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Health Care Fraud Report

BNA’s Health Care Fraud Report™ is the go-to source for health care fraud reporting, with in-depth information on government and private enforcement actions and strategies designed to fight fraud and abuse.

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Protect your company or clients with inside information on a variety of current fraud and abuse topics, complete with expert analysis.


EXPERT NEWS & COMMENTARY

Track the latest news on pertinent legislative, regulatory, and legal developments at federal and state level, as well as policy changes in the private sector. Follow the latest U.S. Deparment of Health and Human Services (HHS) Office of Inspector General (OIG) Advisory Opinions, fraud alerts, Special Advisory Bulletins, investigations, rules, audit reports, and compliance guidance documents.

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Gain insights from analysis and perspective pieces by recognized experts and other special reports within the fastest growing legal specialties.


POWERFUL RESEARCH FEATURES

Access significant documents, including enforcement actions by state insurance departments, and consult original language to form your own interpretations with the right amount of data and detail on health care fraud and abuse — all in just one manageable, well-organized source.


SPECIFICATIONS

Product Structure 

Notification: current reports providing news and developments

Formats and Frequency

Print and Web notification formats are issued and available bi-weekly. Print current reports are indexed every six months, culminating annually. Web current reports are archived to 01.15.1997. 

Email summaries, providing the highlights and table of contents for each report, with URLs to full-text articles and documents are also available.


