A Texas court recently sentenced a 46-year old local man after he pleaded guilty to charges of conspiracy to commit health care fraud. The accused owned and operated the ambulance company in the Houston area from 2009 through 2012.
The Department of Justice (DOJ) released the federal indictments for a group of individuals charged in one of the largest cases of healthcare fraud in recent history. The case is the result of a joint operation involving many agencies including the Federal Bureau of Investigation, U.S. Department of Health and Human Services Office of Inspector General and the Internal Revenue Service Criminal Investigation as well as various state agencies throughout the country.
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.
Texas nursing homes are struggling. Last year Senior Care Centers, the largest nursing facility in the state, filed for bankruptcy.
The government built two successful cases against Texas physicians to start the New Year. The Justice Department’s Criminal Division along with the United States Department of Health and Human Services Office of the Inspector General (HHS-OIG) Dallas Region recently announced the sentences for the accused medical professionals.
The Office of Inspector General (OIG) for the United States Department of Health and Human Services (HHS) has required pharmacy giant Walgreen's to partake in a Corporate Integrity Agreement. The agreement requires the retail store and pharmacy to agree to broad oversight and reviews to ensure it is following requirements when involved in federal programs.
Medical professionals are not the only ones that can face allegations of health care fraud. A recent case out of Alabama provides an example of a politician that found himself the focus of a federal investigation.
Coverage by medical insurance is important for more than just patients—it is also important for those who operate in the health care industry. Businesses that operate in this market often depend on payments from insurance companies to continue operations. Without payment for the services provided, the business may not receive the funds it needs to operate.