We have all heard the terms”health care fraud” and “health care abuse,” and most people realize it’s become a national issue that affects everyone, either directly or indirectly. There are any number of estimates made on an annual basis as to how much money is truly lost to fraud and abuse in the U.S.Regardless of […]
Health Care Fraud and Abuse: What Is It and How Can We Slow It Down? Read More »
CMS contracts with Medicare Advantage plans and private prescription drug plans to offer Part C and Part D managed care benefits to eligible beneficiaries. Federal law prohibits Medicare payments for services provided or prescriptions written by individuals or entities who are excluded from Federal health care programs when the plans know or have reason to know of the
In the News: Ineligible Providers in Medicare Part C and Part D Read More »
In response to the COVID-19 pandemic, CMS implemented waivers and flexibilities that allowed Medicare beneficiaries to access a wider range of telehealth services without having to travel to a health care facility. We will analyze providers’ billing patterns for telehealth services. We will also describe key characteristics of providers that may pose a program integrity risk
Unfortunately, natural disasters represent a prime time for fraudsters to strike – with their multitude of schemes and scams – and during the period when people are likely most vulnerable. During these times, most people aren’t thinking about fraud. Government agencies aren’t either. Their primary focus is onhelping people, as opposed to stopping fraudsters from
The 10 Most Common Fraud Schemes That Have Arose from COVID-19 Read More »
Since the advent of COVID-19, criminals across the globe have been exploiting the virus via a multitude of fraud schemes. This has come to the attention of the FBI and other federal law enforcement agencies, including HHS/OIG. Sadly, this fraud is so rampant that a recent report found that over $175,000,000 has already been scammed
COVID-19 Fraud: Schemes Being Perpetrated and Their True Costs to the United States Read More »
With the advent of the current and ever-growing opioid crisis across the United States we are seeing more than 115 Americans die every day, this according to the National Institute on Drug Abuse. These deaths are solely related to overdoses stemming from misuse and strong addictions to opioids. Opioids are simply a narcotic pain medication
Pill mills and the Opioid Crisis Read More »
One health care fraud and abuse scheme that is incredibly common but not at the top of the list of schemes discussed relates to ambulance and transportation. Health insurance carriers, health plans, Medicare and Medicaid will reimburse for services associated with the transportation of patients and members when medically necessary. Medicaid and Medicaid health plans
Health Care Ambulance and Transportation Fraud & Abuse Read More »
We have all heard the terms health care fraud and abuse and most realize it is a national issue affecting everyone, directly or indirectly. There is any number of estimates made on an annual basis as to how much money is truly lost to fraud and abuse in the U.S. Regardless of the source, the
Health Care Fraud and Abuse—What is it and How can we slow it down? Read More »
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