Monday, March 8, 2021

Entitled

The federal government has a number of entitlement programs that provide beneficiaries with funds for which they qualify. It has been argued that people who take advantage of these programs by stealing benefits they are not entitled to receive are part of an...

Fraud Hot Spot

The Miami area is known as the epicenter of home health fraud. This is not surprising due to the large number of elderly Medicare beneficiaries who live in the South Florida region. The Center for Medicaid and Medicare Services (CMS) has determined that a...

Kicking Back

The word ''kickback'' has several meanings. The most common social definition involves relaxing with friends or family, such as in, ''Why don't you come on over and let's kickback and watch a movie.'' Another definition of the word involves unethical behavior, such as when...

Oh My Aching Back

Medicare does not cover the costs of massage therapy; however, it does pay for physical therapy when deemed medically necessary. The operator of several Los Angeles County rehabilitation clinics tried to skirt around Medicare's explicit rules in this area by claiming his patients had...

Taking a Gamble

To participate in Medicare fraud is to take a huge gamble. The odds of winning are not great as a former owner and manager of three Florida home health agencies can testify. The Medicare Strike Force successfully prosecuted him for his role in a...

Divisive Fraud

If you had to list one thing that fraudsters are usually good at, it would be divisiveness. (They usually come up with a deceptive plan to defraud that benefits them, but causes a lot of problems for their victims.) An article published in The...

Dirty Laundry

Everyone has ''dirty laundry'' that they would prefer others not to know about. I'm not talking about grass stains on your whites, but secrets that need to stay ''in the vault'' so to speak. An article in eNews Park Forest discusses how...

Getting Your Head Examined

Partial Hospitalization Programs (PHP) diagnose and treat people, who have mental illness or substance abuse issues. These programs are not classified as inpatient or outpatient services, but something in-between. Patients usually live at home but can commute to a hospital or medical...

Guest Writer: Greg Sullivan

Using metadata to detect widespread healthcare fraud: a Massachusetts example When I served as state inspector general of Massachusetts, I saw first-hand the value of using sophisticated metadata systems to stop wide-spread health care fraud. When it comes to preventing and detecting fraud, states like...

Taking A Chance

The patients received kickbacks for visiting the clinics where they took sleep and stress tests that were administered by unlicensed and unsupervised personnel. (So people who didn’t know what they were doing gave tests that were not needed. That’s a bit scary.) The two...

Get Your Fraud Fix!

Five days a week wake up to the most current fraud article in your mailbox.