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Healthcare Fraud

All articles tagged with #healthcare fraud

FinCEN Targets Health-Care Benefit Fraud, Proposes Whistleblower Rewards
business12 days ago

FinCEN Targets Health-Care Benefit Fraud, Proposes Whistleblower Rewards

FinCEN issues an advisory warning financial institutions to watch for schemes exploiting government health care benefit programs like Medicare and Medicaid, detailing how fraud rings and transnational criminal organizations file false claims and launder funds through banks and international networks; the agency also unveiled a proposed rule to compensate whistleblowers with 10–30% of penalties from qualifying actions, funded by penalties under the Bank Secrecy Act and the International Emergency Economic Powers Act, as part of a broader effort to protect federal payments.

via U.S. Department of the Treasury (.gov)|
#business#fincen#healthcare-fraud
Aetna Pays $117.7 Million to Resolve Medicare Advantage Coding Allegations
healthcare1 month ago

Aetna Pays $117.7 Million to Resolve Medicare Advantage Coding Allegations

Aetna will pay $117.7 million to settle False Claims Act allegations that it submitted or failed to withdraw inaccurate diagnosis codes to inflate Medicare Advantage payments, including morbid obesity codes for 2018–2023, and related issues from a 2015 chart-review program; a whistleblower, a former Aetna risk-adjustment coder, will receive about $2.01 million. The case was pursued by the DOJ Civil Division, Fraud Section, and HHS-OIG with the U.S. Attorney’s Office for the Eastern District of Pennsylvania.

via Department of Justice (.gov)|
#aetna#false-claims-act#healthcare
politics1 month ago

White House Deploys AI-Driven Crackdown on Medicare Fraud

The administration unveiled a multi-pronged plan to curb healthcare fraud, including deferring $259.5 million in Minnesota Medicaid payments pending review, a nationwide DMEPOS enrollment moratorium, and a CRUSH initiative inviting public input, all backed by real-time AI tools to detect and stop improper payments before they occur, aiming to reduce fraud, save taxpayer dollars, and improve affordability for patients.

via HHS.gov|
#ai#fraud-prevention#healthcare-fraud
Houston Doctor Indicted for Falsifying Records to Deny Liver Transplants
crime2 months ago

Houston Doctor Indicted for Falsifying Records to Deny Liver Transplants

A Houston surgeon, Dr. John Stevenson Bynon Jr., was indicted on five counts of false statements in health care matters for allegedly falsifying medical records to render five patients ineligible for liver transplants; among them, three died and two later received livers at other hospitals. The case prompted Memorial Hermann to temporarily shut down its transplant program, which later reactivated; if convicted, he faces up to five years and a $250,000 fine per count.

via cbsnews.com|
#crime#falsified-medical-records#healthcare-fraud
Newsom Files Civil-Rights Complaint Over Oz Video Tying Armenian Americans to Fraud
politics2 months ago

Newsom Files Civil-Rights Complaint Over Oz Video Tying Armenian Americans to Fraud

California Gov. Gavin Newsom filed a federal civil-rights complaint against Dr. Mehmet Oz for a video that linked Armenian Americans in Los Angeles to about $3.5 billion in hospice and home-care fraud, arguing the remarks were racially charged and discriminatory and calling for a federal investigation amid community backlash and ongoing fraud probes.

via The New York Times|
#armenian-americans#california#civil-rights
Kaiser Permanente to pay $556 million to settle Medicare Advantage fraud allegations
business2 months ago

Kaiser Permanente to pay $556 million to settle Medicare Advantage fraud allegations

The Justice Department announced a $556 million settlement with Kaiser Permanente over allegations that it inflated Medicare Advantage payments by adding improper diagnoses to patient charts after visits, a practice the government says diverted about $1 billion from taxpayers between 2009 and 2018; Kaiser says the settlement resolves the matter without admitting wrongdoing and notes it concerns risk-adjustment practices rather than care quality.

via statnews.com|
#business#doj-settlement#healthcare-fraud
Feds Uncover Billions in Medicaid and Welfare Fraud Across Minnesota and Beyond
crime3 months ago

Feds Uncover Billions in Medicaid and Welfare Fraud Across Minnesota and Beyond

Federal prosecutors in Minnesota have announced new charges in a massive Medicaid fraud scheme involving billions of dollars, with defendants accused of billing for services not provided, using funds for personal luxury, and creating fake companies to claim millions in fraudulent Medicaid claims, highlighting the scale and impact of healthcare fraud in the state.

via MPR News|
#crime#federal-charges#healthcare-fraud
Federal Charges Unveiled in Minnesota Housing Stabilization Fraud
world6 months ago

Federal Charges Unveiled in Minnesota Housing Stabilization Fraud

Eight individuals and four companies in Minnesota face federal fraud charges for allegedly stealing over $8.4 million through Medicaid billing related to Housing Stabilization Services, which was intended to connect vulnerable adults with housing but was exploited for fraudulent billing, prompting investigations and calls for systemic reforms.

via 5 EYEWITNESS NEWS|
#federal-charges#healthcare-fraud#housing-stabilization-services
Imposter Nurse Used Multiple Aliases to Commit Healthcare Fraud in Pennsylvania
crime8 months ago

Imposter Nurse Used Multiple Aliases to Commit Healthcare Fraud in Pennsylvania

A woman working under multiple aliases and without proper credentials posed as a nurse across at least four states, working in numerous healthcare facilities for five years, while facing multiple criminal charges including identity theft, forgery, and endangering patient welfare. Her true identity remains uncertain, and she was caught after a traffic stop in Pennsylvania, with evidence of stolen prescription drugs and falsified documents.

via The New York Times|
#aliases#crime#criminal-charges
U.S. Executes Largest Healthcare Fraud Crackdown, Seizing $14.6B
world9 months ago

U.S. Executes Largest Healthcare Fraud Crackdown, Seizing $14.6B

The Justice Department announced its largest healthcare fraud takedown in history, charging Pakistani national Farrukh Ali and nearly 200 cases involving $14.6 billion in intended losses. Ali allegedly orchestrated a $650 million scheme involving fake billing and kickbacks with Arizona clinics, targeting Medicaid for addiction treatment services that were never provided or were unnecessary, with actual losses of $2.9 billion.

via NPR|
#arizona#doj#farrukh-ali