The United States Government Accountability Office (GAO) has asked the Centers for Medicare and Medicaid Services to improve its recognition and enforcement of antifraud, waste, and abuse efforts and to align with the GAO’s Fraud Risk Framework and the Fraud Reduction and Data Analytics Act of 2015.
An employee of Mauran Ambulance Inc., pled guilty to one count of conspiracy to commit healthcare fraud. Aharon Krkasharyan served as the quality improvement coordinator for Los Angeles-based Mauran. The company’s business model included the provision of non-emergency services to Medicare beneficiaries, many of who were dialysis patients.
A federal district court judge from the District of Columbia ruled in favor of the United States government in a False Claims Act case against former home health company Dynamic Visions, awarding the government $1.98 million.
The Memorial Hermann Endoscopy and Surgery Center of North Houston, an associated medical practice, and one of their physicians reached an agreement to settle with the Office of Inspector General of the Department of Health and Human Services for $1.5 million to settle allegations of Medicare fraud.
Four Houston-area hospitals affiliated with the Hospital Corporation of America (HCA) will settle allegations that they gave rights to transport Medicare and Medicaid patients to specific ambulance companies that paid to receive this business.
The Department of Health and Human Services Office of Inspector General found that Medicare contractors did not always refer cost reports that qualified for reconciliation of the hospital outlier payments, and the Centers for Medicare & Medicaid Services did not always ensure that the Medicare contractors performed the appropriate reconciliation, according a review of Medicare outlier payments performed between October 2003 and March 2011.