Healthcare

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What Does Fraud in the Medicare Advantage Space Mean for the Reverse False Claims Provision?

As the percentage of Medicare and Medicaid beneficiaries in managed care increases, there is a risk that fraudsters will misrepresent Medical Loss Ratios to the government.

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Open Enrollment for Medicare Advantage Plans is Not Open Season for Fraud

The Department of Justice and whistleblowers have pursued False Claims Act cases against at least half of the top ten Medicare Part C providers.

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A Tradition of Fraud Persists in New Types of Medicare Delivery Models

Unscrupulous medical providers, hospitals, and drug manufacturers, can and do defraud Medicare Advantage plans in the same ways they defraud “traditional” Medicare.

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How the Inflation Reduction Act’s Medicare Provisions Will Combat Drug Pricing Fraud

If the IRA’s new Medicare provisions had been in place when the case against Eli Lilly was filed in 2014, many more taxpayer funds may have been recovered.

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One Year’s Tax Revenue is Another Year’s Purchases of Drugs and Biologics

Nearly 70 percent of U.S. adults aged 40-79 used at least one prescription drug in 2019. In this blog, we explore the prevalence of fraud in the pharmaceutical industry.

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Medical Devices Present Opportunities for Fraud, but Whistleblowers Are Fighting Back

In a single year, Medicare paid $13.5 billion for durable and single-use medical equipment, creating a big target for fraud.

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Paycheck Protection Program Fraud: All Cannot Be Forgiven

Estimates say more money has been lost through this program than thirty four years of False Claims Act Litigation has recovered.

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Private Equity Investment in Healthcare is Skyrocketing; Grandma Should Be Scared

Between 2010 and 2019, private equity deals in healthcare nearly tripled in value—from $43 billion to $124 billion—totaling $750 billion over the last decade.

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There’s Billions in “Other” Frauds Outside of Healthcare and Defense Contracting

While healthcare and defense spending take up a large portion of the US budget, we're taking a look at the $4 trillion, or 55 percent of "Other" spending.

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Whistleblowers Can Defeat Medicare Advantage Fraud

Whistleblowers, such as medical coders, providers, and employees of Medicare Advantage plans, have already had success in reporting fraud.