Payer Roundup—5 charged in $20M fraud scheme; Virginia delays Medicaid expansion decision

The word fraud framed by other words
Five people, including a former fraud investigator, have been charged with submitting more than $20 million in fraudulent claims. (Getty/Devonyu)

Five charged in $20 million insurance scheme

Five people, including a former fraud investigator at Anthem, were arrested Tuesday on fraudulent claims charges, according to the Department of Justice. 

The alleged scheme involved inducing patients to two California clinics to receive free cosmetic procedures which were not covered by insurance. The conspirators then obtained the patients' insurance information and fraudulently billed insurers a total of $20 million for unprovided procedures.  

The conspirators collected about $8 million on those claims, according to the indictment. All five defendants were charged with one count of conspiracy to commit healthcare fraud and 13 counts of healthcare fraud. (DOJ)

Webinar

Breaking Through the Barriers to Better CX

Please join this webinar to learn how health plans can streamline member engagement and prioritize cross-departmental goals by leveraging CX technology.

Virginia puts Medicaid expansion on the back burner

In a setback for Medicaid advocates in Virginia, the state Senate has pushed a decision on whether to expand the program until next week. 

The delay followed news that a deal had been struck between Republicans in the chamber that would have given the proposal enough votes the pass the chamber, where it has been stalled for months. The House of Delegates passed its budget bill, which included Medicaid expansion, last month.

The Senate was expected to move on the legislation this week, but the debate has been pushed back to May 30 to give lawmakers more time to consider the proposal, according to WTOP.

Expanding the Medicaid program would provide health coverage to about 300,000 people in the Commonwealth. (WTOP)

Finance Committee leadership praises Medicare, Medicaid opioid bills

The Republican and Democratic leaders on the powerful Senate Finance Committee praised the introduction of almost two dozen bills to address the opioid crisis.

Most of the 22 bills include changes to government payer programs, including expanding telehealth accessibility and additional prior authorizations under Medicare Part D.

“Through stakeholder input, hearings and other member engagement, our committee has spent the first half of the year examining potential solutions to help curb the opioid crisis plaguing our nation,” Sens. Orrin Hatch and Ron Wyden, the committee's chairman and ranking member, respectively, said in a statement. "This marks a significant step in the committee’s legislative process, laying the groundwork for a constructive bipartisan path to confront this very real and serious epidemic." (Statement)

Suggested Articles

Humana has filed suit against the Trump administration over cost-sharing reduction payments.

The Trump administration has launched a new alternative payment model to provide upfront investments to rural healthcare providers.

Here's a look at which pharmacy companies ranked highest among consumers in J.D. Power's latest study.