Fraud Healthcare Medicaid

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
News & Analysis as of

Texas Medicaid Fraud Recovery Passes $400 Million Thanks to Whistleblowers

Operated jointly by federal and state agencies, Medicaid is one of the largest and most complex governmental undertakings in the United States. Not surprisingly, it also provides a breeding ground for fraud, primarily from...more

Medicaid Claims And Health Care Fraud: As The Data Flows, New Cracks Emerge

As we noted in two of our prior posts in the Insider blog, the government has long touted its ability to rely upon data mining as a means of detecting fraud in the federal health care system, and has initiated a host of...more

News from the Health Law Gurus™: Week of May 11th, 2014

News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. ...more

The Louisiana Supreme Court's Decision In Caldwell v. Janssen And The Broader Implications

On January 28, 2014, the Supreme Court of Louisiana set aside a judgment of $257 million in civil penalties that a lower court had entered in favor of the state against Janssen under the Louisiana Medicaid false claims act,...more

New York Reports Record-Breaking Medicaid Fraud Recoveries In 2013

In an official press release issued on February 3, New York State Governor Andrew M. Cuomo stated that 2013 was “the largest single year of recoveries of taxpayer dollars in the history of the Office of the Medicaid Inspector...more

2013 Healthcare Year In Review

Bob Dylan's quote from 1964 -- "The Times They Are A-Changin" -- could equally apply to the healthcare industry in 2013. This was the year that the Affordable Care Act ("ACA") came into full public view with the start of the...more

Health Reform + Related Health Policy News - October 2013 - Issue 3

In This Issue: - Top News ..Deal to Raise Debt Ceiling, End Shutdown Yields No Major Changes to Health Care Law ..Problems with HealthCare.gov Website Continue; HHS Working to Fix Issues ..Kaiser Study...more

Massachusetts Launches New Program to Combat Provider Fraud

Last week, the Massachusetts’ Secretary of Health and Human Services, John Polanowicz, announced the launch of a new $5 million program designed to detect and prevent provider fraud, waste, and abuse in MassHealth, the...more

CMS Imposes Six-Month Moratoria on New Enrollments of Home Health Agencies and Ambulance Suppliers in Three Fraud “Hot Spots”

Last week, CMS announced temporary moratoria on the enrollment of new home health providers and ambulance suppliers in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) in three fraud “hot spots.”...more

Texas Makes Changes to Medicaid Laws and Programs

Texas Governor Rick Perry signed a series of bills into law last week modifying some of the state’s Medicaid statutes and programs. The laws will take effect on September 1, 2013....more

State Medicaid Fraud Control Units' Data Mining Likely to Increase Through Federal Funding

On May 17, 2013, the Office of Inspector General, U.S. Department of Health and Human Services (OIG), announced a final regulation that would permit, effective June 17, 2013, state Medicaid fraud control units (MFCU) to use...more

Health Reform + Related Health Policy News - May 2013

In This Issue: - Top News ..Tavenner Wins Senate Confirmation to Head CMS ..US Charges 89 in Nationwide Medicare Fraud Crackdown - State News ..Vermont Becomes Fourth State to Allow Physician-Assisted...more

Does A Person Submitting False Medicare Bills Abuse The Trust Of The Doctor Making Money Off Of The False Bills?

Hiring is always hard, especially in a small office. You have work that needs to be done. You can't do it all. Maybe you're a professional, like a doctor, and some of the work isn't the best use of your time....more

California Gets Tough on Healthcare Fraud and Abuse: Are You Protected?

The industry should take note of new California anti-fraud laws that have recently gone into effect—and the increasing challenges of compliance in a rapidly transforming industry. Even as lawmakers in Sacramento debate how...more

OIG: Cardiac Catheterization Arrangement Between Hospital and Physicians Not Subject to Sanctions

On January 7, 2013, HHS OIG published a favorable advisory opinion on a management arrangement between a hospital and a cardiology group related to the provision of certain cardiac catheterization services at the hospital. ...more

Record Healthcare Fraud Recovery Calls for Compliance

To date in 2012, the Department of Justice secured a record $3.3 billion in settlements and judgments in civil cases alleging healthcare fraud against the government under the Federal False Claims Act (“FCA”). The figure,...more

Birmingham Medical News: 2012 Health Care Year In Preview

The health care events of 2012 can be properly divided into "Before" and "After": Before the Supreme Court ruling on the Affordable Care Act and President Obama's re-election and After. Before these two events, the viability...more

Who is Committing Healthcare Fraud?

The financial recoveries for healthcare fraud are staggering. The Justice Department and Health and Human Services (Office of Inspector General (“OIG”) and Centers for Medicare and Medicaid Services (“CMS”)) regularly...more

Targeting Healthcare Fraud by Data Mining

The Department of Justice continues to trumpet its healthcare fraud program. Just last week, the Justice Department and HHS announced another nationwide sweep resulting in the arrest of 91 individuals....more

Healthcare Prosecutions for Failures to Return Overpayments

Sometimes the deck is stacked against you. No matter what you do and how hard you try, you will lose. In the healthcare area, hospitals, doctors and other service providers have to feel the frustration when it comes...more

Government Teams with Insurance Companies to Combat Healthcare Fraud

At Ashley D. Adams, PLC, we have a well-established track record of success in false claim cases that can make a difference. For both organization defending against false claims charges and individuals pursuing qui tam...more

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