RECENT HEADLINES

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HHS Inspector General Warns States May Be Misusing ACA Funds
May 13
New House Bill Seeks to Replace RAC Contingency Fees With Fixed Payment
May 13
Lawmakers Introduce Bill That Would Prohibit Adoption of ICD-10 Codeset
May 13
Appeals Backlog Could Be Reduced By Restructuring Process, Wyden Says
May 13
OIG Says Medigap Deal With PPO, Hospitals Won't Result in Sanctions
May 13
OIG: Medicare Potentially Overpaid Physicians $33.4M Due to Coding Errors
May 13
Physician-Owned Hospital in Texas Asks CMS for Permission to Expand Facility
May 13
OIG: Government Inspections of Generic Drug Manufacturers Improve, but Work Remains
May 13
Patient Care Coordination Test May Expand To Other Medicare Programs, Officials Say
May 13
OMB Reviewing Final Rule On Accountable Care Organizations
May 13
FDA, CMS Officials Outline Efforts to Combat Opioid Abuse
May 13
16 Hospitals to Pay $15.7 Million To Resolve False Claims Act Allegations
May 13
Safety Scorecard Records Little Progress By Hospitals to Prevent Errors, Accidents
May 13
Health-Care Cyberattacks Now Most Prevalent Source of Breaches, Study Says
May 13
High Court Denies Hospital's Bid for Review Of Decision That Upheld Damages Award
May 13
DaVita Prepared to Pay Estimated $495M to Settle False Claims Lawsuit
May 13
Express Scripts Subsidiary to Pay $60M In Settlement for Novartis Kickback Scheme
May 13
Drugmaker Amarin Asks Court to Protect Free Speech Right to Discuss Off-Label Use
May 13
New York City Clinic Owner Convicted Of Running $165M Oxycodone Ring
May 13
Consulate Health Care Can't Block Statistical Sampling in Upcoding Case
May 13
Medicaid Fraud Alleged Against Indiana Transportation Services
May 13
Whistle-Blower Can Withdraw Lawsuit But Can't Hide Court Record From Public
May 13
Two Docs Sentenced for Taking Bribes For Referrals to New Jersey Lab
May 13
Dialysis Care Providers Agree to Pay $1.15M to Resolve Medicare Claims Case
May 13
Split Sixth Circuit Says Evidence Of Prior Medicare Fraud OK at Trial
May 13
CEO Who Admitted to Medical Billing Fraud At Nevada Clinic Sentenced to Year of Prison
May 13
Five Ambulance Companies to Pay $11.5M To End False Claims Act ‘Swapping’ Suit
May 13
DME Supply Company Owner Gets Prison Sentence for $7M Medicare Fraud Scheme
May 13
Miami Doctor Sentenced to Five Years In $5.5M Psychiatric Hospital Billing Scam
May 13
Florida Hospitals to Pay for Alleged Improper Claims for Ambulance Transport
May 13
Doctor, Employee Charged With Defrauding Medicare $5.2M in House Call Fraud Scheme
May 13
Doctor, Group Home Owner Indicted For Alleged Role in $5.2M Medicare Fraud
May 13
North Carolina Pharmacy Company Settles Kickback Allegations for $5M
May 13
Tennessee Hospital to Pay Government $1.3M to Resolve Improper Billing Allegations
May 13
Nebraska Pharmacist Indicted In $2.5 Million Medicaid Fraud Scheme
May 13
One-Year Prison Term for Podiatrist In Missouri Health-Care Fraud Case
May 13
ALJ Sustains Revocation of CLIA Certificate for Sending Testing Samples
May 13
Appellate Division Affirms ALJ Sustainment Of Application Denial Due to Moratorium
May 13
Los Angeles Sues Hospital For Alleged Skid Row ‘Patient Dumping’
May 13
Missouri Home-Health Provider to Pay $120K to Settle Medicaid-Fraud Allegations
May 13
Listing
May 13
List of HHS OIG Audit and Inspection Reports
May 13
HHS OIG Program Exclusions
May 13
As Second Open Payments Release Date Nears, Industry Feels Increased Burdens
May 13
CONFERENCES
May 13
Medicare Physician Pay Legislation Contains Fraud Prevention Provisions
April 29
OIG Guidance for Health-Care Boards Reflects Collaboration, Oversight Expectations
April 29
Health-Care Data a Top Target For Cybercriminals, FBI Official Says
April 29
To Aid Corporate Compliance, DOJ To Be More Transparent in Resolutions
April 29
OIG: Medicaid Fraud Control Units Recovered $300M From Criminal Cases in FY 2014
April 29
OIG: Recommendations Could Have Saved Medicare $251M on Infusion Drug Payments
April 29
OIG to Review Effect of Rising Prices For Generic Drugs on Medicaid Program
April 29
VA Whistle-Blowers Still Face Retaliation, Despite Some Progress, House Panel Told
April 29
CMS Adds Star Ratings For Hospital Compare Website
April 29
Hospitals, Others Prepare for Impact Of Reimbursement Cuts in Physician Bill
April 29
DOJ Sends Subpoena to Seek Exparel Marketing Documents From Pacira
April 29
Georgia Hospital to Pay $20M After Medicare Billing Investigation
April 29
