Unfortunately, Medicare, Medicaid, and other government healthcare programs are impacted by fraud. However, we’ve seen a number of successful managed care fraud cases resulting in settlements and whistleblower rewards over the last few years. In managed care, federal and state governments contract private insurers, also known as Managed Care Organizations (MCO), to provide health insurance …
Continue reading “Managed Care: 3 Successful Fraud Cases and Awards”
Managed care fraud is an unfortunate reality that costs the government and taxpayers billions of dollars each year. Managed Care Organizations (MCO) involved in managed care fraud game the system by falsifying patient records and miscoding patient diagnoses in order to qualify for additional funds. This type of fraud takes money away from legitimate government …
Continue reading “Managed Care Fraud: Schemes That Can Lead to FCA Liability”
In July 2022, the Department of Justice (DOJ) announced criminal charges against 36 defendants for committing a variety of alleged schemes to defraud Medicare using telehealth. According to the DOJ, the alleged actions of the defendants led to $1.2 billion in medical fraud, with much of that coming from fraudulent telehealth claims for cardiovascular and …
Continue reading “Rise of Telehealth Fraud in the Healthcare Industry”
Fraud in the healthcare sector continues to be a major concern in the United States. According to the Health Care Fraud and Abuse Control Program Annual Report, healthcare fraud was by far the leading source of the False Claims Act settlements and judgments in 2021. In fact, more than $5 billion of the $5.6 billion …
Continue reading “Top Three Healthcare Fraud and False Claims Recoveries of 2021”
Pharmaceutical fraud exists in many ways. However, one of the most common tactics used in the industry is illegal kickbacks. Kickbacks are anything of value either directly or indirectly offered to a patient or physician that influences their medical decision to use a certain company or product. This action constitutes fraud because it undermines the …
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Healthcare fraud is a costly crime that affects both individuals and businesses alike. Unfortunately, scams like upcoding, double billing, and kickbacks are significant in the industry, costing the nation billions of dollars each year. It can increase taxes, expose people to unnecessary medical procedures and raise insurance premiums. The best way to fight fraud is …
Continue reading “Blowing the Whistle on Healthcare Fraud: What You Need to Know”
The Foreign Corrupt Practice Act, or FCPA, prohibits bribery of foreign officials and physicians to enhance business deals and ensures books and records are properly maintained for full transparency of expenses. The FCPA has an extensive reach that applies to prohibited conduct anywhere in the world. Following a record-setting 2020, the year 2021 saw a …
Continue reading “Three FCPA Enforcement Trends We Saw in 2021”
Billions of dollars are wasted every year due to scams and corruption involving Medicare fraud. In fact, $5 billion of the $5.6 billion total False Claims Act settlements and judgments of 2021 were related primarily to Medicare and Medicaid fraud. When an individual or organization commits Medicare fraud, they take significant resources away from necessary …
The Foreign Corrupt Practices Act (FCPA) was enacted by the U.S. Department of Justice (DOJ) and the Securities Exchange Commission (SEC) to serve a few key anti-bribery and accounting purposes. The U.S. Securities and Exchange Commission (SEC) enforces the law as it applies to market manipulation. In doing so, the SEC protects consumers when individuals …
Continue reading “The Largest SEC Fraud Settlements to Date”
Pharmaceutical fraud exists in many ways. Generally speaking, pharma fraud involves a party (or parties) within the pharmaceutical industry who illegally submit false claims to achieve financial gain from unnecessary services or programs. When individuals or organizations commit these crimes, they often force taxpayers to bear the burden of their wrongdoing Spotting fraud can be …
Continue reading “Seven of the Most Common Fraud Tactics in the Pharma Industry”
