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.

    • Brooklyn Clinic Manager Convicted in $8M Medicare Fraud Scheme

      A New York clinic manager was convicted in an $8 million Medicare fraud scheme built on patient kickbacks and falsified physical therapy records.

    • $56.5M Settlement Targets Medicare Diagnosis Codes Scheme

      Matrix Medical Network, HealthFair, and HealthFair’s founder agreed to pay $56.5 million to resolve False Claims Act allegations over unsupported Medicare Advantage diagnosis codes

    • Contractors to Pay $3.6M Over False Veteran-Owned Small Business Certification

      Two government contractors agreed to pay more than $3.6 million to resolve allegations tied to service-disabled veteran-owned small business set-aside contracts, with the whistleblower set to receive more than $680,000.

    • Louisiana Woman Pleads Guilty in PPP Kickback Scheme

      A Louisiana woman admitted to helping recruit ineligible PPP borrowers, create fake tax forms, and collect kickbacks tied to fraudulent pandemic-relief loans.

    • Colombian Woman Sentenced After Stolen Identity Scheme Tied to Voter Fraud and $404K in Benefits

      Colombian national sentenced after prosecutors say a stolen identity was used for voter fraud, federal benefits, Massachusetts IDs, and a passport application.

    • Hawaii Housing Official Sentenced In $11M Affordable Housing Bribery Scheme

      A former Hawaii County housing official received 46 months in prison after the DOJ said affordable housing agreements worth more than $11 million produced no housing units and nearly $1.93 million in bribes and kickbacks.

    • Delco Woman Pleads Guilty in $7.17M EIDL Fraud-Proceeds Laundering Scheme

      Pennsylvania woman pleads guilty in $7.17M laundering conspiracy tied to fraudulent EIDL proceeds, business email compromise funds, and sham company accounts.

    • Oglethorpe Pays $32M Over Medicare Overpayment Allegations

      Oglethorpe and top executives agreed to pay $32 million over Medicare overpayment allegations tied to psychiatric hospital admissions.

    • Georgia Man Gets 37 Months in $441K COVID Relief Fraud Case

      Brian Graham was sentenced to 37 months and ordered to pay more than $441,000 after prosecutors said he used false PPP and EIDL applications for personal benefit.

    • Brooklyn Clinic Owner Convicted in $52M Health Care Fraud and Kickback Scheme

      Brooklyn clinic owner Tony Brown-Arkah was convicted in a $52 million Medicare and Medicaid fraud scheme involving Suboxone diversion, kickbacks, and false billing.

  • 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.

  • 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 fundsthey may also be eligible for a financial reward if the government recovers money based on their tip.

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