Audit Shows Missouri Didn't Bill Drugmakers For Rebates for Physician-Administered Drugs
April 29
Colorado Paid 800,000 Medicaid Claims With Missing, Invalid Provider IDs, OIG Says
April 29
Smart Card Technology Won't Curb Medicare Fraud, GAO Says
April 29
Consumer Advocates See Privacy Issues In Efforts to Expand Access to Health Data
April 29
OIG EHR Audits are ‘Deep Dive' Into Security Procedures, Attorneys Say
April 29
Pittsburgh Retirement Center Pays $1.3M to Settle False Claims Act Allegations
April 29
Citing OIG Report, Florida Senator Calls for Medicare-Medicaid Rebate Parity
April 29
Former CMS Head Tavenner Joins LifePoint Hospitals Board
April 29
Sixth Circuit Denies Rehearing On FCA Public Disclosure Issue
April 29
Fifth Circuit Restitution Award of $37.7M Against Texas Doctors for Fraud Affirmed
April 29
Government Intervenes in FCA Actions Against ManorCare for Rehab Fraud
April 29
Medtronic Reaches Agreement With DOJ On Manufacturing Standards for Drug Pumps
April 29
Florida Eye Doctor Indicted on Fraud Charges, Billed $190 Million Over Six Years
April 29
U.S. Seizes $1.5M of Unapproved Drugs From Miami Pharma Company
April 29
Florida Home Health Owner Sentenced To Prison Term in $32M Medicare Scam
April 29
Court Levies $169K Attorneys' Fees Award Against FCA ‘Serial Relator'
April 29
Southern California Doctor Charged With $6.5 Million Medicare Fraud Scheme
April 29
Dermatology Business to Pay $3.2M To Settle Improper Referral Claims
April 29
Texas Doctor Sentenced to Prison For Health Fraud, Identity Theft Scheme
April 29
Texas Hospital to Pay $22M to Settle Charges It Paid Docs for Referrals
April 29
Texas Couple Convicted of Fraud Given Prison Sentence, Restitution
April 29
HealthSpring Subsidiary Defeats FCA Retaliation Lawsuit
April 29
Physician Involved in Medicare Fraud Pleads Guilty to $56M Home Health Scheme
April 29
Home Care Agency Owner Pleads Guilty in $7M Medicaid Fraud Scheme
April 29
Detroit Health Agency Owners, Operator Sentenced in $29M Medicare Fraud Case
April 29
Detroit Home Health Agency Owner Pleads Guilty in $2.6M Medicare Fraud Scheme
April 29
Psychiatric Hospital Beats FCA Action on Overflow Patient Allegations
April 29
Ten-Year Prison Term Ordered for Operator Of Two Chicago Home Health Firms
April 29
ALJ Sustains Revocation Because IDTF Not Operational
April 29
Appellate Division Remands Case To Consider All Hardship Evidence
April 29
Massachusetts Health System Pays $1.75M to Settle Medicaid Billing Claims
April 29
New York Comptroller Identifies Widespread Improper Payments, Medicaid Overpayments
April 29
Georgia Hospital Pays $2.95M To Settle State Medicaid Billing Allegations
April 29
Former Hospital CEO Hits Law Firms, ‘Non-Patients' With $30 Million Lawsuit
April 29
Listing
April 29
List of HHS OIG Audit and Inspection Reports
April 29
CONFERENCES
April 29
OIG Reviewing How States Are Coping With Medicaid Expansion, Official Says
April 1
CMS Might Be Waiting on N.Y. Court Ruling In Delay of 60-Day Overpayment Final Rule
April 1
Federal Anti-Fraud Efforts Recovered $3.3 Billion in FY 2014, Report Says
April 1
OIG Says Exclusive Lab Referral Proposal Could Implicate Anti-Kickback Law Sanctions
April 1
DOJ's Western Michigan District Announces Hospital Settlement, Says Fraud a Priority
April 1
Bipartisan Group Introduces Bill in Senate To Cut Down on Medicare, Medicaid Fraud
April 1
Roughly 1,100 Large Data Breaches Since September 2009, HHS Official Says
April 1
Lawmakers Dismayed Over High Medicare Improper Payments Rate
April 1
SGR Bill Seeks OIG Report on Fraud Risks Of Alternative Medicare Payment Methods
April 1
Report: Delaying Claims Repayment Until After ALJ Hearing Would Save CMS Millions
April 1
Lab Testing Company HDL Says Settlement With DOJ Imminent
April 1
Florida Dermatologist to Pay $788,000 To Settle Improper Billing Allegations
April 1
Cardiac Device Company to Pay $6.4M To Settle Federal Overbilling Allegations
April 1
Maryland Incorrectly Allocated $28M In Costs to Insurance Exchange, OIG Says
April 1
Biomet Says Regulators Extend Monitoring Amid Zimmer Takeover
April 1
Health Plan Must Defend FCA Action Filed By Salesman Alleging Marketing Fraud
April 1
Florida Hospital Group to Pay $5.4M to Settle False Claims Suit
April 1
Three Execs of Bankrupt Hospital Convicted on Kickback Counts
April 1
Court Dismisses Relators' Suits Alleging Novartis, Genentech Violated FCA Over Xolair
April 1
Pharmacist's FCA Suit Alleges Fraud In Walgreens' Medicare, Medicaid Claims
April 1
