Mar 24, 2025 | Administrative Law, Health Care, Medicare and Medicaid, Overpayment Appeals
Because Medicare processes over one billion fee-for-service claims annually, it is impossible for CMS and its contractors to review every claim – or even a substantial percentage of claims – on a pre-payment basis. Accordingly, Medicare has set up various...
Mar 18, 2025 | Healthcare Transactions, Medicare and Medicaid
On March 14, Dr. Mehmet Oz, President Donald Trump’s nominee for the Centers for Medicare and Medicaid Services (CMS) Administrator, appeared before the Senate Finance Committee for his confirmation hearing. During the two-and-a-half-hour session, Dr. Oz navigated a...
Mar 4, 2025 | Medicare and Medicaid
A federal jury in Detroit convicted Sherif Khalil, a 50-year-old man from Redondo Beach, California, for his involvement in a fraud scheme that put Medicare out of over $4 million. The fraud stemmed from the submission of false claims for medically unnecessary urine...
Feb 20, 2025 | DMEPOS, Government Investigations, Health Care, Health Care Fraud, Medicare and Medicaid
If you are a DMEPOS supplier and are purchasing opt-in Medicare leads, you should be aware of Medicare’s prohibition against telephone solicitation of beneficiaries. In order to enroll as a Medicare DMEPOS supplier, and as a condition of payment, DMEPOS providers must...
Feb 17, 2025 | False Claims Act, Fraud Investigations, Government Investigations, Health Care Fraud, Medicare and Medicaid
The DOJ announced that SVCMC Inc., formerly known as Saint Vincent’s Catholic Medical Centers of New York (SVCMC), will pay $29 million to resolve allegations of violating the False Claims Act. According to the DOJ, the medical center knowingly retained...
Nov 25, 2024 | Medicare and Medicaid
Twenty years ago, Robert Peter Sauve faced charges for orchestrating a significant scheme that defrauded the federal Medicare program of millions of dollars. However, before authorities could detain him, Sauve managed to escape the Miami area, evading capture for two...
