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busted: the top fraud and abuse busts in Q1 2017

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May 23, 2017

Tens of billions of dollars are wasted each year thanks to fraudulent healthcare billing practices, according to the National Health Care Anti-Fraud Association (NHCAA). Exposing the toughest and largest cases often requires close collaboration between health plans, the Department of Justice, the Federal Bureau of Investigation, and the Centers for Medicare & Medicaid Services (CMS).

 

Take a look at some of the top fraud cases that occurred during the first quarter of 2017.

$172 million in prescription cream fraud

Nine South Florida residents received federal prison sentences of up to 15 years for taking part in a $172 million insurance fraud scheme involving prescription creams. Insurance companies paid as much as $31,000 per tube of prescription cream, which was prepared and sold in bulk although the defendants claimed they were prescribed for specific individual patients. The defendants also defrauded TRICARE, the U.S. military’s healthcare program. An additional seven people have pleaded guilty to taking part in the scheme.

$150 million in unnecessary surgeries

A doctor, who has since fled the country, and several of his business associates are among the 12 people indicted for allegedly conspiring to scam insurance companies out of $150 million for unnecessary surgeries. Munir Uwaydah allegedly worked with his associates to convince nearly two dozen victims to have unnecessary surgeries, leaving them with lasting scars or requiring new surgery to repair the damage. A physician’s assistant, who is also charged in the scheme, was the one who actually performed the surgeries, according to prosecutors. The defendants are also accused of fraudulently billing for unnecessary prescriptions and fake MRIs. Uwaydah’s medical license was canceled in 2013.

$70 million in unnecessary tests

The former owner of a healthcare clinic in Brooklyn, New York, has been sentenced to five years in prison related to $70 million in fraudulent claims submitted to Medicaid and Medicare. Victor Lipkin and several others pleaded guilty to recruiting financially disadvantaged and homeless people from soup kitchens and welfare offices to undergo medically unnecessary tests performed by unlicensed personnel, then paying them cash kickbacks. CMS paid out more than $25 million before the scammers were caught.

 

 

 

How does Verscend help payers get ahead of constantly evolving healthcare fraud practices by delivering turnkey allegations to health plans? Get the facts about our Fraud Detection solution. 

read the fact sheet

As director of product marketing, Warren Lesnefsky is responsible for the go-to-market planning and execution of Verscend’s Payment Accuracy and Risk Adjustment solutions. He brings nearly 20 years of healthcare marketing experience in leading cross-functional teams to successfully launch information technologies and analytic services to the payer and provider markets. Prior to joining Verscend in 2015, Warren held various marketing management roles at McKesson Health Solutions with a wide range of responsibilities covering events management, marketing communications, and product marketing. He holds a BA in Marketing from the University of Northern Colorado.

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