The Government Accounting Office says that Medicaid wrongfully paid out more than $14 Billion to managed care organizations (MCO's) which partner with states in providing health care services to patients. The improper payments included services that were not necessary, never performed or weren't eligible for coverage. MCO's allow Medicaid beneficiaries to get their care through...

The Centers for Medicare & Medicaid services has failed to collect over $226 million in Medicaid over payments to 11 states according to a report by the Inspector General's Office just released. Over payments in Pennsylvania, Oregon, New Jersey, Missouri, Louisiana, Kansas, Illinois and Indiana were mentioned in the report. In October, the American...

Sean Hellein, a WellCare financial analyst became a whistleblower and worked with the FBI wearing a wire, secretly recording 650 hours of conversations culminating in a pending criminal prosecution against the former CEO Todd Farha. His tips have revealed a vast plot to defraud Medicaid in Florida. Under law, the companies are supposed to...

The United States is intervening in a whistleblower case brought against the New York City Department of Education for improperly billing Medicaid for psychological counseling services to special education students in the New York City public schools. Medicaid pays DOE a flat fee of $223 for each student which DOE provides at least two...

Sue Thayer, a former Planned Parenthood Heartland Clinic Manager has filed a whistleblower lawsuit under The False Claims Act, alleging that the company filed nearly 500,000 false claims with Medicaid, from which PP received and retained over $28 million. In the suit, Thayer says that Planned Parenthood implemented the "C-Mail" program which automatically mailed...