Medicare Advantage, also known as Medicare Part C, has become the country’s largest taxpayer-funded health insurance program with more than 31 million participants. But as annual expenditures for the program have tripled over the past decade to $450 million, fraud is on the rise as well.  According to a New York Times report, the Department of Justice and whistleblowers have pursued False Claims Act cases against at least half of the top 10 Medicare Advantage providers. Also, the U.S. … [Read more...]

The nonpartisan U.S. Government Accountability Office, in a first-of-its-kind report, has produced an estimate of how much money the federal government is losing each year to fraud. It’s not only a staggering figure — $233 billion to $521 billion annually — but of even greater concern is the amount of undetected fraud in that estimate. According to GAO statistics, confirmed fraud in fiscal years 2018 to 2022 ranged from $4.41 billion to $7.31 billion annually, a fraction of the GAO’s annual … [Read more...]

As the Department of Justice’s annual False Claims Act report shows, Medicaid fraud comprises a significant portion of all the frauds against the federal government each year. In fiscal year 2023, the DOJ reported $2.68 billion in FCA settlements and judgments. Almost half that, $1.2 billion, was recovered from Medicaid provider fraud and patient abuse or neglect. And because California’s Medicaid program, Medi-Cal, is exponentially larger than in most other states, it’s a big target for … [Read more...]

Weeks after a cyberattack on UnitedHeath Group’s Change Healthcare unit crippled the processing of medical claims and prescriptions nationwide — and potentially exposed patient data — some lessons have emerged. First, the federal government and industry executives have known for years that the U.S. healthcare system was vulnerable to hacking, according to The Washington Post, but failed to make improvements that could stop attacks. Ransomware gangs like “Blackcat” (also known as ALPHV) that … [Read more...]