A federal Medicare fraud case has ended with a final forfeiture order covering $7,051,089.08 in two financial accounts and three vehicles: a Land Rover Range Rover, a BMW and a Ford F-150. The order followed the conviction of laboratory operator Jamie P. McNamara, whose companies billed Medicare for genetic tests generated through telemarketing and kickbacks…

A Tennessee health-care executive has been ordered to pay $6,970,583.50 in restitution after years of false billing to Medicare and other government programs. Federal prosecutors say the companies submitted roughly $11 million in false claims and received about $6.9 million. The judgment follows a guilty plea and a 42-month prison sentence, so the case has…

Two certified transplant centers received $154,210 in Medicare reimbursement for five organs they could not adequately document, according to a federal audit. That exact amount is only one finding inside a much larger examination of organ-acquisition accounting. The inspector general also estimated that conflicting guidance cost Medicare roughly $380 million over six years. Medicare reimburses…

A $350,000 federal settlement traces back to tests that prosecutors say were ordered and billed under an unusually rare diagnosis. St. Michael’s Eye & Laser Institute and its physician owner agreed to resolve allegations that their arrangements led to false Medicare claims. The payment settles civil allegations; it is not a criminal judgment and the…

Medicare can sometimes pay a medical bill conditionally when another insurer is supposed to pay first but has not done so promptly. Medicare generally treats 120 days as the point at which the provider may bill Medicare for a conditional payment. The payment can keep a claim from sitting indefinitely, but it is temporary: Medicare…

A Medicare drug plan sometimes has only 24 hours to decide whether it will cover a prescription or grant an exception. That expedited clock applies when the plan or prescriber determines that waiting for the ordinary 72-hour decision could seriously jeopardize life, health or the ability to regain maximum function. It is a pre-purchase coverage…

A denial on a Medicare Summary Notice is an initial payment decision, not necessarily the last word on a medical bill. A person with Original Medicare generally has 120 days from receiving that determination to request the first appeal, called a redetermination. The exact deadline printed on the notice controls, and a late filing may…

Patients covered by Lee Health in southwest Florida got an insurance notice this month that reads differently depending on which UnitedHealthcare product sits in their wallet. Lee Health is ending its hospital and physician contracts with UnitedHealthcare, a split that will push several plan types out of network starting January 1, 2027. But Lee Health’s…

Every state has the job of inspecting its nursing homes for Medicare and Medicaid compliance, but a growing number hand part of that work to outside contractors instead of using state employees. A federal audit released this month checked how well the agency in charge of the whole system, the Centers for Medicare & Medicaid…

When a hospital or a large group of doctors drops out of a Medicare Advantage network mid-year, the plan doesn’t have to let members leave right away. Medicare treats a serious network shakeup as a case-by-case situation rather than an automatic trigger for a new enrollment window. That distinction matters, because the two-month window some…