Spotlight on Fraud, Waste, and Abuse - March 2023

Why This Topic Matters

It helps healthcare compliance, coding, billing, and revenue cycle professionals recognize common enforcement themes tied to improper claims, documentation, and reimbursement practices. The article is relevant for understanding current fraud and abuse risk areas and the role of federal and state enforcement activity.

Article Sections

1. Texas psychiatrist settlement for brain stimulation claims

   A case summary involving federal allegations, settlement activity, and whistleblower involvement related to healthcare billing and medical necessity concerns. The section also references government enforcement and the broader fraud and abuse context.

2. Medical equipment company settlement over Medicaid claims

   A case summary involving durable medical equipment reimbursement, Medicaid programs, settlement terms, and compliance oversight. The section also discusses a corporate integrity agreement and whistleblower provisions under federal law.