health care fraud


Also found in: Acronyms.

health care fraud

Deceptive, dishonest, and unlawful misrepresentations to a health insurer (such as Medicare) made by a provider or a patient in order to obtain money or services to which one is not entitled.
References in periodicals archive ?
While at Tufts, he was invited by the Department of Justice to represent private health plans at the groundbreaking 2010 Health Care Fraud Summit held in Bethesda, Maryland.
BEIRUT: Financial Prosecutor Ali Ibrahim Friday charged 11 people, including a doctor and a pharmacist, with health care fraud.
The Department of Justice (DOJ) in 2014 also opened 924 new criminal health care fraud investigations, and federal prosecutors filed criminal charges in 496 cases involving 805 defendants, HHS said in its report.
The grand jury added seven charges of health care fraud involving five more patients.
In a two hour live webcast, a panel of key thought leaders and professionals assembled by The Knowledge Group will provide an overview of the latest trends and best practices in Health Care Fraud Identification, Mitigation, and Compliance in 2015.
The success of this joint DOJ- HHS effort was made possible in part by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in Medicare and Medicaid and to crack down on individuals and entities that are abusing the system.
This was a record-breaking year for the Departments of Justice and Health and Human Services in our collaborative effort to crack down on health care fraud and protect valuable taxpayer dollars," Holder said in a statement.
The eyebrow-raising figure is the largest health care fraud recovery that the federal government has made in a single year.
The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor in the history of [the Health Care Fraud Prevention and Enforcement Action Team] and our Medicare Fraud Strike Force operations," said Deputy U.
of Tennessee-Knoxville) presents this investigative report on health care fraud in the United States.
Following the introduction, nine chapters address federal physician self-referral restrictions; application of the substantive, qui tam, and voluntary disclosure provisions of the False Claims Act in health care prosecutions; practical considerations for defending health care fraud and abuse cases; legal issues surrounding hospital and physician relationships; risk areas in managed care fraud and abuse for government program participants; corporate compliance programs; potential liabilities for directors and officers of health care organizations; disclosure of qui tam suits and investigations; and control of fraud, waste, and abuse in the Medicare Part D Program.
The agencies that investigate health care fraud and abuse include the OIG, MFCU, the Federal Bureau of Investigations (FBI), the Internal Revenue Service (IRS), the Postal Inspection Service, the Department of Defense (DOD), and State Insurance Departments (DOI).

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