company defrauded the state and federal governments of $130 million. The accusation is that the company allowed "unlicensed, unqualified, and unsupervised employees" to treat patients. Doing so would be in clear violation of Medicaid regulations and requirements, the suit says.

New York doctors get prison for $100 million Medicare fraud

Three New York-based doctors will receive prison time after pleading guilty to accepting bribes. Their sentences are the most recent development in a massive scandal that involved $100 million in Medicare payments to a specific diagnostic lab. An extensive investigation by the Department of Justice has led to the conviction of over 30 physicians, including two from Staten Island and one from Yonkers.

Spotting fraud as a beneficiary

As a beneficiary of Medicare or Medicaid, you use these entitlements to pay for important medical bills or gain access to necessary prescriptions. Protecting the future of these programs remains a top social priority for many, but fraud continues to threaten resources. According to the Coalition Against Insurance Fraud, more than 2,500 people have been charged with Medicare fraud in the past decade, totaling nearly $8 billion in false claims.

NYC pharmacist accused of defrauding Medicaid of $11 million

A New York City pharmacist is facing both a civil complaint and criminal charges after allegedly bilking Medicaid out of $11 million. The pharmacist is accused of giving kickbacks to Medicaid patients in exchange for the opportunity to refill their prescriptions -- or to buy the prescriptions outright and bill Medicaid despite never intending to fill them. The patients were typically poor and the prescriptions were often for expensive HIV medications.

Justice Department forms first Health Care Fraud Unit

After last month's takedown of some 400 medical professionals accused of $1.3 billion in false billings, the Justice Department intends to remain vigilant in its fight against healthcare fraud. It has just announced the creation of the nation's first Health Care Fraud Unit to focus on issues like kickback schemes, upcoding and false diagnoses.

400+ healthcare professionals accused of Medicare/Medicaid fraud

The Justice Department has just announced what it calls the "largest health care fraud takedown operation in American history." 412 doctors, nurses, pharmacists and other licensed medical professionals have been charged with a massive kickback scheme involving the prescription of opioid medications. The scheme allegedly involved $1.3 billion in false billing to Medicare, Medicaid and TRiCARE insurance, and people were charged in 41 federal districts.

The University of Rochester is ordered to repay Medicaid $100,000

The University of Rochester's Medical Center (URMC) has agreed to reimburse both the state and federal governments the $113,722.10 that they are alleged to have illegally pocketed. URMC is alleged to have violated both the New York False Claims Act as well as federal law when it improperly used a billing code in filing claims through its Flaum Eye Institute.

Have you noticed time discrepancies in Medicaid billing?

There are many different forms of fraud that involve billing Medicaid. In some cases, a doctor, billing specialist or medical business will intentionally bill for drugs, procedures or services that were never administered or performed. In other cases, doctors or dentists perform unnecessary medical or dental procedures on unwitting patients. One of the less known forms of Medicaid fraud is time theft, where a doctor, therapist or other professional bills for time when no services were provided to the client.

Have you noticed time discrepancies in Medicaid billing?

There are many different forms of fraud that involve billing Medicaid. In some cases, a doctor, billing specialist or medical business will intentionally bill for drugs, procedures or services that were never administered or performed. In other cases, doctors or dentists perform unnecessary medical or dental procedures on unwitting patients. One of the less known forms of Medicaid fraud is time theft, where a doctor, therapist or other professional bills for time when no services were provided to the client.

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