A Big Three health insurer says it paid the fine to head off potential Medicare Advantage sanctions as it disputes the Centers for Medicare & Medicaid Services’ finding over alleged overpayments.
False Claims Act
The Takedown involved the use of data analytics to target the worst actors and the seizure of over $182m in cash, luxury vehicles, jewelry, and other assets from medical professionals and others.
As enforcement priorities evolve and new areas of risk emerge, insurance coverage remains a vital component of managing the financial exposure associated with FCA investigations and litigation.
Assistant AG Shumate says his new directive is in response to the “rise in fraudulent schemes” targeting federal benefits programs, such as Medicaid.
The agreement resolves allegations into whether the company’s speaker programs and meals for physicians violated anti-kickback laws.
Alongside the initial monetary settlement, the provider will pay additional amounts based on profits and submit to a CIA regimen.
This article examines the evolving federal and state AI enforcement landscape and outlines practical considerations for companies deploying AI technologies.
In a case involving an unlicensed person performing medical procedures on unwitting patients, the two California men billed state and federal programs $3.2m in false claims.