News

NHCAA CEO Testifies Before Senate Committee

Published on Wednesday, March 26, 2014 in “Announcements” by “John Smith”

On March, 26, NHCAA CEO Louis Saccoccio testified at a Senate Special Committee on Aging hearing titled, "Preventing Medicare Fraud: How Can We Best Protect Seniors and Taxpayers?" Mr. Saccoccio was joined by four other witnesses and devoted the majority of his comments to discussing the importance of anti-fraud information sharing.

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HHS-OIG Reports

Published on Thursday, March 13, 2014 in “Announcements” by “John Smith”

The Department of Health and Human Service, Office of Inspector General has released two recent reports - the first report is titled, "Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse."

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Fiscal Year 2013 HCFAC Report Issued

Published on Wednesday, February 26, 2014 in “Announcements” by “John Smith”

Today, the Fiscal Year 2013 Health Care Fraud and Abuse Control (HCFAC) Program Report to Congress was published.

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Q&A with Board Chair Ralph Carpenter

Published on Thursday, January 09, 2014 in “Announcements” by “John Smith”

Ralph J. Carpenter, Director of the Special Investigations Unit (SIU) for Aetna has been elected the 2014 Chair of its Board of Directors. The Institute Update spent time with Ralph in December to discuss the coming year.

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Healthcare Fraud Prevention Partnership Launches New Website

Published on Tuesday, December 03, 2013 in “Announcements” by “John Smith”

The Healthcare Fraud Prevention Partnership (HFPP) recently announced a new public information website providing updates on HFPP activities and study results, and to promote engagement and involvement in the partnership.

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2013 Medical Director Award Winner

Published on Tuesday, November 19, 2013 in “Announcements” by “John Smith”

The National Health Care Anti-Fraud Association (NHCAA) has named Gary Cicio, DPM as its 2013 Medical Director Award recipient for his significant contributions and outstanding accomplishments to the field of health care fraud-fighting.

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Aetna's Ralph Carpenter Elected NHCAA Board Chair

Published on Tuesday, November 19, 2013 in “Announcements” by “John Smith”

The National Health Care Anti-Fraud Association (NHCAA) today announced that Ralph J. Carpenter, Director of the Special Investigations Unit (SIU) for Aetna has been elected as the new Chair of its Board of Directors. Carpenter succeeds Alanna Lavelle, Director of Enterprise Investigations for WellPoint, Inc.

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2013 Investigative Excellence Award

Published on Tuesday, November 19, 2013 in “Announcements” by “John Smith”

The National Health Care Anti-Fraud Association (NHCAA) today presented the Special Investigation Unit (SIU) of WellPoint, Inc. with its Investigative Excellence Award in recognition of the implementation of WellPoint's Predictive Modeling Tool, a unique and innovative approach to health care fraud-fighting.

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2013 Investigation of the Year Award

Published on Tuesday, November 19, 2013 in “Announcements” by “John Smith”

The National Health Care Anti-Fraud Association (NHCAA) today presented its Investigation of the Year Award to a team of federal and state agencies and a Medicare Part C health plan that together helped uncover a multimillion-dollar health care fraud scheme committed by now-convicted Mississippi physician Meera Sachdeva.

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NHCAA Partners With SmartBrief on New E-Newsletter

Published on Monday, September 16, 2013 in “Announcements” by “John Smith”

Carefully designed to provide only the most relevant news and intelligence, the NHCAA SmartBrief is delivered directly to 13,000 subscriber inboxes daily, with information collected from multiple trusted resources. The ad-based brief also includes career development information, learning opportunities, and more.

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Choosing Wisely Initiative Releases Lists of Unnecessary Procedures

Published on Wednesday, September 04, 2013 in “Announcements” by “John Smith”

A number of leading medical specialty societies are releasing lists of specific tests or procedures they say are commonly ordered but which are not always necessary and could potentially cause patient harm. These lists are part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign.

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NHCAA Education earns NASBA credit

Published on Monday, August 05, 2013 in “Announcements” by “John Smith”

CPAs can now earn continuing professional education credit through attendance at NHCAA's In-Person NETS and Online NETS training programs. Visit Year-at-a-Glance for program details and credits offered.

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2013 Medical Director Award Nomination

Published on Thursday, June 27, 2013 in “Announcements” by “John Smith”

Nominations Now Being Accepted for the 2013 NHCAA Medical Director Award. Deadline to submit application is Friday, September 13.

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NHCAA Board Chair Testifies Before Senate Committee on Prescription Drug Fraud

Published on Thursday, June 27, 2013 in “Announcements” by “John Smith”

On Monday, June 24, NHCAA Board of Directors Chair Alanna Lavelle (WellPoint) testified before the Senate Homeland Security & Government Affairs Committee. Ms. Lavelle was among four other witnesses testifying at the nearly two-hour hearing titled "Curbing Prescription Drug Abuse in Medicare."

