Americans Deserve
High-Quality, Affordable Healthcare.
What stands in the way?
The Worst of the Truth
The cost of waste to our healthcare system is up to $935 billion annually
An in-depth look at how Parkview in Indiana “jacked up prices”
193 people charged by DOJ for $2.7B in fraudulent healthcare schemes
Hospital billed payers $1.4B for medically unnecessary laboratory testing
EHR vendor ordered to pay $18.25M to resolve kickback allegations
Billing and Claims
- Registered Nurse and Nurse Practitioner in Rhode Island sentenced for $12M in fraudulent billing scheme
- Two California physicians ordered to pay more than $2.4M for kickbacks
- The University of Washington and other public hospitals routinely settle medical malpractice cases with NDAs. Some legal experts say that needs to stop.
- Former pharmacy owner sentence for role in $11.5M Medicaid fraud scheme
- New York physician pleaded guilty for ordering medically unnecessary brain scans
- New Jersey cardiologists sentenced to nearly 3 years for $1.9M in fraudulent claims
- Michigan pharmacist and brother convicted in $15M billing scheme
- Tennessee pharmacy owners indicted for $8.7M in fraud
- Texas physician gets 10 years in prison for $54M Medicare fraud
- New York doctor pleads guilty to $900K fraud scheme
- Arizona physician sentenced to 2 years for $3.7M in fraud
- Dallas pharmacy owner convicted in $41M fraud scheme
- Hospital upcoding is big business
- Study: Upcoding associated with $14.6B in hospital payments in 2019
- Penn State Health ordered to pay $11.7M to resolve allegations of improper Medicare billing
- New York-Presbyterian Hospital agreed to $800K fine for improper radiology billing
- Cape Cod Hospital paid $24.3M to settle claims it had violated Medicare reimbursement protocols in whistleblower case
- Oroville Hospital in California paid $10.25M to settle kickbacks and false billing allegations
- San Diego physician and medical practice pay $3.8M to settle false claim allegations
- San Diego neurosurgeon charged in $100M insurance fraud case
- 2 charged in $54M Medicare fraud scheme in California
- Louisiana physician indicted in $32.7M Medicare billing scheme
- Texas behavioral health provider indicted for $2M Medicaid fraud
- Delaware physician agrees to pay $1M to settle allegations of ordering medically unnecessary durable medical equipment
- CEO of Massachusetts-based behavioral health company pleads guilty to fraud
- Louisiana lab CFO sentenced for $127M Medicare fraud scheme
- California physician sentenced for $2.8M Medicare fraud scheme
- Montana-based St. Peter’s Health to pay $10.8M to resolve false claims for oncology services
- Ohio physician sentenced for defrauding Medicare and Tricare for $14.6M
- Connecticut therapist pleads guilty to $1.6M in Medicaid fraud
- Kentucky physician sentenced to two years in $14M fraud conviction
- California physician pleads guilty to $3.2M Medicare fraud
- Texas behavioral health providers pay $1.1M to settle Medicare false claims charges
- University of Colorado Health agrees to pay $23M to settle upcoding allegations
- Alaska physician and husband charged with $10M in fraud and tax evasion
- Former Georgia Insurance Commissioner sentenced to more than 3 years for billing insurers over $2.5M in false claims
- Illinois physician pleads guilty to fraud
- Tennessee podiatrist sentenced for defrauding Medicare and Medicaid $4M in reimbursements
- Two New York pharmacy owners sentenced to 14 collective years in $18M Medicare laundering case
- Baylor agrees to pay $15M to settle concurrent billing allegations
- Texas physician convicted in $70M fraud scheme
- Illinois physician sentenced to eight years for more than $1.2M in Medicaid fraud
- California pharmacist sentenced to two years for billing more than $1M in fraudulent claims
- Alabama physician and wife plead guilty to $2.3M fraud scheme
- Massachusetts psychiatrist sentenced in $19M Medicare and insurance fraud scheme
- Twin physicians plead guilty to defrauding payers millions in fraudulent billing
- Massachusetts orthopedic surgeon convicted for role in upcoding scheme
- Arizona physician pleads guilty to $3.7M fraud scheme
- New York/New Jersey pharmacy leaders admit to defrauding payers more than $65M
- Former clinic owner in California convicted for submitting more than $5M in fraudulent claims
- New Jersey counseling center owner pleads guilty to billing insurers for services never provided
- Houston pharmacy CEO convicted for fraudulently billing payers $160M for expensive topical creams
Waste
- 600K patients in Washington State received $282M in unnecessary treatment
