Health Management Associates allegedly billed government healthcare programs for inpatient services that should have been billed as outpatient or observation, paid physicians for patient referrals and submitted inflated claims for ER facility fees.
The once-heralded blood-testing startup Theranos is shutting down, according to a media report. Theranos was unable to sell itself and is now looking to pay unsecured creditors its remaining cash of about $5 million in the upcoming months.
CMS Administrator Seema Verma last week said that her agency is working closely with states, the Government Accountability Office and HHS' Office of Inspector General to root out fraud in Medicaid.
The U.S. comptroller general urged a Senate panel to tighten oversight of Medicaid providers and managed-care plans, and criticized the Obama administration's lax auditing of Medicaid insurers as millions joined the rolls through expansion.
Providence Health and Services has been sued by a data analysis firm that claimed the 50-hospital system pushed its doctors to add complications or comorbidities to treatment documents so they could get higher Medicare reimbursement.
Regulators and insurance experts worry the Trump administration's new rule expanding association health plans will spark a surge of insurance fraud and insolvencies that plagued consumers and healthcare providers in the past.
Federal prosecutors indicted Elizabeth Holmes for allegedly defrauding investors, doctors and the public as the head of the once-heralded blood-testing startup Theranos. Federal prosecutors also brought charges against the company's former second-in-command.
The U.S. Justice Department charged a former investigator for health insurer Anthem Blue Cross, a physician and three others for submitting false claims to insurers.
A doctor, a patient recruiter and four pharmacists in metro Detroit have been indicted on charges ranging from the unlawful overprescribing of opioids to healthcare fraud.
Prosecutors say a 43-year-old New Jersey man and others used The Good Samaritans of America and offers of free ice cream to gain access to low-income senior housing complexes and convince them to submit to unnecessary genetic testing.
Elizabeth Holmes, a Stanford University dropout once billed as the "next Steve Jobs," has forfeited control of Theranos, the blood testing startup she founded, and will pay $500,000 to settle charges that she oversaw a "massive fraud."
The two largest healthcare payers plan to work together to curb fraud and abuse within their networks in a rare collaboration.