Fraud And Abuse: DME, Genetic Testing Fraud Bring Big Enforcement Actions

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article summarizes a set of recent federal enforcement and whistleblower matters involving Medicare fraud and abuse. It is aimed at readers who follow healthcare compliance, medical billing oversight, and fraud-and-abuse developments, especially in durable medical equipment, genetic testing, psychotherapy, and therapy services. The piece also notes an HHS OIG resource update related to advisory opinion requests.

Why This Topic Matters

The article helps compliance, revenue integrity, and legal audiences track current enforcement priorities and understand the kinds of billing and referral conduct drawing government scrutiny. It also highlights a new OIG template that may be relevant to organizations seeking formal guidance on fraud-and-abuse questions.

Article Sections

  1. DME, genetic testing

    This section discusses federal enforcement activity involving Medicare-related durable medical equipment and genetic testing allegations, including criminal and kickback-related conduct.

  2. Psychotherapy

    This section summarizes a federal fraud case involving psychotherapy billing allegations tied to nursing home patients and Medicare claims.

  3. Therapy

    This section covers a qui tam settlement involving therapy billing allegations, federal program exclusions, and related compliance consequences.

  4. OIG Releases Advisory Opinion Template

    This section notes an HHS OIG update announcing a new template for advisory opinion requests on fraud-and-abuse topics.

What You Will Learn

  • Recent federal enforcement themes in Medicare fraud and abuse
  • The types of compliance issues drawing attention in DME and genetic testing matters
  • How psychotherapy and therapy billing allegations appear in enforcement actions
  • What the OIG advisory opinion template is intended to support

Who Should Read This

  • Healthcare compliance professionals
  • Medical coders
  • Billing managers
  • Revenue cycle leaders
  • Healthcare attorneys
  • Fraud and abuse investigators
  • Practice administrators

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