What's New

September 18, 2025

Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled Residents OEI-05-24-00180

Serious Falls Resulting in Hospitalization Among Medicare-Enrolled Nursing Home Residents, July 2022–June 2023 OEI-05-24-00181

September 17, 2025

Updated:

• EMTALA/Patient Dumping
• CMP and Affirmative Exclusions
• Fraud Self-Disclosures
• Stipulated Penalties and Material Breaches

Enforcement Actions

September 16, 2025; U.S. Attorney's Office, District of Maryland

Exactech Agrees to Pay $8 Million to Resolve False Claims Act Allegations for Selling Defective Knee Implant Devices

September 16, 2025; U.S. Attorney's Office, Western District of Virginia

Roanoke Home Health Care Attendant Pleads Guilty to Health Care Fraud

September 15, 2025; U.S. Attorney's Office, Southern District of Florida

Fraud Charges Filed Against 12 Defendants in Phase II of Operation Nightingale

What's Trending

1. Medicare Part B Payment Trends for Skin Substitutes Raise Major Concerns About Fraud, Waste, and Abuse
2. Medicaid Managed Care Organizations' Denials
3. Audit of Diagnosis Codes That MA Organizations Submitted to CMS for Use in Medicare Part C Risk-Adjustment Program
4. Novitas Solutions, Inc., Reopened and Corrected Cost Report Final Settlements for Desk Reviews Only With Obvious Errors To Correct Payments Made to Medicare Providers
5. Submit a Hotline Complaint