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Medicare Whistleblower Insight: Reporting Healthcare …

Experts estimate that up to 10% of all healthcare spending results from false claims. That amounts to tens of billions of dollars a year in fraudulent billings to Medicare and other government healthcare progr… See more

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URL: https://constantinecannon.com/practice/whistleblower/whistleblower-types/healthcare-fraud/

Managed Care Risk Adjustment Enforcement Continues with …

WebSutter Health will pay the Government $90 million under the False Claims Act for allegedly submitting inaccurate and unsupported medical information on tens of …

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New York Doctor Indicted for $20.7 Million in Medicare Fraud and

WebOn February 21, 2024, a federal grand jury in New Jersey indicted Dr. Alexander Baldonado, of Queens, New York, for his alleged involvement in a complex health care fraud and …

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Top Ten Healthcare False Claims Act Recoveries for 2023

WebThe county organized health system that contracts for health care services under California’s Medicaid program and three health care providers agreed to pay $68 …

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Electronic Health Records (EHR) Fraud

WebAn electronic health record (EHR) is a digital version of a patient’s chart. The systems, in theory, allow for real-time sharing of patient-centered records including histories, orders, prescriptions, lab and imaging …

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Healthcare Fraud also Harms Private Insurers

WebRecent Private Health Insurance Fraud Cases. Forest Park Medical Center On April 10, 2019, seven individuals, including four doctors, were convicted for their roles …

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Medical Billing Fraud

WebUpcoding Fraud. Upcoding is a kind of medical billing fraud that occurs when a provider sends a bill to Medicare or another payor for a more expensive service than the one actually performed. For example, the …

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Nurse Practitioner Convicted in $200 Million Medicare Fraud Scheme

WebPosted September 28, 2023. In a landmark healthcare fraud case, a federal jury in Miami has convicted a nurse practitioner $200 million for her central role in a massive Medicare …

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Catch of the Week: NextGen Healthcare

WebThis week’s Department of Justice (DOJ) Catch of the Week goes to electronic health record (EHR) technology vendor NextGen Healthcare Inc.. Today, DOJ …

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Top Ten Healthcare Fraud Recoveries of 2020

WebHere are the top ten healthcare recoveries of 2020 by the numbers: Purdue – In October, the creator and distributor of oxycontin, the world’s most lucrative opioid, agreed to a blockbuster $8.3 billion …

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Medically Unnecessary Services Healthcare Fraud

WebMedically Unnecessary Services. Government-funded healthcare programs will only pay for services, supplies or equipment that are reasonable and necessary for the diagnosis or …

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Home Health Care and Hospice Fraud

WebHome health care has long been recognized as vulnerable to fraud, waste, and abuse. In 2015, Medicare reimbursed more than 11,000 home health care agencies approximately …

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Community Health Network Pays $345 Million to Settle Stark Law …

WebCommunity Health Network Inc., based in Indianapolis, recently settled with the U.S. government for $345 million, addressing allegations under the False Claims Act …

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Hospital Fraud Whistleblower Lawyers

WebWhistleblowers have played a critical role in reporting hospital fraud under the False Claims Act and other whistleblower laws. A whistleblower may have information about hospital …

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Top Ten False Claims Act Recoveries in 2023

WebHere is our listing of the Top-10 False Claims Act recoveries for 2023, which alone totaled nearly $1.8 billion. And once again, Constantine Cannon made the Top-10 …

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Anti-Kickback Statute and Stark Law

WebThe Anti-Kickback Statute. The Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), covers a broader range of activity than the Stark Law, and extends to all medical providers in a …

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Pharmaceutical Fraud – The Common Types Reported by …

WebSome of the more common types of fraud occurring under the Medicare Part D program include: Billing for drugs not actually provided. Billing for drugs not covered by Medicare. …

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Banner Health Agrees to Pay $18 Million to Settle Whistleblower …

WebBanner Health has agreed to pay over $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by …

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Plaintiff Class Appeals Antitrust Decision in Sutter Health Case

WebToday, the Plaintiffs in an antitrust case entitled Sidibe et al. v. Sutter Health are announcing their decision to appeal the Final Judgment entered in that case. The suit …

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Health Quest Systems and Putnam Hospital Center

WebHealth Quest will pay $895,427 to the State of New York to address its misconduct’s impact on the New York State Medicaid program. In addition, Health Quest …

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