Monthly Spotlight on Fraud, Waste, and Abuse

Why This Topic Matters

The article helps readers understand current enforcement patterns and the types of billing, documentation, and compliance issues that can trigger investigations, settlements, or criminal charges. It supports internal compliance review and awareness of payer-program integrity risks without disclosing premium article specifics.

Article Sections

1. MassHealth fraud indictment involving addiction services businesses

   Summarizes allegations tied to Medicaid billing, provider qualifications, and use of another provider’s identification information. Also identifies the state agency and program integrity context.

2. California hospice fraud arrests and felony charges

   Covers a multi-agency investigation into hospice-related fraud involving multiple people and facilities. Discusses the enforcement response, program types, and state and federal oversight roles.

3. False Claims Act settlement involving a skilled nursing facility

   Describes a civil resolution centered on quality-of-care allegations, compliance program issues, and a corporate integrity agreement. Also notes the whistleblower component and the agencies involved.

4. Physician sentenced in healthcare fraud case

   Summarizes a criminal case involving fraudulent billing by a physician practice and the resulting sentence, restitution, and forfeiture. The section places the conduct in the context of specialty care billing and payer reimbursement.