The Centers for Medicare & Medicaid Services (CMS) has issued a final rule focusing on new safeguards to reduce Medicare fraud. The new rule gives CMS the "ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare."
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December has been a month filled with pharmacy fraud arrests, convictions and court cases. Phramacy fraud activity and allegations involving repackaged drugs, alleged kickbacks, along with whistleblower award litigation, were reported in Ohio, Maryland, Michigan, Illinois and California.
As insurers look for ways to fight healthcare fraud and identity theft, one insurance company is turning to automated alert system to offer real time identity theft monitoring and fraud resolution for its beneficiaries. That's why Moda Health is incorporating an alert system developed by ID Experts into its plans as a way to help members identify false claims.
Remember Florida Healthcare Plus, the managed care company that looked like it had a shot at redemption following an FBI raid and fraud arrests? Turns out that won't be the case.
Miami certified nursing assistant Rodolfo Santaya, 55, was sentenced to more than 12 years in prison for his involvement in the largest mental health scam in U.S. history. The scheme totaled nearly $200 million in fraudulent Medicare payments.
Senate Finance Committee Ranking Member Orrin Hatch (R-Utah) and House Ways and Means Subcommittee on Social Security Chairman Sam Johnson (R-Texas) have calld out the discrepancies between Medicare fraud prevention efforts and the lack thereof at the Social Security Administration.
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There's no room for doubt that the healthcare industry needs to improve patient safety, Robert Wachter, M.D., told the audience at the Institute for Healthcare Improvement's recent forum on the issue--and he has a few ideas about how to go about it.
At a time when standalone hospitals feel pus hed to form alliances to survive, one California provider has thrived without sacrificing its independence, accord ing to MedCity News.