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Home » Fraud

Fraud in the Spotlight

Submitted by on July 14, 2020 – 2:06 am
Fraud in the Spotlight

Two Pittsburgh residents — and home health employees — have pleaded guilty in federal court to one count each of health care fraud and conspiracy to defraud the Pennsylvania Medicaid program. The conspiracy was carried out by submitting fraudulent claims for services they never provided. Home Health Care News brought this interesting information to our attention in their article, “False Claims and Ghost Employees: $87M Home Health Conspiracy Continues to Unravel.”

The cost of this scheme netted more than $87 million.

Medicare fraud occurs when someone knowingly deceives Medicare to receive payment when they should not, or to receive higher payment than they should. There are many ways this shows up in health care, one of which involves providers billing for a service or equipment that patients never received. About $19 billion (7%) of federal Medicaid dollars were absorbed by improper (pertaining to fraud, abuse, and unintentional slip-ups like paperwork errors) payments.

Melody K. Smith

Sponsored by Access Integrity, delivering advanced technology solutions for full and complete compliant processing of medical transactions to the healthcare industry.

Photo, https://pixabay.com/illustrations/audit-tax-inspection-auditor-3929140/

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