#medicare-fraud

#medicare-fraud

During a four-year period beginning in 2020, Violetta Mailyan pocketed more than $25 million for Botox injections through Medicare payments, more than five times what any other doctor made in the same time frame, according to a news release from the Department of Justice. Turns out, it was all part of an elaborate fraud scheme that prosecutors say ignored Medicare's rules for Botox coverage and brazenly fabricated medical records, all to fund the doctor's lavish lifestyle.

SAN FRANCISCO Kaiser Permanente affiliates will pay $556 million to settle a lawsuit that alleged the health care giant committed Medicare fraud and pressured doctors to list incorrect diagnoses on medical records to receive higher reimbursements, federal prosecutors said. The deal announced Wednesday came more than four years after the U.S. Department of Justice filed the legal claim in San Francisco that consolidated allegations made in six whistleblower complaints.

CMS announced the start of the "Crushing Fraud Chili Cook-Off Competition" on Aug. 19, calling it "a market-based research challenge" to identify emerging technologies that can "detect anomalies and trends in Medicare Fee-for-Service (FFS) claims data that can be translated into novel indicators of fraud." The agency said it is "prioritizing the use of innovative, data-driven approaches, including explainable AI/ML" that can analyze large datasets to "uncover unusual patterns, anomalies, or trends that may signal fraudulent activity."

The settlement, reaching over $810,000, resolves allegations of Medicare fraud against a Kendall radiology center and its associated physicians.