Friday, February 28, 2020

Fraud Vessels

Blood vessels are tubular structures that carry blood throughout the body to tissues and organs. Veins are blood vessels that carry oxygen-depleted blood toward the heart. A Missouri doctor and his company used veins as a vessel to carry out a healthcare fraud scheme...

Detecting Patterns

Fraud schemes are usually detected when a pattern becomes apparent. Such is the case for a Murfreesboro, Tennessee dentist, who continued to commit healthcare fraud for more than four years by using the same pattern of fraudulent billing practices. The dentist in today’s fraud...

Compounding the Problem

Reimbursement rates for compounded drug prescriptions are high because a lot of work goes into combining and mixing the ingredients of a medication that is made specifically for a patient’s particular needs. These high reimbursement rates are a huge incentive for fraudsters to scam...

Taking the Government on a Ride

The owners of a Columbus, Ohio medical transportation company attempted to take three government agencies on a very costly ride. But, the Medicare and Medicaid programs and the Internal Revenue Service (IRS) put a stop payment on the $3.3 million fare to cover the...

Fraudulent Air

According to the Mayo Clinic, hyperbaric oxygen therapy (HBOT) is used to treat decompression sickness, a hazard of scuba diving. It can also be used to treat serious infections, air bubbles in veins and arteries, and wounds that won’t heal. The owner of a...

Rx for Fraud

A 52-year-old Decatur, Georgia man was recently sentenced to prison for committing healthcare fraud. He defrauded TRICARE and other insurance companies out of more than $6.5 million by using a Pensacola, Florida pharmacy to fill fraudulent prescriptions. While many instances of prescription fraud involve...

Overinflated

A Newton, Massachusetts doctor submitted overinflated claims to Medicare and MassHealth, the Massachusetts Medicaid program, for care he supposedly provided to nursing home patients. The consequences of his overblown actions require him to pay the two government healthcare programs $680,000 to resolve allegations that...

Sticky Situation

Acupuncture, which was developed more than a thousand years ago in China, is an alternative medical practice that uses needles to alleviate pain and nausea or treat chronic health conditions. (For those who do not like needles, physical therapy and chiropractic treatment can also provide...

Loud and Clear

The False Claims Act (FCA) came about in 1863 when Congress became concerned that suppliers serving the Union Army during the Civil War were defrauding the Army. At that time, the FCA required any person who knowingly submitted false claims to the government to pay $2,000...

Deliberate

Medicare and Medicaid beneficiaries who receive home healthcare services are required to use providers approved by the Centers for Medicare and Medicaid Services (CMS). (CMS is explicit on compliance requirements so that beneficiaries receive good healthcare and providers receive payment for their claims in a timely...

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