Collaborating Authors

Machine Learning Could Help in Medicare Fraud Detection MarkTechPost


Medicare fraud is quite, unfortunately, an ongoing epidemic according to a recent study. Machine learning has recently become a very useful tool in rooting out a variety of Medicare fraud that has been occurring, however. It's estimated that Medicare fraud is responsible for almost $65 billion in losses each year. With AI going through a wide range of cases it could be possible to prevent some of these effects from happening. According to researchers at Florida Atlantic University, it may be possible to use machine learning to identify instances of fraud effectively.

Justice Department charges three in 1 billion Medicare fraud scheme

FOX News

The Justice Department on Friday unsealed charges in its largest-ever criminal health-care-fraud case, charging three individuals with using a network of doctors, hospitals and health-care providers across South Florida to improperly bill more than 1 billion to Medicare and Medicaid. Philip Esformes, the owner of more than 30 Miami-area skilled-nursing and assisted-living facilities, was the project's mastermind, the indictment alleged. He and two co-defendants, along with other co-conspirators, allegedly paid and received bribes and kickbacks to get thousands of patients admitted to facilities Mr. Esformes controlled. In those facilities, they were often given medically unnecessary and sometimes harmful treatments, which were then billed to Medicare and Medicaid, according to court papers. Esformes attorneys Marissel Descalzo and Michael Pasano of Carlton Fields said their client "adamantly denies these allegations and will fight hard to clear his name."

HHS hints at major changes to Medicare that could mean higher costs for patients

PBS NewsHour

Secretary of Health and Human Services Tom Price testifies on Fiscal Year 2018 Budget Blueprint before the Committee on Appropriations at the U.S. Capitol in Washington, D.C. Photo by Joshua Roberts/Reuters WASHINGTON -- The Trump administration is signaling it will pursue significant changes to Medicare that could put beneficiaries on the hook for higher costs. In an informal proposal on Wednesday, federal health officials hinted at several new pilot programs it may implement in the months ahead. One idea would give doctors more latitude to enter into so-called private contracts to charge Medicare beneficiaries more for certain services, if the patients were willing to pay. Elsewhere in the document, officials indicated they might offer more incentives to encourage beneficiaries to join private Medicare plans, known as Medicare Advantage plans. Democrats and other experts said the language suggested interest in the controversial "premium support" model long favored by Republican policymakers.

My Medicare only provides minimal coverage out of state. What should I do?

PBS NewsHour

Medicare Maven Phil Moeller answers your Medicare questions. Editor's Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in "Ask Phil, the Medicare Maven." Send your questions to Phil. I will get to as many questions as I can here, but please accept my apologies that I am not able to answer everyone's questions. Holly – N.Y.: My husband and I both have Medicare, and we have separate drug coverage through his old employer.

U.S. Can Sue UnitedHealth in $1 Billion Medicare Case, Judge Rules

U.S. News

U.S. District Judge Michael Fitzgerald in Los Angeles on Monday ruled that the department had sufficiently alleged UnitedHealth submitted invalid diagnostic data related to the health status of patients enrolled in Medicare Advantage plans.