Whistleblower News

About a third of Americans who make it to their 65th birthdays will need nursing home care, according to the U.S. Department of Health and Human Services. In 2021, Medicare spent $92.6 billion on skilled nursing facility care and home health services.Unfortunately, nursing home fraud is particularly problematic in facilities where vulnerable patients live away from loved ones. When care is motivated by financial gain, it also puts patients’ lives at risk. Both the state and federal … [Read more...]

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, Medicare Part C fraud is on the rise as well. False Claims Act Cases Against Top Medicare Advantage Providers According to a New York Times report, the Department of Justice and whistleblowers have pursued False Claims Act cases against … [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 government 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.What the GAO Estimate Found According to GAO statistics, confirmed fraud in fiscal years 2018 to 2022 ranged from $4.41 billion to $7.31 billion … [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, including lessons about cybersecurity fraud and the whistleblowers who expose it.What the Change Healthcare Attack Exposed 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 … [Read more...]