Anti-Fraud Coalition Calls on Congress for Medicare Reforms

A national coalition of organizations advocating healthcare fraud prevention called on Congress this week to implement program integrity reforms to further protect America’s seniors from fraud and abuse. Fight Fraud First! (FFF!) is an collaborative effort on behalf of seniors, persons with disabilities, military veterans and family members to advocate for the elimination of waste, […]

State Medicaid Fraud Crackdowns Now Qualify for Federal Funds

State Medicaid fraud prevention programs now have the ability to receive federal funding to identify fraud through data mining, according to a new final rule from the Office of the Inspector General of the Department of Health and Human Services. The new rule amends a provision in HHS regulations that barred state Medicaid Fraud Control […]

Industry Leaders Called to Zero-In on Suspected Home Health Fraud

On the heels of an announcement yesterday that nearly 100 individuals have defrauded the government for $223 million in Medicare fraud, home health leaders are calling for a more targeted approach to zero-in on suspected areas within their industry. “The government’s own data show that abusive billing practices in home health occur in isolated parts […]

Strike Force Busts 89 Scammers in Massive Medicare Fraud Takedown

At least three home health agencies were busted in a nationwide Medicare Fraud Strike Force takedown of 89 people in eight cities for their alleged roles in submitting about $223 million in bogus charges to the taxpayer-funded program, the Department of Health and Human Services (HHS) and Department of Justice announced on Tuesday.  The indictments […]

Patient Recruiter Sentenced in $20 Million Home Health Kickback Scheme

The former patient recruiter for a Miami home health agency charged with $20 million in fraudulent Medicare billing has been sentenced to 37 months in prison and has been ordered to pay $1.85 million in restitution for his participation in the scheme.  Manuel Lozano pleaded guilty to one count of conspiracy to receive health care […]

Largest For-Profit Hospice Provider Sued by DOJ for Medicare Fraud

Chemed Corporation, the largest for-profit hospice chain in the United States, has been accused of fraudulent Medicare billing for hospice and healthcare services—such as crisis care for a patient who was playing bingo part of the time—the Department of Justice announced on Thursday.  The government’s complaint alleges that Chemed and Vitas Hospice Services LLC, a […]

Detroit Home Heath Employee Pleads Guilty in Medicare Fraud Scheme

An employee of a Detroit home health company pleaded guilty last week for her role in a Medicare fraud conspiracy, according to the Federal Bureau of Investigation (FBI).  Dana Sharma, 30, of Detroit, pleaded guilty before U.S. District Judge Denise Hood in the Eastern District of Michigan to one count of conspiracy to commit health […]

NY Times: Adult Day Centers Blur Medicaid Eligibility

In New York City, adult day care centers provide seniors with community-based services, while simultaneously blurring the line for Medicaid eligibility, according to a New York Times article. To receive the benefits of Medicaid, individuals must be impaired enough to require at least 120 days of help with activities such as walking, bathing and even getting […]

Ohio Man Pleads Guilty to $2.5 Million Home Health Fraud

A man from Orange, Ohio admitted to overfilling Medicaid and Medicare by more than $2.5 million, according to U.S. Attorney Steven M. Dettelbach from the Northern District of Ohio.  Divyesh “David” C. Patel, age 39, pleaded guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud.  Patel […]

Home Healthcare Community Applauds Senate Committee for Medicare Reform Initative

The Partnership for Quality Home Healthcare (PQHH) commended members of the Senate Finance Committee for urging regulators to increase efforts to combat Medicare waste, fraud and abuse.  Senators Orrin Hatch (R-UT), Chuck Grassley (R-IA) and Tom Coburn (R-OK) are urging the Centers for Medicare and Medicaid Services (CMS) to implement a moratorium on the installment […]