healthcare fraud Archives

30
Sep

healthcare fraud

The Prior Authorization Paradox in Healthcare Fraud

Randall Casciello / September 30, 2026
0

Prior authorization was supposed to be a main abuse control for healthcare. Yet at the same time Medicare rolled out preauthorization, the Centers for Medicare and Medicaid Services (CMS) cut reimbursement for wound grafts from tissue banks from $1,450 to $127 per square centimeter, and launched an AI-assisted prior authorization pilot in the same stretch. […]

20
Aug

Inside Gray Zone Fraud, AKA ‘Its Not Fraud, Just Coding’

Randall Casciello / August 20, 2026
0

Gray zone fraud is one of the trickiest and most costly, and also most undetected healthcare fraud schemes in the industry. These unsavory billing practices are so gray that they are not always flagged as fraudulent. The Centers for Medicare and Medicaid Services (CMS), in fact, even after recognizing $28.8 billion in Medicare FFS improper […]

07
Jun

Billing Identity Theft: When Healthcare Providers Become Victims

Randall Casciello / June 7, 2026
0

Healthcare fraud is usually focused on how the providers perpetrate the theft and less on how they are also victims – of billing identity theft. A less talked about crime, billing identity theft is when service provider credentials are used as a means for crooks to perpetrate their crimes against healthcare payers. Fraudsters hijack a […]

11
May

DME Fraud: The Undead Zombie of Healthcare Fraud

Randall Casciello / May 11, 2026
0

Durable Medical Equipment (DME) consists of things like knee braces, back braces, glucose monitors, wheelchairs, and any other medical equipment prescribed for a patient. For providers, prescribing and distributing DME is not a one-time transaction, they are healthpayer billing streams. Unlike other healthcare services provided, such as fee-for-service, DME offers providers high reimbursement rates, repeatable […]

07
Apr

How Telehealth Became the Perfect Vehicle for Fraud

Randall Casciello / April 7, 2026
0

Until telehealth, there may never have been a better example of the fraud axiom that everything we do to make it easier for the consumer also makes it easier for the crooks. Telehealth was supposed to be the key to unlock access to health care, replacing waiting rooms with video calls and having prescriptions written […]

08
Mar

‘The Fraud Supply Chain’: How Healthcare Fraud Is Industrialized

Randall Casciello / March 8, 2026
0

Healthcare fraud has evolved beyond the image of lone individuals falsifying claims or inventing phantom treatments into full-on fraud factories with supply chains. Today’s schemes resemble sophisticated, multi-faceted organized businesses: specialized teams handle lead generation, patient recruitment, shell clinics, complicit providers, billing aggregation, and money laundering. In 2025 alone, a coordinated National Health Care Fraud […]

09
Feb

Why Healthcare Still Accepts Fraud Levels Other Industries Wouldn’t

Randall Casciello / February 9, 2026
0

Healthcare fraud losses remain orders of magnitude higher than what financial services would tolerate for comparable transaction volumes. In banking, sustained fraud measured in basis points triggers executive escalation, regulatory scrutiny, and rapid control changes. In healthcare, materially larger losses have historically been treated as an unfortunate but expected cost of doing business. In this […]

The Prior Authorization Paradox in Healthcare Fraud

Inside Gray Zone Fraud, AKA ‘Its Not Fraud, Just Coding’

Billing Identity Theft: When Healthcare Providers Become Victims

DME Fraud: The Undead Zombie of Healthcare Fraud

How Telehealth Became the Perfect Vehicle for Fraud

‘The Fraud Supply Chain’: How Healthcare Fraud Is Industrialized

Why Healthcare Still Accepts Fraud Levels Other Industries Wouldn’t

2nd Revolut Breach in a Month,.

FTC Fines Payments Processors $17M for.

Scanovate, a Digital Identity Company, Acquired.

Revolut Accidentally Shares Customer Data with.

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