Federal prosecutors allege a Pennsylvania medical equipment company submitted more than $1.3 billion in fraudulent claims to Medicare and other insurers, using stolen patient identities as part of an international fraud and money laundering operation.
Maryland brokers accused in a multimillion-dollar health insurance fraud scheme say CareFirst’s own claims and enrollment records show the insurer detected suspicious activity too early for its lawsuit to proceed.
State investigators allege a North Carolina woman submitted 17 forged health insurance claims totaling more than $123,000. The investigation began after Blue Cross Blue Shield of North Carolina reported suspicious claims.
A former insurance agent received a six-month jail sentence after illegally selling annuity policies while his license was revoked. The case also follows an earlier conviction involving stolen client premiums and obstruction of justice.
Federal prosecutors say shell medical equipment companies submitted billions in fraudulent insurance claims. The case underscores why policyholders and insurers should closely monitor billing activity for signs of fraud.
Minnesota regulators say Seguro Medico misled consumers about the scope of their health insurance coverage and violated multiple state insurance laws. The enforcement action follows guilty pleas in a related federal fraud case.
Licensed insurance agents allegedly used personal information gathered through telemarketing calls to submit life insurance applications without consumers’ knowledge. Regulators say the scheme is generating significant losses for insurers and exposing older adults to additional fraud risks.
A review of nearly 2,000 closed malpractice claims found technical skill issues were the most common contributing factor, but clinical judgment failures produced the highest average indemnity payments. The findings offer new insight for underwriters, adjusters, and healthcare risk managers.
Federal prosecutors announced charges against hundreds of defendants in alleged Medicare, Medicaid, wound care, opioid, hospice, and behavioral health fraud schemes. Investigators credited advanced data analytics and coordinated enforcement efforts for identifying the cases.
A federal lawsuit claims hundreds of ineligible individuals were enrolled in Maryland-based health plans through an alleged scheme involving fraudulent residency information and referral networks.
Federal prosecutors allege a Houston-area clinic owner and co-conspirators submitted hundreds of millions of dollars in fraudulent Medicare and Tricare claims tied to medically unnecessary allograft procedures. Investigators say the scheme generated nearly $300 million in government payments and involved kickbacks and patient referrals.
Health insurers are investing in voice authentication, deepfake detection, and advanced analytics as criminals use AI-generated records, synthetic identities, and automated calls to exploit healthcare systems.
A federal jury found Takeda used an anticompetitive settlement to delay generic Amitiza, exposing the drugmaker to potentially billions in damages under federal antitrust law. The verdict is the first plaintiff win in a jury trial involving pharmaceutical pay-for-delay claims since a 2013 U.S. Supreme Court ruling.
Federal prosecutors said Brad Heppner used shell companies, falsified records, and misleading debt transactions tied to GWG Holdings and Beneficient, leaving thousands of investors facing major losses.
The Hartford says younger workers are turning to tools like ChatGPT during open enrollment as medical costs, inflation and benefit confusion increase pressure on household budgets.