- Whistleblower suit filed against MultiCare Health in Washington for medically unnecessary spinal surgeries
- Kentucky lab to pay $10.5M to settle allegations of unnecessary testing in Medicare and Medicaid
- Telemedicine company owner guilty in $110M medically unnecessary durable medical equipment scheme
- National durable medical equipment company to pay $25.5M for continuing to bill federal health programs for equipment no longer used or needed
- Florida call center owner indicted in durable medical equipment kickback scheme costing Medicare $97M
Abuse
- Michigan physician office accused of illegally prescribing controlled substances
Studies
- Detecting Fraud, Waste, and Abuse in Substance Use Disorder Treatment (Health Services Research)
- What Should Health Care Organizations Do to Reduce Billing Fraud and Abuse (AMA Journal of Ethics)
- Combating Fraud in Health Care: An Essential Component of Any Cost Containment Strategy (Health Affairs)
- Reducing Fraud, Waste, and Abuse Through Real-Time AI-Based Screening: Prospective Results in Deployment (NEJM Catalyst)
- Categorizing and Describing the Types of Fraud in Healthcare (Science Direct)
- Eliminating Waste in US Health Care (JAMA Network)
- Health Care Fraud and Abuse: Lessons From One of the Largest Scandals of the 21st Century in the Field of Spine Surgery (Annals of Surgery Open)
- Medicare and Medicaid: Additional Actions Needed to Enhance Program Integrity and Save Billions (GAO)
- Upcoding in Medicare: Where Does It Matter Most? (Health Economics Review)
- Price Increases Versus Upcoding as Drivers of Emergency Department Spending Increases, 2012-19 (Health Affairs)
- Upcoding Linked to Up to Two-Thirds of Growth in Highest-Intensity Hospital Discharges in 5 States, 2011-19 (Health Affairs)
- Better Understanding the Downsides of Low-Value Healthcare Could Reduce Harm (BMJ)
- Health Care Fraud: Physicians as White Collar Criminals? (The Journal of the American Academy of Psychiatry and the Law)
General
- Healthcare fraud and abuse perpetuates health disparities
- Why it’s so tough to reduce unnecessary medical care
- How public hospitals protect doctors by silencing the patients who accuse them
Provider Networks
- New York medical practice pays $600K to settle allegations of services billed by providers not enrolled in Medicare and Medicaid
- Tennessee-based Erlanger Health System faces federal lawsuit alleging it overpaid physicians for improper referrals
- Texas radiology group fined $8.8M for illegal referrals
Fraud
- Surgical group and hospital pay $12.76M to settle allegations of improper relationships with two physician groups
- Medical device manufacturer settles improper billing allegations
- Marketer pleads guilty to $7.8M durable medical equipment fraud and kickback scheme
- Home healthcare and hospice provider, Intrepid, ordered to pay $3.85M to settle false claims
- Durable medical equipment company owner pleads guilty to scheme to defraud Medicare of $39.5M
- Denver-based durable medical equipment company biller charged with $1.2M in false Medicaid claims
- Ohio woman arrested for $1.5M Medicaid fraud
- Boston electronic health records vendor ordered to pay $18.25M to resolve kickback allegations
- Tennessee woman accused of selling fake weight-loss drugs
- Kindred at Home ordered to pay $19.4M to settle false claims and overpayments allegations
- Louisiana physician convicted for illegally distributing 1.8M opioids and more than $5.4M in fraud
- Massachusetts home health company owner convicted in $100M Medicaid fraud scheme
- Ohio physician sentenced to 26 months for $8M of Medicare fraud
- Montana physician pleads guilty to $39M Medicare telehealth fraud
- Home health company settles Medicaid fraud allegations for nearly $1M
- CityMD settles $12M COVID test fraud suit
- Las Vegas physician convicted in $2M Medicare and Medicaid fraud scheme
- Michigan physician convicted for role in $6.3M Medicare fraud scheme
- Kentucky physician sentenced to two years for role in $14M kickback scheme
- Houston physician to pay $1.8M to settle Medicare false claim allegations
- Florida pharmacy owner guilty in $36.2M Medicare fraud scheme
- Florida couple convicted for $125M worth of fraudulent Medicare and Tricare claims
- Florida compounding pharmacy CEO sentenced for role in $40M Tricare fraud scheme
- Washington physician pleads guilty in Medicare and Tricare fraudulent telemarketing and medical supply scheme
- Ohio pharmacy owner convicted for dispensing gastroenterology drugs without prescriptions and overcharging Medicaid $2.3M
- New York physician indicted for involvement in $20.7M worth of false claims in Medicare and Medicaid
- Illinois physician convicted of $1.2M in Medicaid fraud