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July Case Discussion Roundtable Meeting

Published on Wednesday, May 22, 2013 in “Announcements” by “John Smith”

This complimentary credit opportunity, scheduled for Monday, July 22, provides a forum for our private and public sector members to come together to share information and discuss active health care fraud investigations as well as schemes, trends, and fraud patterns.

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Latest Issues of Inside SIRIS Released

Published on Wednesday, May 22, 2013 in “Announcements” by “John Smith”

The April 2013 issue of Inside SIRIS is now available. This members-only resource provides you with key updates and a comprehensive compilation of information gathered from SIRIS in the previous month.

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NHCAA Congratulates New AHFIs

Published on Wednesday, May 22, 2013 in “Announcements” by “John Smith”

NHCAA would like to congratulate the individuals who successfully passed the recent AHFI® examination. These new AHFIs join the nearly 500 other health care fraud professionals who bear the designation proudly.

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Final Rule on Medical Loss Ratio for Medicare Parts C&D

Published on Monday, May 20, 2013 in “Announcements” by “John Smith”

The Centers for Medicare & Medicaid Services (CMS) has published in the Federal Register a final rule implementing Medical Loss Ratio (MLR) Requirements for Medicare Advantage and Medicare Prescription Drug Benefit Programs (Medicare Parts C & D).

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Final Rule on Data Mining in Medicaid

Published on Friday, May 17, 2013 in “Announcements” by “John Smith”

The U.S. Department of Health and Human Services, Office of Inspector General today issued a final rule relating to the use of data mining by Medicaid Fraud Control Units (MFCUs).

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PERC Online

Published on Tuesday, May 07, 2013 in “Announcements” by “John Smith”

The collective fraud fighting experience of our Member Organizations is an invaluable resource. PERC (Peer Experience Resource Center) offers NHCAA Membership Forum Representatives the chance to seek input from their industry peers about unusual, pressing or particularly challenging investigations or policy-related issues. PERC offers the ability to reach NHCAA's membership quickly and effectively.

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Automated RIAs!

Published on Tuesday, May 07, 2013 in “Announcements” by “John Smith”

NHCAA is pleased to announce that the Request for Investigation Assistance (RIA) process has been integrated into the Special Investigation Resource and Intelligence System (SIRIS) secure database - NHCAA's premier information-sharing and fraud fighting tool. The RIA process is a unique members-only tool that allows our Law Enforcement Liaisons to submit inquiries concerning specific cases of suspected health care fraud for distribution to NHCAA Member Organizations.

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Senate Finance Committee Report on FWA

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

Senators issue report compiling ideas from 160+ organizations (including NHCAA) on preventing and combating health care fraud, waste and abuse.

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Health Care Fraud & Abuse Control Report for Fiscal Year 2012

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

The Fiscal Year 2012 Health Care Fraud and Abuse Control (HCFAC) Program Report to Congress was recently published. The national Health Care Fraud and Abuse Control Program (HCFAC) was established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Program is carried out jointly at the direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS), acting through the Inspector General.

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2013 NHCAA Annual Report

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

Because of the support of our members, NHCAA experienced another exciting year of accomplishments and advancements as demonstrated in our 2013 Annual Report. We strive to continuously improve our service to our members and to champion the integrity of our nation's health care system.

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NHCAA Anti-Fraud Laws Database

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

NHCAA announces the addition of a new member resource to the website. The NHCAA Anti-Fraud Laws Database offers state-by-state profiles that include legal citations along with the accompanying statutory and regulatory language.

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Purchasing Insurance? Don't get Scammed.

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

Fake insurance scams are abundant. Beware of too good to be true coverage and rates, and don't provide personal information without first investigating the legitimacy of the company.

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Health Care Fraud - Everyone Pays

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

The United States spends over $2.7 trillion on health care every year. Of that amount, NHCAA estimates that tens of billions of dollars are lost to health care fraud.

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Read that EOB!

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

Don't throw away the Explanation of Benefits (EOB) you receive from your insurer; it could contain important clues to uncover health care fraud.

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Safeguard your Medical Identity

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

Treat your health insurance card like your credit card. Medical identity theft is a fast-growing crime, and difficult to rectify. Medical identify theft occurs when someone steals your insurance card number to obtain prescriptions, medical services or medical supplies.

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Join the Senior Medicare Patrol

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

The Senior Medicare Patrol (SMP) is a grassroots network of volunteers who work to educate seniors and other Medicare and Medicaid beneficiaries on how to protect, detect, and report health care fraud.

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Beware of Free Medical Services

Published on Tuesday, April 09, 2013 in “Announcements” by “John Smith”

If offered a complimentary medical service, beware! Offers of "free" medical treatments or consultations often sound appealing and legitimate. They may come in advertising, a telephone solicitation, or even at your front door.

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The Faces of Fraud

Published on Monday, April 08, 2013 in “Announcements” by “John Smith”

This Web page contains information about OIG's most wanted health care fugitives. In all, the HHS-OIG is seeking more than 170 fugitives on charges related to health care fraud and abuse. Here are some of the faces of health care fraudsters.