Fifth Circuit: Process Matters In Health-Care Conviction Appeal
April 1
No Kickback Motive in Hospital's Emergency Physician On-Call Contracts
April 1
First Circuit Reinstates FCA Action Against Psychiatric Facility for Unlicensed Treatment
April 1
Supreme Court Denies Petition From California Counties Seeking Medicare Funds
April 1
Medicare Re-Enrollment Review Separate From OIG Exclusionary Sanctions Decision
April 1
Second Circuit Affirms Doctor's Conviction For Health Care Fraud, False Pension Reports
April 1
States Receive Shares From Settlement With Daiichi Sankyo on Kickback Charges
April 1
New York Pharmacy Operator Charged With Making $5 Million in False Claims
April 1
Whistle-Blower Alleging Drug Fraud At Dialysis Center Dodges Dismissal
April 1
Hospital's Plea for ALJ Hearing Denied; Courts Say Solution Lies With Congress
April 1
Former DME Supplier Guilty in $3.5M Scheme to Defraud Medicare, Medi-Cal
April 1
California Pharmacist Pleads Guilty To Medicare Part D Fraud Scheme
April 1
Los Angeles Medical Supply Firm Owner Found Guilty in $3.3M Medicare Scam
April 1
Fraud Sentences Reduced For Cooperation With Prosecutors
April 1
New York Pharmacist Given 36 Months, Must Pay $7.5M for Role in Drug Scheme
April 1
Texas Speech Therapist Pleads Guilty In $3.7M Fraudulent Billing Scheme
April 1
Missouri Reaches $5M Fraud Settlement With Medicaid Care-Coordination Contractor
April 1
Physician Pleads Guilty in Medicare Home Health Kickback Scheme
April 1
Hospital Gets FCA Lawsuit Dismissed; Whistle-Blowers Can Try Again
April 1
Appellate Division Sustains Revocation For Failure to Post Hours of Operation
April 1
ALJ Sustains Petitioner's Revocation For Failure to Be Open and Accessible
April 1
New York Issues Compliance Guidance For Medicaid Holding Companies
April 1
AG Charges Physician, Employees In Scheme Involving Unlicensed Services
April 1
New Mexico Medicaid Fraud Bill Fails to Advance
April 1
Estimated $9 Million Due Plan Members In N.Y. Mental Health Parity Settlement
April 1
Jury Convicts New York Clinic Owner Of Running $100M No-Fault Fraud Scheme
April 1
Listing
April 1
List of HHS OIG Audit and Inspection Reports
April 1
Dismissing an Indictment on Appeal: DOJ's Rare Response
April 1
Juggling RACs: Auditors Contend With Old RAC Program While Learning New Rules
April 1
CONFERENCES
April 1
Sandoz to Pay $12.6M in Settlement For Drug Pricing Misrepresentations
March 18
Physician Groups Urge CMS to Develop Contingencies for Potential ICD-10 Failures
March 18
CMS Unveils New ACO Model With More Financial Risk, More Shared Savings
March 18
Senate Bill Would Prevent Full Payment To Medicaid Providers With Tax Liabilities
March 18
ACO Final Rule Should Attract Providers And Ensure Quality, Consultants Say
March 18
Weakened Audits Program Endangers Medicare, Group Representing RACs Says
March 18
Comment Letters Urge OIG to Broaden Gainsharing, Access to Care Safe Harbors
March 18
CMS Action on OIG Recommendations Could Have Saved Billions, Report Says
March 18
OIG: Medicare Could Have Saved $4B By Adjusting Rural Hospital Bed Payments
March 18
Oregon Failed to Collect $3 Million In Medicaid Drug Rebates in 2010, OIG Says
March 18
Patient-Safety Consultant to Pay $1 Million to Settle Kickback Allegations
March 18
SEC Official Says Drug Firm FCPA Violations Involve Three Main Categories of Misconduct
March 18
Home-Health Provider Says Patient Info May Be at Risk Due to 142 Missing Laptops
March 18
California Pharmacy Pays $1 Million To Settle Controlled Substances Violations
March 18
Tennessee Medical Practice Settles Case Involving Unapproved Drug Imports
March 18
Whistle-Blower Can Allege False Claims Occurring After Employment Ended
March 18
Attorney Can't Pursue FCA Action Pro Se Without Retaining Local Counsel
March 18
5th Cir. Upholds Nursing Facility Fine for Rx Violations, Splits With 9th Cir. on ALJ Review
March 18
News Article Nixes FCA Claims Against Drug Company Under Public Disclosure Bar
March 18
FCA Whistle-Blower Runs Afoul Of Bankruptcy Disclosure Rules
March 18
Federal Court Again Rebuffs Effort by SNF To Sue Over Loss of Provider Agreement
March 18
Appeals Court: New RAC Contract Terms Violate Federal Contracting Regulations
March 18
Physician's FCA Upcoding Allegations Against Hospital and Staffing Company Dismissed
March 18
Home Health Agency to Pay $1.1M To Settle Kickback Allegations
March 18
Two Mississippi Women Sentenced In Connection With Hospice Fraud Scheme
March 18
