Aetna hits South Texas hospital with $120 million kickback lawsuit

Aetna has filed a $120 million kickback lawsuit against North Cypress (Texas) Medical Center and its CEO, Robert A. Behar, M.D., claiming it paid kickbacks to physicians for patient referrals and used other improper billing techniques such as upcoding,

Proactive risk management needed as increased fraud enforcement continues

Increased funding for healthcare fraud and abuse oversight highlights a growing need for healthcare organizations to take a proactive approach to corporate compliance and risk assessment.

Multiple commercial data sources bolster fraud investigations

Applying pattern recognition software to multiple databases offers an efficient and frequently effective way for investigators to root our potential fraud.

DOJ investigating Humana's Medicare Advantage billing process

The Department of Justice has requested information from Humana regarding risk adjustments assigned to Medicare Advantage beneficiaries, according to an annual report the insurance company filed to the Securities and Exchange Commission.

Study: Medical identity theft increased 22 percent since 2013

More than 2 million Americans were victims of medical identity theft in 2014, a 22 percent increase from the previous year, contributing to a gradual upward trend over the past five years, according to a study published by the Medicare Identity Fraud Alliance.


From Our Sister Sites


Nina Pham contracted Ebola during the care she provided to Thomas Eric Duncan at Texas Health Presbyterian Hospital Dallas last year, and is now suing the parent company for the damaged she suffered. 


A former employee Hospital Corporation of America, Inc., the large publicly-traded hospital operator, accused the organization of engaging in unnecessary surgeries in a whistleblower lawsuit, the  Wall Street Journal  has reported.