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Health Care Investigations Archives

CMS rule: A closer look at affiliation reporting for managers

As noted in a previous post, the Centers for Medicare and Medicaid Services (CMS) has a new rule that allows the agency to penalize those who fail to disclose affiliations with those who have had enrollment to Medicare or Medicaid previously revoked or denied.

Rule gives CMS authority to act against affiliates of bad actors

The Centers for Medicare and Medicaid Services (CMS) have a new rule that allows a more proactive approach to enforcement efforts. Lawmakers wrote the rule to provide another tool against health care fraud. According to the Federal Register, the Program Integrity Enhancements to the Provider Enrollment Process, has two main provisions.

Diagnostic lab accused of improper dealings with TX hospitals

The government has strict regulations when it comes to relationships between hospitals and diagnostics labs. These regulations were recently highlighted when the Department of Justice (DOJ) reached a multi-million-dollar settlement with a diagnostic lab over allegations the lab improperly billed federal healthcare programs.

Feds accuse Texas doctor of False Claims Act violation

The federal government recently accused an orthopedic surgeon from Texas of False Claims Act violations. The health care fraud crimes the physician face allegedly included illegal kickbacks. More specifically, the Department of Justice (DOJ) accused the specialist of taking payouts from OK Compounding in exchange for prescribing on of their medications for a span of approximately two years.

TX case highlights DOJ's $3B in health care fraud winnings

Yes, billions. The Department of Justice (DOJ) continues its crackdown on health care fraud violations in part because it results in large payouts. In 2019, the federal agency reports it recovered over $3 billion from settlements and judgements for False Claims Act violations.

What triggers an HHS OIG investigation?

The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) ensures HHS programs run smoothly. This agency holds those who abuse the program accountable for their wrongdoing by, when necessary, pursuing criminal charges.

CMS to conduct audits, review risk adjustment payments

The United States Department of Health and Human Services Office of Inspector General (OIG) recently released the findings from a study that focused on the Centers for Medicare and Medicaid Services (CMS) provision of unsupported risk adjustment payments. The OIG questioned the CMS' failure to support the risk adjustment payment requests from Medicare Advantage organizations (MAOs) when the MAO failed to provide evidence it conducted a face-to-face appointment to support the requested payment.

DOJ charges Texas billing clerk with health care fraud

The United States Department of Justice (DOJ) continues its focus on health care fraud investigations involving National Football League (NFL) players. The agency recently announced another round of criminal charges. As discussed in a recent post, the agency indicted ten players earlier this month for health care fraud crimes. This round of criminal charges involves a billing clerk that was allegedly affiliated with a health care fraud scheme that involved another, former NFL player.

DOJ accuses football players of health care fraud

The United States Department of Justice (DOJ) recently announced it will pursue charges against ten former players for the National Football League (NFL). The government has accused these professional athletes of partaking in a scheme to file false and fraudulent claims for medical equipment.

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