Eleven people have been charged in a Russia-based scheme to defraud $10.6 billion from Medicare. The scheme involved purchasing legitimate medical equipment companies and then using the stolen personal information of more than 1 million Medicare beneficiaries to bill for equipment that was never delivered, according to prosecutors. The defendants allegedly laundered proceeds through shell companies and cryptocurrency.

Fadel Alshalabi of Waxhaw, N.C.; Samuel Harris of American Fork, Utah; and Dr. Benjamin Toh of Chicago have been sentenced for their roles in a multimillion-dollar Medicare and Medicaid kickback scheme. According to prosecutors, they orchestrated a large-scale scheme that submitted over $129 million in false claims to Medicare and Medicaid for unnecessary genetic tests after tests were approved by telemedicine doctors who never met the patients.

Darnell King of Clayton, N.C., has been sentenced to nearly six years in prison for his involvement in fraud operations. Prosecutors say that King applied for a Paycheck Protection Program loan using falsified bank and tax records, falsely claiming employment as an Uber driver before the pandemic, resulting in the disbursement of over $15,000 in federal relief funds, among other schemes.

Health care organizations are leveraging advanced statistical methods such as Bayesian inference and mixed-effects models to analyze the growing volume of data from electronic health records and wearable devices. These methods enhance adaptive trial designs and longitudinal data analysis, leading to faster clinical trials and better patient outcomes. However, significant computational power and collaborative tools are essential to fully realize these benefits.

The US Supreme Court issued a 6-3 decision in favor of the Affordable Care Act's provision mandating that insurers cover preventive services such as the HIV prevention drug PrEP. The majority said the appointment of the US Preventive Services Task Force by the health and human services secretary is constitutional.

Hospital-at-home programs are expected to continue growing, even with the potential expiration of a Medicare waiver that has supported them, according to executives from Mass General Brigham, Atrium Health and Ochsner Health. The programs are credited with reducing costs, easing hospital overcrowding, improving outcomes and achieving high patient satisfaction.

NHCAA Partner Webinars, available only to NHCAA Member Organizations, provide an opportunity to showcase your anti-fraud expertise through live training hosted on your preferred webinar platform. Partners receive and manage all registration data. NHCAA provides promotion for your webinar with two targeted emails and a spotlight on our website. For more information or to schedule a Partner Webinar, visit the Sponsorship Opportunities page on the NHCAA website or contact us at programs@nhcaa.org with any questions or ideas.