Steven Powell, a psychiatrist living in Georgia, has been sentenced to a year and a day in prison for his role in a $1.9 million Medicare fraud scheme. Powell signed medically unnecessary orders for braces for more than 500 beneficiaries without examining patients, enabling suppliers to submit about 1,400 false claims, prosecutors said. He was ordered to pay $761,202.75 in restitution after pleading guilty to healthcare fraud.

Seven people have been charged in Rhode Island Superior Court with Medicaid fraud totaling more than $1 million. The charges stem from various alleged schemes, including submitting false claims for services not rendered and billing for transportation services without proper insurance or registration.

Jose Llerena of Miami pleaded guilty to conspiracy to distribute a controlled substance after authorities said he played a role in a scheme to distribute more than 87,000 oxycodone pills. Prosecutors said that as a "patient recruiter," Llerena paid people to pose as patients and obtain illegal prescriptions for oxycodone from South Florida clinics and doctors, which a co-conspirator filled.

HealthTap, a virtual primary care provider, has launched a program to help positive airway pressure equipment suppliers connect patients who may have sleep disorders to physicians for clinical exams, documentation and orders. The program supports positive airway pressure therapy from initial evaluation to device replacement.

A survey by eHealth found that 60% of Medicare beneficiaries plan to use AI tools to review their options during open enrollment. AI can streamline plan comparisons and help beneficiaries find relevant information quickly, but human oversight is essential to ensure accuracy and keep information up to date, said Whitney Stidom, vice president of consumer enablement at eHealth. "It's definitely not a year to be on autopilot if you're a Medicare beneficiary," Stidom said. "You're going to need to pay attention."

The Cigna Group expects to save $3 billion by 2030 by modernizing operations, including streamlining workflows, using AI tools, focusing on subscribers with complex healthcare needs and engaging in "disciplined supplier and vendor management," according to CEO Brian Evanko. Some of the savings will be reinvested in growth initiatives, and some will go to earnings growth. The insurer is already using AI for specialty pharmacy benefit reviews and to assist care managers, among other uses.

NHCAA's platinum, premier and supporting members are leading providers of products and services to the health care anti-fraud industry, are valued partners who support our mission and have demonstrated outstanding commitment to the fight against health care fraud. Visit our Become a Member page for more information and to apply.

NHCAA's Platinum and Premier Supporting Members are leading providers of products and services to the health care anti-fraud industry, are valued partners who support NHCAA's mission, and have demonstrated outstanding commitment to the fight against health care fraud. Learn more about these companies on the Fraud Solutions Directory.