Suburban New York Mental Health Group To Pay $304,000 in Medicaid Settlement
March 18
Two Counselling Clinic Workers Sentenced To Prison for Roles in $2.4M Fraud Scheme
March 18
Appellate Division Affirms ALJ Decision On Violating Fire Prevention Standards
March 18
New York Insurer Pays $400,000 to Cover Anesthesiology Services in Colonoscopies
March 18
New Mexico Senate OKs Bill Defining Medicaid Fraud, Protecting Providers
March 18
Residential Care Facility Owner, Administrator Charged with Elder Abuse
March 18
Georgia Couple Pleads Guilty In $1.4 Million Rehab Therapy Scam
March 18
Behavioral Health Managed Care Company To Pay $900,000 to Resolve Parity Probe
March 18
Eleven Charged in Identity Theft, Fraud Conspiracy Involving MBCBS
March 18
Two Southern California Residents Guilty In $50M Health Insurance Fraud Scheme
March 18
Listing
March 18
List of HHS OIG Audit and Inspection Reports
March 18
HHS OIG Program Exclusions
March 18
CONFERENCES
March 18
CMS Extends Good-Faith Safe Harbor To 2015 for Noncompliant Health Plans
March 4
House Panel Advances Fraud Bill That Would Strip SSNs From Medicare Cards
March 4
CMS Introduces New Program Audit Areas Focusing on Medication, Network Adequacy
March 4
CMS Clarifies Use of ICD-9 Codes for Some Claims Submitted After Conversion Deadline
March 4
CMS Says New ACO Model May Be Unveiled in March
March 4
Hospital Group Asks CMS to Change Short-Stay and RAC Policies
March 4
Pro-Recovery Audit Contractor Group Launches New Website, Changes Name
March 4
OIG Won't Sanction Hospital Network For Discounts Offered to Medigap Plan
March 4
MFCU Investigations Led to $2B In Medicaid Recoveries in FY 2014
March 4
OIG: Insurance Marketplaces a Focus Area For Upcoming Affordable Care Act Reviews
March 4
OIG: CMS Paid $10.7M to Doctors In Debt to CMS for Medicare Overpayments
March 4
Medicare's Drug Substitution Policy Saved $13 Million From 2013-2014, OIG Says
March 4
Skilled Care Facilities Firm Pays $3.5M To Settle Medicare False Billing Charges
March 4
Patient Safety Group to Examine Concerns With EHR Copy and Paste Tools
March 4
DOJ Official Offers Enforcement Insight At Health-Care Competition Workshop
March 4
Consumer Group Warns Hospitals Against Partnerships With Screening Test Company
March 4
Sixth Circuit Reverses Hospital Win Against Whistle-Blower on Public Disclosure
March 4
Hospitalist Company Must Face Government Upcoding Charges
March 4
Medical Practice Wins False Claims Summary Judgment Against Whistle-Blower
March 4
Third Circuit Affirms Dismissal Of Pharmacist's False Claims Case
March 4
11th Circuit Affirms Multiple Convictions For Medicare Fraud, Kickback Operation
March 4
DME Supplier Dealt Blow In Medicare Part B Fraud Litigation
March 4
DOJ Asks Humana to Hand Over Medicare Advantage Data, Risk Policies
March 4
Guilty Plea Submitted in $13.7M Miami Home Health Agency Scheme
March 4
Miami Man Pleads Guilty In $5M DME Medicare Fraud Scheme
March 4
Florida Doctors, Their Wives to Pay Over $1M to Settle Kickback Allegations
March 4
Three Arrested in Connection With Miami Home Health Fraud
March 4
Two Sentenced to Six Years in Prison As Part of $63M Mental Health Scam
March 4
Hospice Company to Pay $6M to Settle U.S., New York False Claims Act Case
March 4
Oklahoma Eye Care Clinic Settles False Medicare, Medicaid Billings Case
March 4
Jury Convicts Two for Roles in $1.6 Million Home Health Agency Medicare Fraud Scheme
March 4
Chief Executive, Pharmacist Plead Guilty To Rebranding, Restocking Medications
March 4
Health Services Company, Rehab Facility To Pay $1M to Settle False Claims Suit
March 4
Psychotherapy Clinic Owner Sentenced To 87 Months for Medicare Fraud Scheme
March 4
Sentencing Including Restitution Announced in Louisiana DME Fraud Case
March 4
Home Nursing Agency Owner Sentenced To 92 Months in Prison for Medicare Scam
March 4
St. Louis Jury Convicts Physician of Billing Medicare, Medicaid for Services Not Provided
March 4
Three in Tennessee Indicted for Paying Kickbacks in Power-Wheelchair Scheme
March 4
Mental Health Counselor Gets Five Years In Prison for Role in $2.4M Medicaid Fraud
March 4
California Regulators Fine 10 Hospitals A Total of $700,000 for Harmful Errors
March 4
Long-Term Care Employees Didn't Breach Duty to Report Suspicion of Elder Abuse
March 4
State AG Announces $150K Health Care Fraud Settlement with In-Home Provider
March 4
Nurse Practitioner Indicted in Alleged $2.2 Million Allergy Testing Scam
March 4
List of HHS OIG Audit and Inspection Reports
March 4
CONFERENCES
March 4