DOJ Sues California Medicaid Plan Over $320M Misused Federal Funds
The DOJ sues Inland Empire Health Plan for allegedly misusing $320 million in federal Medicaid surplus funds, highlighting compliance challenges in managed care programs.
Georgia Man Sentenced for Illegal Medicare Genetic Testing Kickback Scheme
Georgia man sentenced to 46 months and $7.2M restitution for illegal Medicare kickbacks tied to unnecessary genetic tests, reflecting enforcement on healthcare fraud.
Seattle Man Sentenced for $1M Medicare Fraud Scheme Involving Lab Testing
An Everett-based lab operator was sentenced to prison for a $1.17M Medicare fraud scheme involving fraudulent billing for unperformed COVID-19 and respiratory tests. The case underscores ongoing regulatory challenges.
Illinois Physician Charged with Over $1M Medicaid and Medicare Fraud
Illinois physician faces multiple felony charges for stealing over $1 million in Medicaid and Medicare payments through fraudulent billing practices involving unlicensed medical services.
Medicare Open Enrollment Ends Soon Amid Increased Scam Risks
Medicare open enrollment closes Sunday with heightened scam risks. Seniors urged to protect information and use local resources like Emporia Friendship Center for enrollment help.
Health First Urgent Care Settles $2.8M Medicare Medicaid Overbilling Case
Health First Urgent Care agrees to $2.8 million settlement for Medicare and Medicaid overbilling linked to improper diagnostic test billing practices in Washington State.
Court Awards Attorney Fees to FCA Defendants Due to Relator's Fraudulent Conduct
A Massachusetts court awarded attorneys' fees to FCA defendants after finding relator engaged in fraudulent conduct by ordering unnecessary PCR tests to support whistleblower claims under the False Claims Act.
Trump Administration Proposes Medicare Pilot for GLP-1 Weight Loss Drug Coverage
Trump administration proposes a Medicare and Medicaid pilot to cover GLP-1 weight loss drugs, highlighting access benefits alongside fraud and regulatory oversight challenges.
Massachusetts Man Pleads Guilty in $4M Medicare DME Fraud Scheme
Krishna Gidwani pleaded guilty to conspiracy in a $4M Medicare fraud involving durable medical equipment. Part of DOJ's 2025 National Health Care Fraud Takedown.
DOJ Expands Probe into UnitedHealth’s Medicare Billing Practices
The DOJ is investigating UnitedHealth Group's Medicare billing practices, focusing on diagnostic coding and in-home evaluations that may have led to inflated government payments. This probe highlights compliance and regulatory risks in Medicare Advantage programs.