$556 million. One settlement. One health system that is simultaneously the insurer and the physician group. The largest Medicare Advantage risk adjustment fraud settlement in history, and a warning for every physician group in an MA contract.
Tag: billing
Fraud on Fridays: Operation Never Say Die
Healthy patients recruited at grocery stores, cash in envelopes, and a fraud ring that didn’t stop even when its ringleader was already sitting in a federal prison.
Fraud on Fridays: Bonnie and Clyde, M.D.
A husband-and-wife team, expired injections, and 15 years of fraud. This Bonnie and Clyde didn’t rob banks, they robbed their patients.
Fraud on Fridays: It’s What Was in the Goody Bag
Opioids, unnecessary prescriptions, unlicensed interns, and a Goody Bag no patient actually wanted.
Fraud on Fridays: From Telehealth to Telefraud
Another week. Another fraud.
This Friday’s case shows how telehealth can quietly turn into federal wire fraud—without physicians realizing the risk until it’s too late.
Five Ophthalmology Practices See Eye to Eye in False Claims Act Settlement
Five ophthalmology practices agreed to pay nearly $6M over alleged kickbacks and unnecessary testing. Learn the FCA risks every physician group must understand.
Fraud on Fridays: Bogus Billing for Botox?
Learn why poor documentation and bad fixes can turn mistakes into criminal exposure—and how one physician allegedly blurred the lines of Botox billing.
Fraud on Fridays: Pink Slipped
From sell-mates to cellmates? Used car salesmen/financiers and the lesson for healthcare leaders.
Off to Prison. An Update on How to Almost Make Half a Billion Dollars: The Arizona Wound Graft Fraud
Now that they’ve been sentenced to prison, I can reveal the fate of the healthcare power couple, Alexandra Gehrke and her husband, Jeffrey King, whose wound care graft graft put close to $615,000,000 in their pockets, albeit temporarily.
Fraud on Fridays: Deceit Was in His Genes
Perhaps he should have genetically tested himself for the propensity to commit fraud.