- Washington physician pays settlement to resolve allegations he ordered medically unnecessary durable medical equipment
- President of pharmacies in New Jersey pleads guilty to $32M worth of Medicare and Tricare fraud charges
- Ohio physician convicted for $1.5M of Medicaid fraud
- Washington durable medical equipment supply company owner settles fraud case
- Guardant Health settles false Medicare and Tricare claims allegations
- Medical marketer convicted and ordered to pay $59M in restitution for defrauding Tricare and other federal health programs
- Florida medical supply company owner arrested for submitting false Medicare claims exceeding $17M
- Philadelphia pharmacy owners to pay $4.6M for submitting false claims to Medicare and Medicaid
- St. Louis home health company owner accused of defrauding Missouri’s Medicaid program out of more than $3M for over a decade
- Texas hospital pays $14.2M to settle anti-kickback, Medicare violations
- Texas medical supplier sentenced for defrauding Medicare and Medicaid for $1.7M
- Shuttered healthcare-sharing ministry co-founder convicted for $8M fraud scheme in Missouri
- Texas lab owner charged in $79M Medicare and Medicaid fraud scheme
- Michigan home health owner sentenced for $7.9M Medicare fraud
- Michigan home health owner sentenced to nine years for $2.8M Medicare fraud
- QOL Medical and its CEO to pay $47M to settle anti-kickback allegations
- Pomona Valley Hospital Medical Center in California to pay $2M to settle 340B overbilling allegations in Medicaid
- New York medical billing operator sentenced to 12 years and ordered to pay $336M for billing fraud
- California lab owner sentenced to ten years for $234M worth of Medicare fraud
- California hospice physician convicted for his role in a $2.8M Medicare fraud scheme
- Former Cardiac Imaging executive charged for anti-kickback violations
- Mental health services administrator in Washington, DC sentenced to five years in prison and ordered to pay more than $4.45M for Medicaid fraud
- New Jersey seized $6.4M worth of assets from the estate of deceased owner of mental health clinics for thousands of false Medicaid claims
- Catheter billing scam could be costing Medicare $2B
- Owner of Chicago-based durable medical equipment pharmacy, Symed, sentenced to prison for $87M kickback scheme
- Florida lab owner convicted for defrauding Medicare out of $30M in fraudulent COVID test claims
- California marketing company owner charged in fraud and kickback scheme that cost Medicare more than $10M
- New York medical billing company owner pleads guilty to submitting false claims
- Idaho clinic chain ordered to pay $2M to settle fraud allegations
- Former leaders of Arkansas medical supply business sentenced to prison and ordered to pay more than $5M for fraud and kickbacks
- South Carolina owner of at least ten durable medical equipment companies sentenced to prison for one of the “largest Medicare fraud schemes in history”
- Massachusetts owner of home health company, Arbor Homecare Services, convicted in $100M fraud scheme
- Three labs agreed to pay $2.45M to settle allegations of manipulating codes in claims submitted to Medicare and Medicaid
- California lab agrees to pay $1M for double-billing Medicare for urine drug testing
- Skilled Nursing Facility operator, Grand Healthcare System, pays $21.3M for billing federal healthcare programs for services that were unreasonable, unnecessary, unskilled, or didn’t occur
- New Orleans hospice owner sentenced to 20 years for defrauding Medicare $84M
- Louisiana hospice owner sentenced to six years and ordered to pay more than $3.6M for healthcare fraud
- Mississippi man with connections to pharmacies, durable medical equipment companies, and laboratories, pleaded guilty for role in $51M Medicare scheme
- Illinois lab owner charged in $60M Medicare COVID testing scheme
- California sleep clinic owner sentenced for submitting $1.5M in fraudulent claims to Medicare and Medicaid
- Penn Highlands Healthcare in Pennsylvania to pay $735K to settle whistleblower suit alleging self-referral violations
- Owners of New York transportation company plead guilty to $2.1M in Medicaid fraud and kickbacks
- Tennessee outpatient clinic to pay more $1.1M to settle improper billing allegations
- Managers of Chicago mental health center sentenced for defrauding Illinois’ Medicaid program of $2.5M
- Chicago nurse practitioner group pays $2M to settle upcoding allegations in Medicare and Medicaid
- Medical device CEO sentenced to six years for selling fake chronic pain devices implanted in patients
- Teva Pharmaceuticals to pay $425M to resolve kickback allegations