In health insurance, abuse of diagnosis is one of the key fraud problems, which damages the interests of insured people. To address this issue, numbers of studies have focused on this topic. This paper develops a healthcare fraud detection approach based on the trustworthiness of doctors to ...
a dozen doctors are among 16 people in michigan and ohio sentenced to prison for a health care fraud that included the distribution of 6.6 million opioid doses and $250 million in false billings. a multi-state network of pain clinics participated in the scheme from 2007 ...
of Las Vegas, Nevada, was convicted by a federal jury of “conspiracy to commit health care fraud and conspiracy to defraud the United States and receive kickbacks.”Apparently, the doctor issued “medically unnecessary” prescriptions to fictitious patients so that he could receive kickba...
Financial fraud against government-funded healthcare programs is a federal offense. Doctors, hospitals, and other health care providers that shirk our nation’s laws and put profits before the health and wellbeing of people can be held accountable for their actions through the False Claims Act. W...
I agree that some doctors run too many tests, but it's probably not fraud if there is sound reasoning behind it. ByfBoyle— On Mar 05, 2014 Is it health care fraud if a doctor uses medical tests that are unnecessary? During my last check up, I mentioned to my doctor that I have ...
1993; Leap 2011; and Sparrow 2000 each deliver comprehensive analyses of healthcare fraud and abuse in the United States. These books are foundational works in the study of healthcare fraud. Jesilow, et al. 1993 looks specifically at how doctors defraud Medicaid (a program that pays for the...
By James D. Ratley, CFE From the President and CEO Death and taxes. Add health care to that short list of certainties. And while you're at it, tack on the word fraud to health care. In May 2012, U.S. authorities charged 107 people, including doctors, nurses and other licensed ...
“It’s OK to question doctors,” Verisk Health's Portice agrees. “The vast majority is in it for humanitarian reasons, but there’s a small subset that are questionable.” Sneed of BCBSA says another form of health-care fraud that is on the rise is medical identity theft. In “a ...
Doctors also might perform medically unnecessary tests or procedures for the purpose of billing the insurance company and collecting the funds. This type of healthcare fraud is covered under the Federal False Claims Act, which states that anyone who intentionally submits a false claim is liable ...
conspiracy to commit health care fraud, and violations of the antikickback statute. Touted by DOJ and HHS as “the largest criminal takedown in the history of the Department of Justice,”1the medical professionals charged included doctors, nurses, and physical therapists. The schemes char...