fraud
publication date
Payer
GOP Talking Point Holds ACA Is Haunted by 'Phantom' Enrollees, but the Devil's in the Data
The percentage of enrollments without any medical claims was 19% in 2021. That percentage jumped to 35% in 2024. Critics...
Technology
Exactech Will Pay $8M To Settle Lawsuits Over Defective Knee Implant Parts
The settlement resolves two whistleblower lawsuits alleging the Florida company violated the federal False Claims Act.
Payer
An Arm and a Leg: A Wild Health Insurance Hustle
Telemarketer scam signs victims up for fake 'jobs.'
Revenue Cycle
What's Happening with DOJ Investigations into UnitedHealth?
UnitedHealth Group has confirmed it is under investigation by the DOJ. For healthcare leaders, the multiple probes into the payer...
Payer
What Are 'Improper' Medicaid Payments, and Are They as High as a Trump Official Said?
"One out of every $5 or $6 in Medicaid [payments] is improper," said Russell Vought in an interview on CNN?s...
CEO
UnitedHealth Group Facing Criminal Probe for Medicare Fraud
It's the latest concerning development in a tumultuous stretch for the healthcare giant.
CEO
Trump Says He'll Stop Health Care Fraudsters. Last Time, He Let Them Walk.
Trump's history of showing leniency to convicted fraudsters contrasts with his present-day crackdown.
CMO
Pain Clinics Made Millions From 'Unnecessary' Injections Into 'Human Pin Cushions'
Pain MD's injections have been proved in court to be part of a decade-long fraud scheme.
Payer
In Settling Fraud Case, NY Medicare Advantage Insurer, CEO Will Pay up to $100M
Independent Health will make "guaranteed payments" of $34.5 million in installments from 2024 through 2028.
Payer
Anti-Fraud Efforts Meet Real-World Test During ACA Enrollment Period
CMS says its efforts are working, pointing to the 30% drop in complaint casework.
Technology
Are RPM Programs Riddled With Fraud?
Digital health supporters say there?s no evidence of fraud in RPM programs, refuting an OIG report that calls out the...
Payer
HealthSherpa and Insurers Team Up To Curb Unauthorized ACA Enrollment Schemes
HealthSherpa, which has its own sales team, announced the new initiative ? called 'Member Defense Network' ? July 16.