Arizona's sweeping crackdown on Medicaid fraud continues to produce criminal convictions and measurable declines in suspicious billing activity, nearly three years after state officials first exposed the sober living home scandal that exploited vulnerable Native Americans and cost Arizona's Medicaid program billions of dollars.
The...Arizona News
A new federal healthcare fraud task force will tackle Medicare and Medicaid fraud on the West Coast, including states like Arizona and Nevada, in addition to California.
The Centers for Medicare and Medicaid Services (CMS) has a new data analytics system that will be deployed with the "West Coast Health Care Fraud Strike Force" to...National News
The effort, branded the Comprehensive Regulations to Uncover Suspicious Healthcare initiative, or CRUSH, was introduced at the White House by Vice President J.D. Vance, Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz as part of a broader strategy aimed...Arizona News
Arizona is getting assistance from the federal government in its ongoing effort to clean up fraudulent activity in the tribal health sector. The U.S. Attorney's Office for the District of Arizona has charged the CEO of Apache Behavioral Health Services (ABHS) and a co-conspirator on embezzlement, wire fraud and conspiracy charges.
The...Arizona News
The United States alleged that the home health agency operator Bayada purchased two of Watermark’s properties in Arizona to induce referrals of Medicare beneficiaries. A former Bayada executive earned about $3.8M for blowing the whistle.
Based in Tucson, Watermark manages 79 senior retirement homes but the scheme was designed around...National News
Throughout 2021, The Department of Justice (DOJ) cracked down on healthcare fraud, with special emphasis on fraud related to Medicare and Medicaid. As the population ages, Medicare Advantage plans have increased in popularity, leading to a direct increase in Medicare related fraud. The Department of Justice’s focus on healthcare fraud...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced proposed payment policy changes for the Medicare Advantage and Part D programs for Calendar Year (CY) 2023. The proposal includes a 7.98% payment increase and health equity provisions for MA participation, for example in star ratings.
The advance notice was...
On Tuesday, the U.S. Department of Justice announced that it garnered more than $5.6 billion in judgements and settlements from False Claims Act cases, the largest since 2014. Over $5 billion of those claims are related directly to the healthcare industry.
From the DOJ press release:
Health care fraud was once again the leading...Arizona News
In the most recent update from the long list of ongoing scandals associated with Hacienda HealthCare, William J. Timmons, former CEO, has been sentenced to three years of supervised probation and will pay over $700,000 in fines.
Timmons and Joseph O’Malley, the company’s former chief financial officer, were indicted in August...
Across the county, accusations of fraud related to Medicare, Medicaid, and Medicaid Advantage have increased and Arizona has not escaped involvement. While, nationally, complaints against Kaiser Permanente and UnitedHealthcare have been filed or escalated, in Arizona, 27 individuals and business entities have been indicted on criminal...
Several healthcare fraud cases have advanced or resolved this month, including the case of Elizabeth Holmes, who got state lawmakers and Governor Doug Ducey to change Arizona law in 2015 to financially benefit her company.
Holmes goes to trial this week on charges of fraud and conspiracy after she “knowingly misrepresented the...
A federal judge sentenced a Miami mogul to 20 years in prison and $207 million in restitutions for committing what prosecutors are calling the largest healthcare fraud scheme in America’s history.The culprit in this case is 50-year-old Philip Esmores, the mastermind behind a network of nursing homes and healthcare facilities that...Arizona News
Just weeks after five states agreed to pause lawsuits regarding the drug manufacturers role as a catalyst in the opioid epidemic in order to facilitate settlement agreements, the state's Attorney General Mark Brnovich filed a consumer fraud suit against former executives in the company.
Brnovich's lawsuit against Founder and...Arizona News
Last week on Oct. 12, 33-year-old Nicholas White and 60-year-old Jeffrey White, father and son duo pleaded guilty to defrauding Affordable Care Act (ACA) programs out of $27 million across at least 12 states--including Arizona. Both were healthcare professionals out of Twin Peaks, California.
According to the Department of Justice...
