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Posts tagged "Health Care Investigations"

AI: The next tool in the fight against 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 physicians sentenced to prison for Medicare Fraud

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.

Retail giant settles Medicare fraud case

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.

Company closes after Medicare stops covering diagnostic test

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.

HHS makes headway on Medicare reimbursement appeal backlog

The Recovery Audit Contractor Program is one group that contracts with the government ot correct inaccurate Medicare payments. Those who disagree with the program’s findings can appeal the process. However, one of the biggest critiques of the appeals process is the length of time it takes to reach a resolution. As of February 2015, the appeals process took an average of 572 days.

TX city official sentenced to 2 years for health care fraud

The Southern District of Texas recently accused a Texas pharmacy owner of an elaborate health care fraud scheme. During the investigation, the prosecution gathered evidence to support allegations a city official was also involved in the scheme. The accusations were serious and included involvement in an alleged scheme to receive over $1.7 million in false payments from Blue Cross and Blue Shield of Texas.

Did a TX hospital commit a crime by failing to release patients?

Psychiatric facilities must operate while maintaining a difficult balance: provide the care patients need while not discharging them at a time they could injure themselves or others. A failure to navigate this balance wisely can result in allegations of criminal wrongdoing.

Insurance company demands TX hospital return $1 million

Navigating the intricacies of insurance payments is difficult, even for hospital officials. One local hospital is attempting to figure out what went wrong that led to an insurance company accusing the hospital of fraudulent billing practices.

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