In CMS
Sep 19th, 2019
Proactive rule seeks to curb fraud and abuse against vitally important federal health care programs. The Centers for Medicare & Medicaid Services (CMS) issued a final rule earlier this month that strengthens their ability to stop fraud before it happens by keeping unscrupulous providers out of our federal health insurance programs. This first-of-its-kind action changes ...
May 23rd, 2018
In what reads like a cheesy TV script, a McAllen-area, Texas physician is being charged of healthcare fraud and abuse by abusing patients and money laundering by the Department of Justice (DOJ) to the tune of $240 million. Jorge Zamora-Quesada faces a seven-count Grand Jury indictment alleging he and his co-conspirators “orchestrated a massive fraud scheme that jeopardized ...
In Audit
Jul 10th, 2017
A Detroit-area medical biller was recently sentenced to 50 months in prison for helping with a $7.3 million Medicare and Medicaid fraud scheme where services were billed but not rendered. Dawn Bentley, 56, of Oakland County, Michigan, was also ordered to pay $3,253,107 in restitution with her co-defendants for one count of conspiracy to commit ...
Jan 26th, 2016
Two recent cases from Georgia demonstrate that organizations must not ignore—and certainly shouldn’t fire (as a knee-jerk reaction)—employees who raise compliance concerns and who are protected by the False Claims Act (FCA). In one case, HCA Holdings, Inc., (HCA) the largest operator of healthcare facilities in the United States, entered into an agreement with the ...
Aug 29th, 2015
By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA Predictive analytics, according to a report in the Government Computer News, is being used to detect fraudulent claims before they are paid. A new system called the Fraud Prevention System (FPS) is one of the “big guns in the government’s battle to reduce improper healthcare ...