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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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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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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.


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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
CMS Delays Publishing Final Rule On Repaying Medicare Overpayments
February 18
Budget Proposal Seeks to Reduce Appeals Backlog; Hospital Groups Say More Needed
February 18
Rule Includes OIG Recommendations On Disenrolling Ineligible Plan Enrollees
February 18
Medicare, Medicaid Remain Among Government's High-Risk Programs
February 18
Fraudulent Overbilling Cost $272B in 2014; Health Plans Should Weigh Anti-Fraud Tactics
February 18
Lawmakers Split Over Merits of ICD-10 Implementation, Impact on Health Industry
February 18
Medicare Has Made Progress on ICD-10 Transition, Readiness, GAO Report Says
February 18
OIG Says No Sanctions for Providing Free Items in Maternal Health Program
February 18
ACO Proposal Wouldn't Benefit Patients, Advocacy Group Says
February 18
OIG Audit: N.Y. Could Have Saved $8.9M On Medicaid if State Used Competitive Bids
February 18
OIG Report Outlines Corrective Steps From OIS Review of New Mexico Fraud Unit
February 18
Federal Agencies in Connecticut Form Public Corruption Task Force
February 18
Iowa Home Health Company Pays $5.6M to Resolve False Billings Case
February 18
Excluded Provider May Receive Payments For Services Prior to Exclusion, OIG Says
February 18
AstraZeneca Pays $7.9M to Resolve Pharmacy Benefit Kickback Allegations
February 18
Medtronic to Pay $2.8 Million to Settle Whistle-Blower Lawsuit on Spinal Treatment
February 18
Florida Hospital Seeks High Court Review Of Decision That Upheld Damages Award
February 18
Home Health Provider Can Sue Billing Company Over Denied Claims
February 18
Court Strikes Several of Drug Company's FCA Defenses in Medicaid Fraud Case
February 18
Tennessee Hospital Pays $40,000 To Settle Alleged EMTALA Violation
February 18
Physician and Fiancée to Face Kickback Charges Over Spinal Implants
February 18
Testosterone Replacement Therapy Maker To Pay $1.6M in Medicare Fraud Settlement
February 18
U.S. Bars Firms, Execs From Distributing Adulterated, Misbranded Cardio Devices
February 18
7th Cir. Affirms Physician's Conviction For Home Health Referral Kickbacks
February 18
Chicago Psychiatrist Pleads Guilty To Accepting Kickbacks From Drug Firms
February 18
Federal Court Rejects Retaliation Claims Of Employed Hospitalist Under FCA, EMTALA
February 18
Ambulance Company Owner Pleads Guilty in Fraud Scheme
February 18
Couple Convicted in Multi-Million Dollar Health-Care Fraud Scheme
February 18
Texas Medical Supply Company Owner Gets 87 Months for Wheelchair Fraud
February 18
New York City HR Employee Sentenced To 63 Months in Medicaid Check Scheme
February 18
New Jersey Doctor Admits to Role In $100 Million Lab Kickback Case
February 18
Device Maker Pays $1.25 Million To Settle Lawsuit Over Medicare Billing
February 18
Oklahoma Hospice Provider to Pay $4 Million to Settle False Claims Allegations
February 18
Home Health Owner, Recruiter Sentenced In $6 Million Medicare Scam in Miami
February 18
Florida Doctor Accused of Faking Diagnoses for MA Higher Capitation Rates
February 18
Clinic Owners Sentenced for Fake Prescriptions in $8.5M Home Health Scam
February 18
Miami Home Health Owner Pleads Guilty in $6.9 Million Medicare Scam
February 18
Jury Convicts Unlicensed Physician Said To Be Part of $4.7M Medicare Fraud Scheme
February 18
Two Michigan Doctors Plead Guilty To Narcotics, Health Fraud Charges
February 18
Court Rejects Challenge to DAB Refusal To Accept Untimely Overpayment Appeal
February 18
Ambulance Company Manager Sentenced For $5.5 Million Medicare Fraud Scheme
February 18
Appellate Division Affirms ALJ Decision Holding Hospital Ineligible for CAH Status
February 18
ALJ Affirms Revocation of Supplier's Billing Privileges Over On-Site Inspection
February 18
Four Texans Arrested for Conspiring To Commit Health Care Fraud, Money Laundering
February 18
California Regulators Fine 10 Hospitals A Total of $700,000 for Harmful Errors
February 18
Conviction of Iowa Provider Affirmed For Falsifying Care Records to Medicaid
February 18
California Surgical Center May Not Enforce Alleged Oral Contract With Insurance Carrier
February 18
List of HHS OIG Audit and Inspection Reports
February 18
HHS OIG Program Exclusions
February 18
New CMS Enrollment and Revocation Regulations: Are We Charting the Unknown?
February 18
CONFERENCES
February 18
CMS Administrator Tavenner Will Leave Post in February
January 21
CMS Should Reduce Incentives for Hospices Targeting Assisted Living Facilities, OIG Says
January 21
Medicare Incorrectly Paid $4.6M To Hospitals for Clinic Visits, OIG Says
January 21
Award of DME Recovery Audit Contract Leads to Protest From Another RAC
January 21
CMS Imposes $164,600 Penalty On Oregon Medicare Plan After Audit
January 21
High Court Skeptical of Perpetual FCA Tolling Amid Sharp Questions to Relator's Counsel
January 21
Alleged Rx Kickback Scheme Defendants Win Slight Victory on Public Disclosure Issue
January 21
FCA Action Against Pharmacy Survives On Discount Drug Overbilling Allegations
January 21
District Court in California Denies Motion To Dismiss in False Claims Retaliation Case
January 21
Five States Complete $22.5 Million Settlement, as Part of Larger DaVita Deal
January 21
Daiichi Sankyo Settles Lawsuit Alleging Illegal Physician Kickbacks
January 21
Third Circuit Says Medical Director In ‘Position of Trust' for Sentencing
January 21
Miami Home Health Agency Owner Pleads Guilty in Medicare Scheme
January 21
Court Grants Preliminary Approval of Plan To Reorganize Nursing Home in Bankruptcy
January 21
Drug Company to Pay $2.1 Million To Resolve NIH Contract Allegations
January 21
Federal Court Rejects FCA as Basis for Claim For Damages From Health System for Breach
January 21
Medical College Pays $840,000 To Settle Improper Billing Allegations
January 21
Physician Owners of Mental Health Clinic Sentenced in $97M Medicare Fraud Scheme
January 21
Missouri Podiatrist Pleads Guilty To Submitting Fraudulent Claims
January 21
Home Health Care Agency Owner, Spouse Sentenced for $1.5M Medicaid Fraud
January 21
Court Rejects Gilead FCA Case Based on FDA Drug Quality Violations
January 21
Urgent Care Company Settles FCA Lawsuits, Agrees to Restrict Services
January 21
Michigan Physician Sentenced to 15 Months In $2.1 Million Medicare Fraud Case
January 21
Humana Will Pay $162K to Resolve Missouri Insurance Enforcement Action
January 21
New York Physicians to Refund Patient Copays Due to Claims Processing Error
January 21
New York Medicaid Program Overpaid $1M In Pharmacy Claims, State Comptroller Says
January 21
Listing
January 21
List of HHS OIG Audit and Inspection Reports
January 21
Compliance Corner: Long-Term Care and the OIG Work Plan: As HHS Sharpens its Focus, Providers Should Set Their Sights on Compliance
January 21
CONFERENCES
January 21