Medicare Advantage, or Part C, was created with the idea that private insurers could provide more cost-effective healthcare than traditional Medicare. But while the program has become popular — it’s the largest taxpayer-funded health insurance … [Read more...]
Government watchdog flags risk-adjusted Medicare Advantage payments
In September, the U.S. Department of Health and Human Services’ Office of Inspector General issued a report raising concerns that some Medicare Advantage companies inappropriately used chart reviews and health risk assessments, or HRAs, to receive … [Read more...]
Keller Grover, Constantine Cannon and Kleiman Rajaram Announce Record $90 Million False Claims Act Whistleblower Settlement with Sutter Health
Sutter Health settles closely watched whistleblower lawsuit alleging it violated the False Claims Act by submitting inaccurate and unsupported medical information on tens of thousands of patients enrolled in Medicare Advantage. SAN FRANCISCO, Aug. … [Read more...]
Five Ways Hospice Providers Use Terminally Ill Patients to Rip Off Taxpayers
Hospice care is the provision of specialized palliative treatment for terminally ill patients, focused not on curing them but making their last days as comfortable as possible. Hospice has gone from a grassroots movement on the outskirts of the U.S. … [Read more...]
Whistleblowers Stop Nursing Home Fraud and Patient Harm – With help from the False Claims Act
Healthcare fraud puts patients’ lives at risk and costs billions of dollars every year. Nursing homes, which house vulnerable patients away from loved ones and the outside world, are especially fertile breeding grounds for healthcare fraud schemes. … [Read more...]
Court embraces use of statistics to hold massive healthcare providers accountable
Healthcare fraud costs Americans as much as $300 billion a year. But uncovering fraud in a healthcare system as sprawling and complex as ours—Medicare alone processes over 1 billion claims annually from over 1 million providers—is like digging for … [Read more...]
Switch to ICD-10 Not A Cure-All For Healthcare Fraud
The World Health Organization is the public health arm of the United Nations. Since 1948, WHO has been responsible for updating the International Classification of Diseases (ICD), a worldwide system for collecting, processing, classifying and … [Read more...]
Inspector General Report Provides Strong Clues on Trends in Healthcare Fraud
The U.S. Department of Health and Human Services (HHS) is the federal agency that runs the Medicare and Medicaid programs. Within the Department, the Office of the Inspector General (OIG) is charged with preventing fraud on the Medicare and Medicaid … [Read more...]