tci Medicare Compliance & Reimbursement - 2018 Issue 4
Fraud And Abuse: Feds Send Message with Huge Punishments — It's Payback Time
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Article Overview
This article reviews several 2018 federal fraud and abuse cases and the enforcement response from DOJ and other agencies. It is relevant to compliance teams, coders, auditors, and healthcare leaders who monitor Medicare billing risk, false claims exposure, opioid-related investigations, and broader fraud enforcement trends. The coverage focuses on case summaries, legal outcomes, and the general types of conduct that triggered penalties.
Why This Topic Matters
The article shows how enforcement priorities can affect billing compliance, documentation oversight, and organizational risk management. It helps readers understand the kinds of fraud-and-abuse issues that are drawing severe federal penalties.
Article Sections
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Fraud and Upcoding Net MD 13 Years in Prison, Millions in Returns
Discusses a federal fraud case involving Medicare claims, alleged upcoding, and criminal penalties. The section also references claims submitted to CMS and related enforcement findings.
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False Claims Suit Renders Massive $16 Million Judgment Against MRI Company
Summarizes a civil false claims matter involving an imaging provider, Medicare billing, and qui tam activity under the False Claims Act. It highlights the government’s response and the case outcome.
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Long Prison Sentences Mark Illegal Opioid Distribution and Prescription Cases
Covers multiple enforcement actions tied to controlled substances, prescription practices, and healthcare fraud. The section also describes related prison sentences, forfeiture issues, and agency statements.
What You Will Learn
- What types of fraud-and-abuse cases are drawing federal attention
- How Medicare-related billing misconduct can lead to civil and criminal enforcement
- Why controlled-substance prescribing and distribution are a major compliance concern
- How false claims allegations can arise in imaging and other outpatient settings
- What agencies and legal mechanisms are commonly involved in these cases
Who Should Read This
- Medical coders
- Compliance officers
- Healthcare auditors
- Practice managers
- Physicians
- Healthcare attorneys
- Revenue cycle professionals
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