The push for healthcare providers to adopt electronic health records has been fueled by promises of improved efficiency and usability, greater accessibility to health information, and in some cases, better patient care. Despite multiple warnings from experts, researchers and government agencies, fraud vulnerabilities still exist within current EHR systems, leading to improper billing, and in some cases, brazenly fraudulent records.
Over the course of five years as U.S. Attorney for the Eastern District of Tennessee, Bill Killian collected more than $200 million from healthcare fraud cases alone, and saw five-fold increase in civil claims. However, he argues that healthcare fraud isn't increasing--state and federal agencies are just getting better and detecting it. Following his resignation as U.S. Attorney, FierceHealthPayer: Antifraud spoke with Killian about some of the important healthcare fraud trends and where the government is directing most of its attention.
James Slattery, CEO of Millennium Laboratories, who was once awarded a regional entrepreneur of the year award from Ernst & Young, prided himself on his fast-growing company's culture. But behind the scenes, court documents show that company attorneys warned employees not to be "weasels," and company executives pushed an agenda that ultimately led to a $256 million fraud settlement with the federal government. Through a series of financial tricks, however, Slattery stands to walk away with his pockets lined. Read more...
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Two bills are making their way through the Alaska state Senate with support from lawmakers who say Medicaid fraud is contributing to the state's $4 billion deficit, according to KTVA.com.
Legislators are asking industry stakeholders for input regarding potential changes to. Stark law in light of the ongoing transition towards value-based payments, according to a report by Bloomberg BNA.
Minnesota overpaid as much as $271 million over a five-month period on ineligible beneficiaries within the state's health insurance exchange program, according to a recently released audit.
More than a dozen organizations submitted amicus briefs to the Supreme Court last week, imploring the court to overturn a False Claims Act decision that relies on a broach interpretation of "implied certification," according to case updates on SCOTUSblog.
A prominent physician and former CEO of an Oregon health system says he was fired by the governing board last year for suggesting the provider self-report $10 million in improper Medicare claims, according to The Oregonian,
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A new study examines the role of specific antibiotics in the development of Clostridium difficile infections, a drug-resistant, bacterial "superbug" that now rivals Methicillin-resistant Staphylococcus aureus as the most common and severe infection resistant to antibiotics.
Affordable Care Act marketplace sign-ups for 2016 totaled about 12.7 million people, the federal government announced Thursday, including 9.6 million who enrolled through Healthcare.gov and 3.1 million through state exchanges.