The Official Medicare Set Aside Blog And Information Resource

$40 Million Dollars Paid by Insurance Carriers and 13,000 California Patients Affected in an Alarming Kickback Scheme

Fraud, Medicare Set-Aside Blog, Work Comp on April 21, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, 26 defendants (21 doctors, 2 pharmacists, 1 physician assistant, and 2 business owners) were criminally charged in connection with a 40-million-dollar kickback scheme affecting 13,000 California patients statewide.  Two defendants, Tanya King and Christopher King “the Kings”, allegedly masterminded a complex insurance fraud scheme by recruiting both pharmacists and doctors to prescribe medically unnecessary […] Continue

Supreme Court Provides Argument Against Post-Settlement Bass Boat Purchases

Commentary, Fraud, Medicare, Medicare Set-Aside Blog, MSP Litigation on January 20, 2016 | Posted by Jennifer Jordan, JD, MSCC

We joke quite regularly about how quickly settlement funds will disappear and what will be bought. Well the Supreme Court today may have just made that less amusing for plaintiffs. In an 8-1 decision, the United States Supreme Court prevented an ERISA plan from recovering from a plaintiff who settled a third-party claim for $500,000 […] Continue

CMS’ Fraud Prevention System Creates Significant Impact

Fraud, Medicare, Medicare Set-Asides on July 29, 2015 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

The Centers for Medicare & Medicaid Services (CMS) recently recognized and applauded the agency’s internal Fraud Prevention System for the identification or prevention of $820 million in improper payments during the program’s first three years of operation. The focus of the Fraud Prevention System is to help protect Medicare Trust Funds and prevent fraudulent payments […] Continue