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Billing Medicare programs for services that are more costly than the actual procedure that was done. [5] It is a form of billing fraud where healthcare service providers submit false billing codes to obtain higher reimbursement at the expense of programs like Medicare, Medicaid, and TRICARE. [7]
The False Claims Act of 1863 (FCA) [1] is an American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. It is the federal government's primary litigation tool in combating fraud against the government. [ 2 ]
The Anti-Kickback Statute [1] (AKS) is an American federal law prohibiting financial payments or incentives for referring patients or generating federal healthcare business. . The law, codified at 42 U.S. Code § 1320a–7b(b), [2] imposes criminal and, particularly in association with the federal False Claims Act, civil liability on those who knowingly and willfully offer, solicit, receive ...
Walgreens has agreed to pay $106 million to settle lawsuits that alleged the pharmacy chain submitted false payment claims with government health care programs for prescriptions that were never ...
The case was settled in August 2018 for $65 million, resolving the "allegations that 14 Prime hospitals in California knowingly submitted false claims to Medicare by admitting patients who required only less costly, outpatient care and by billing for more expensive patient diagnoses than the patients had (a practice known as "up-coding")."
(Reuters) - Electronic health records vendor NextGen Healthcare Inc has agreed to pay $31 million to resolve allegations that the company violated the False Claims Act, the U.S. Justice Department ...
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