Tag Archives: fraud

Just Following Orders isn’t a Defense to Fraud

A case from North Carolina highlights what we see too often:  healthcare entrepreneurs and providers committing fraud, paying monetary penalties and even facing incarceration. But rarely do we see the penalties travel down the ladder to a company’s employees. A … Read Full Post

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The DOJ Targets MA Plans

The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) reported that a study conducted in 2019 revealed, “Unsupported risk adjusted payments are a major driver of improper payments in the Medicare Advantage (MA) … Read Full Post

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What We’re Reading – Medical identity theft is a growing problem

Nothing seems to be off limits these days. Not only are people stealing identities for financial gain, but also for medical purposes.  In this article, Jim Koenig, director & leader of PwC’s identity theft practice said, “Medical identity theft is … Read Full Post

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Alcohol Abuse vs. Dependence: Is it Fraudulent to Knowingly Soft-Pedal a Diagnosis?

Do you think a provider would chart heart disease for a patient with – say – hypertrophic cardiomyopathy because it’s a ‘warmer, fuzzier’ diagnosis? Or try to scare a patient with metabolic disorder into losing weight by diagnosing her prematurely … Read Full Post

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