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Health Care Fraud and Organized Criminal Groups

Published on Monday, April 08, 2013 in “Announcements” by “John Smith”

In South Florida alone, government programs and private insurers have lost hundreds of millions of dollars in recent years to criminal rings that fabricate claims from non-existent clinics, using genuine patient-insurance and provider-billing information that the perpetrators have bought and/or stolen for that purpose.

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Medicare Patients with Diabetes - Beware of this Scam

Published on Monday, April 08, 2013 in “Announcements” by “John Smith”

Although the precise method may vary, the scheme generally involves someone pretending to be from the Government, a diabetes association, or even Medicare, calling you to offer "free" diabetic supplies, such as glucose meters, diabetic test strips, or lancets.

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NHCAA Testifies before U.S. House Committee

Published on Wednesday, November 28, 2012 in “Announcements” by “John Smith”

NHCAA CEO Louis Saccoccio testified before the Health Subcommittee of the House Committee on Energy and Commerce November 28, 2012. The hearing, entitled "Examining Options to Combat Health Care Waste, Fraud and Abuse" focused on a number of issues related to fraud in our current health care system, in particular, Medicare fraud.

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2012 Investigation of the Year

Published on Thursday, November 15, 2012 in “Announcements” by “John Smith”

(Anaheim, CA) - The National Health Care Anti-Fraud Association (NHCAA) today presented its Investigation of the Year Award to the consortium of federal and state agencies who uncovered a major health care fraud scheme committed by a convicted Texas psychiatrist, Anthony Francis Valdez, who wrongly billed over $42 million in medical procedures, received payments totaling over $12 million in office visits not performed, and employed unqualified individuals, including a janitor, to administer p...

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2012 Medical Director Award

Published on Thursday, November 15, 2012 in “Announcements” by “John Smith”

(Anaheim, CA) -The National Health Care Anti-Fraud Association (NHCAA) awarded its 2012 Medical Director Award to George M. Koumaras, DDS for his outstanding accomplishments in the health care fraud- fighting field.

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Lavelle 2013 Board Chair

Published on Thursday, November 15, 2012 in “Announcements” by “John Smith”

(Anaheim, CA) - The National Health Care Anti-Fraud Association (NHCAA) today announced that Alanna M. Lavelle, AHFI, MS, CPC, Director of Special Investigations of WellPoint, Inc., has been elected as the new Chair of the Board of Directors. Lavelle succeeds Jack Price, former Chief Security Officer of BlueCross BlueShield of Tennessee.

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HHS-OIG to Launch Free Outlook 2013 Webcast

Published on Tuesday, October 23, 2012 in “Announcements” by “John Smith”

Hear OIG's top leadership discuss issues such as improper payments, Medicare fraud, exclusions, and other key subject areas from the recently published 2013 Work Plan.

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Need to Report Suspected Health Care Fraud?

Published on Monday, October 15, 2012 in “Announcements” by “John Smith”

Health care fraud is a serious crime that can affect anyone. If you have observed or been a victim of health care fraud, learn about the resources available and ways to report it.

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Legal Brief

Published on Friday, August 24, 2012 in “Announcements” by “John Smith”

In a February 8, 2012 notice, CMS solicited public comments on the draft version of the Compliance Program Guidelines. NHCAA along with 67 other entities submitted comments. Upon review, CMS incorporated a number of the recommendations made by NHCAA into the final guidance.

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What Does Health Care Fraud Look Like?

Published on Tuesday, August 21, 2012 in “Announcements” by “John Smith”

The majority of health care fraud is committed by organized crime groups and a very small minority of dishonest health care providers. The most common types of health care fraud include:

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Budget Adequately for 2014 Trainings

Published on Tuesday, August 21, 2012 in “Announcements” by “John Smith”

Make sure to budget adequate travel dollars for training and travel to take advantage of NHCAA's educational programs. Member Organizations and Law Enforcement Liaisons receive up to two tuition-free seats per individual NETS program.

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NHCAA Statement on Initiative to Protect Medicare and Seniors from Fraud

Published on Tuesday, August 21, 2012 in “Announcements” by “John Smith”

The National Health Care Anti-Fraud Association (NHCAA) Chief Executive Officer Louis Saccoccio released the following statement regarding the U.S. Department of Health and Human Services (HHS) announcement awarding $9 million to the Centers for Medicare & Medicaid Services (CMS) to help Senior Medicare Patrol (SMP) programs across the nation continue their work fighting Medicare fraud.

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Jack Price Elected Board Chair

Published on Friday, August 10, 2012 in “Announcements” by “John Smith”

Jack L. Price, AHFI, ALHC, CFE, Chief Security Officer of BlueCross BlueShield of Tennessee (BCBST), has been elected as the new Chair of the NHCAA Board of Directors.

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NHCAA Statement on National Fraud Prevention Partnership

Published on Monday, July 30, 2012 in “Announcements” by “John Smith”

The National Health Care Anti-Fraud Association (NHCAA) Chief Executive Officer Louis Saccoccio released a statement today regarding the White House announcement of the new National Fraud Prevention Partnership.

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