The state of Texas recently accused Xerox, the giant in the copying industry, of violating its Medicaid Fraud Prevention Act. The law makes it illegal to fraudulent charge the state’s Medicaid system.
The United States Department of Justice created the Health Care Fraud Unit to investigate allegations of health care fraud. This unit does not just focus on doctors and hospitals. Any professional that submits a bill with Medicare, Medicaid or other health insurance providers can find themselves the subject of the unit’s scrutiny and under investigation for alleged health care fraud.
The Federal Bureau of Investigation (FBI) estimates health care fraud costs the United States billions of dollars every year. Artificial intelligence (AI) specialists claim they have a tool that can help the government recoup these losses. These specialists state they can develop AI for the government that will find three of the more common healthcare fraud crimes: upcoding, billing for services that were not provided and illegal kickbacks.
The health care market is evolving. Physicians are becoming more specialized and patients are more likely to see many different providers. A single patient may have one doctor to manage diabetes, another to manage heart issues and still a third for problems with their joints. Technological advances have also worked to help better ensure physicians are aware of other treatments a patient may receive. In some cases, the government has even become involved.
Texas nursing homes are struggling. Last year Senior Care Centers, the largest nursing facility in the state, filed for bankruptcy.
Running a business of any kind takes diligence to ensure it satisfies all relevant regulations, from classifying employees to paying taxes. When your business is in the healthcare industry, such as running a pharmacy, the laws you must follow are even more numerous, complicated and ever-changing. It is easy to find yourself facing an audit, or worse.
As someone who owns or operates a health care business, you may know all too well that medical billing and coding can prove time-consuming and complex. You can land in serious trouble, however, if Medicare, Medicaid or an insurance company alleges that you were fraudulently overcharging in a practice commonly called "upcoding."
A government investigation recently led to allegations a nursing assistant was involved in a multi-year scheme to defraud Medicare and Medicaid. The investigation resulted in enough evidence to support criminal charges.