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...
A Senate report shows that UnitedHealth Group (UHG), the parent company to the nation's and Arizona's largest Medicare Advantage (MA) insurer, UnitedHealthcare (UHC), is artificially inflating the risk adjustment scores of its MA members in order to achieve higher reimbursement from the Medicare program.
The report is based on 50,000...
Federal prosecutors have charged seven individuals in Arizona in connection with alleged schemes to defraud Medicare and the Arizona Health Care Cost Containment System (AHCCCS) as part of the U.S. Department of Justice’s 2025 National Health Care Fraud Takedown. The coordinated enforcement action includes charges against 324...
A federal jury in Florida convicted Gary Cox, the CEO of Power Mobility Doctor Rx, for his role in operating an internet-based platform that generated false doctors’ orders to defraud Medicare and other federal healthcare benefit programs of more than $1 billion.
Gary Cox, 79, of Maricopa County faces 60 years in prison after being...National News
UnitedHealth Group's tough run continued this week as the Department of Justice has announced yet another investigation into potential criminal allegations that continued the precipitous fall of the company's stock price.
More than half the company's entire market value -- $266 billion -- has been obliterated in the past month, STAT...Arizona News
Tennessee-based Community Health Systems' (CHS) operational practices are the subject of a new investigation by the U.S. Department of Justice (DOJ). The investigation was made public in a Securities and Exchange Commission (SEC) filing.
The filing said that CHS received a Civil Investigative Demand in January and that the company was...National News
The National Association of Accountable Care Organizations (NAACOS), a nonprofit which represents accountable care organizations (ACOs), uncovered a Medicare fraud scheme that may have cost the government $2 billion.
Federal officials are now investigating the fraudulent billing of nearly 406,000 patients for catheters. The Washington...News
Medicare Advantage enrollees who use insulin may not know the insulin cost cap limits all monthly out-of-pocket costs for insulin to $35 -- and that could influence how they select their Medicare Advantage plans during the open enrollment period.
For the current open enrollment period, the insulin cost cap was not factored into the...
The fight between providers and Medicare Advantage (MA) plans over prior authorization is heating up as the American Medical Association (AMA) and the American Hospital Association (AHA) continue their appeals to government agencies to take action against plans.
Last Friday, the American Hospital Association asked the Centers for...
Although day-to-day life in the U.S. has largely moved on from COVID-19, the Biden administration is continuing to pursue coordinated efforts to combat the COVID-19 pandemic and urge Congress to increase funding for antiviral treatments and preparation for future surges.
In Arizona, there were 2,350 new cases of COVID-19 and 99 new...
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...National News
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...
Throughout September and well into October, a large number of Medicare and Medicaid related fraud cases have come to public light. This week, it's time to double back on cases that have stayed in the wings for the past two months.
In late September, the U.S. Department of Justice (DOJ) announced criminal charges for 42 providers...
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) ran an audit on Aetna's Medicare Advantage (MA) business according to parent company CVS Health. The HHS OIG has cracked down on inaccurate adjustment scores submitted by MA plans including Humana and Anthem.
Aetna's MA reimbursement is...Arizona News
Acting United States Attorney Glenn McCormick announced the settlement May 5 after alleging the Phoenix hospital owned by Dignity Health and the neurosurgical practice, which resides on the hospital campus, allegedly billed Medicare for, "certain doubly and triply concurrent and overlapping surgeries."
According to KJZZ, the...Arizona News
An investigation by Bloomberg Law this week uncovered that over $36 billion in interest-free loans from Medicare have gone to companies that have settled on cases accusing them of Medicare or Medicaid fraud in the past.
Healthcare providers could apply for these loans during the pandemic for expected cash flow shortages having to...National News
One of the country's oldest nonprofit health insurance plans allegedly exploited Medicare of millions; Seattle-based Group Health Cooperative was taken to federal court in a whistleblower case.
Filing suit against the health plan is one of the company's former medical billing managers, Teresa Ross, who alleges that Group Health...National News
The U.S. Department of Justice (DOJ) cracked down on 35 individuals found to be tampering with genetic testing reimbursements in a fraudulent Medicare billing scheme totaling $2.1 billion. The defendants were linked to various telemedicine and telemarketing companies as well as cancer genetic testing labs for their participation in the...National News
Arrested include 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings.
CMS official Jonathan Morse said that the “largest contributors” to billing mistakes in standard Medicare were claims from home health...
