Find Corporate Waste

Category: Medicaid Fraud

  • Michigan Health Care Provider Ordered to Pay $334,807 to Settle False Claims Act Allegations

    Michigan Health Care Provider Ordered to Pay $334,807 to Settle False Claims Act Allegations

    In the Eastern District of Michigan, M&Y Care, LLC, a Michigan-based home health provider, has agreed to pay $334,807.20 to resolve allegations that it defrauded the Medicare and Medicaid programs by billing for services rendered by unqualified staff.

    According to the Department of Justice, M&Y Care caused the United States Government to be billed for services provided by unqualified staff. Using the incorrect CPT code, G0156, which refers to a home health aide, they defrauded the federal government for services at a reimbursement rate higher than the non-skilled rate to which their employees were entitled.

    The misconduct came to light thanks to a False Claims Act lawsuit filed under the law’s qui tam provisions. The investigation was prompted by a whistleblower complaint under the False Claims Act (FCA), showing the critical role private citizens play in holding corporations accountable for wasting our money.

    At Find Corporate Waste, we applaud this outcome and the whistleblower who made it possible. Every time a company siphons money from Medicare or Medicaid, they are not just defrauding a system—they are stealing from the sick, the elderly, and the taxpayer.

    We are committed to ensuring that fraud like this doesn’t go unanswered.

    If you have information about misconduct involving government programs or contracts, visit our page on how whistleblowers protect public funds. You might be the reason the next $300,000 gets returned to the American people.

    • Indian National Charged with Falsely Claiming U.S. Citizenship to Vote in 2024 Election

      An Indian national faces two federal charges for allegedly falsely claiming U.S. citizenship on a Minnesota voter certificate to cast a ballot in the 2024 general election.

    • Health Care Fraud Can Carry a Life Sentence When Patients Die

      Did you know? Federal health care fraud can carry a life sentence when the fraud results in a patient’s death. Under 18 U.S.C. § 1347, knowingly and willfully executing—or attempting to execute—a scheme to defraud a health care benefit program can ordinarily result in up to 10 years in federal prison. But the penalties escalate…

    • Pennsylvania Medical Supplier Billed $1.3B in Five Months, DOJ Says

      ND Medical Solutions allegedly submitted $1.3 billion in fraudulent claims within five months and transferred insurance proceeds overseas.

    • Mount Sinai Reaches DOJ Agreement Amid False Claims Act Investigation

      Mount Sinai Health System has reached an agreement with the Justice Department resolving a federal investigation into its provision of gender-transition procedures to minors. Under the agreement, Mount Sinai will stop providing puberty blockers, cross-sex hormones and surgical procedures to minors. The health system will also pay a monetary penalty and dedicate $2 million to…

    • Complete Health Pays $14.1M Over Inflated Medicare Advantage Diagnoses

      Complete Health allegedly pushed unsupported mental health and substance-dependence diagnoses that increased Medicare Advantage payments. A former risk-adjustment executive will receive nearly $2.5 million for exposing the scheme.

    • Boston Eye Practice to Pay $3.9M Over Unsupported Medicare Billing

      Ophthalmic Consultants of Boston will pay nearly $3.9 million to resolve allegations that it improperly billed Medicare and MassHealth for office visits performed alongside eye injections.

    • Abusive Michigan Day Care Owner Billed Medicare for Dead Patients

      New Beginnings Adult Center owner Yolanda Matthews admitted billing Medicare more than $539,000 for nonexistent psychotherapy, including claims for hospitalized and deceased patients

    • NYC Correction Officers Among Defendants in $3M Fake Check Scheme

      Current and former NYC government employees allegedly helped deposit more than $3 million in fraudulent checks, generating over $500,000 in proceeds.

    • Dallas Lab and Founders Pay $24M Over COVID Testing Claims

      Magnolia Diagnostics, its owners and investors will pay $24 million to resolve allegations involving medically unnecessary respiratory testing billed to Medicare.

    • Brooklyn Adult Day Care Owner Gets 57 Months for $3.2M Medicaid Fraud

      Prime Life owner Eric Zhu was sentenced to 57 months in prison for billing Medicaid $3.2 million for adult day care services never provided.

  • DOJ-HHS Launch New Initiative to Combat Healthcare Fraud

    DOJ-HHS Launch New Initiative to Combat Healthcare Fraud

    July 2, 2025

    Washington, D.C.


    In a decisive move to enhance the fight against healthcare fraud, the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS) have taken significant action. They have launched the DOJ-HHS False Claims Act Working Group.

    This strategic alliance formalizes long-standing cooperation between the two agencies.

    It also shows how the False Claims Act (FCA) is used. This law protects federal healthcare programs from fraud, waste, and abuse.

    The Working Group will concentrate enforcement in seven key areas:

    • Medicare Advantage fraud, such as upcoding and inflated risk scores
    • Drug and device pricing manipulation, such as undisclosed rebates and improper discount arrangements
    • Access to care violations, including non-compliant provider networks
    • Kickback schemes, involving drugs, medical devices, and durable medical equipment
    • Defective medical devices that compromise patient safety
    • Electronic Health Records abuse, such as system manipulation to boost Medicare billing
    • Data-driven investigations, powered by cross-agency analytics and audit findings

    The new Working Group encourages whistleblowers to report false claims involving federal healthcare dollars related to specific enforcement priorities.

    At Find Corporate Waste, we spotlight whistleblower-driven accountability.

    If you become a relator under the False Claims Act, your role would expose fraud and recover taxpayer dollars.

    Becoming a relator is a serious decision.

    If you have inside information on healthcare contracts or schemes, we’re here to assist you.

    Report Fraud

  • How States Game the System: Medicaid Fraud and the FMAP Loophole

    Medicaid was originally created as a partnership between the federal government and individual states. The concept was simple: every time a state spends a dollar, the federal government matches a portion of that investment.

    This is known as the Federal Medical Assistance Percentage (FMAP).

    Over time, some states discovered a way to manipulate the system by shifting the burden entirely to the federal government while padding their own budgets.

    How Medicaid Fraud Works

    1. The state taxes hospitals or nursing homes.
    2. The state pays this tax back to the provider as Medicaid reimbursements.
    3. The federal government matches a percentage of the returned funds through FMAP.
    4. The provider gets their money + the FMAP.
    5. The state contributes nothing, while the federal government is on the hook.

    Why It All Adds Up to a Big Problem

    This fraud is one of the major factors contributing to the systemic weakness of our entire healthcare system.

    When states are allowed to run these schemes, Medicaid becomes more expensive, draining money away from the people who actually need help.

    Instead of creating a safety net, the system becomes a slush fund for state coffers—and the federal government (read: taxpayers) gets stuck with the tab.

    At Find Corporate Waste, we dig deep into these kinds of backdoor deals because we believe in a system that’s honest, accountable, and actually works for the people it’s supposed to serve. Not one that lets bureaucrats and politically connected hospitals game the rules for a payday.

    But here’s the thing—we can’t do it alone.

    If you’ve seen this kind of scheme from the inside—maybe you work in healthcare, government, or finance—you might be sitting on information that could make a real difference. Thanks to the False Claims Act, whistleblowers who step forward not only help protect public funds—they may also be eligible for a financial reward if the government recovers money based on their tip.

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