FBI — DME Owner Heads to Prison for Multiple Counts of Health Care Fraud

HOUSTON—Andrea Michelle Tellison, 47, has been ordered to federal prison for eight years following her convictions of 14 counts of health care fraud and seven counts of aggravated identity theft, announced United States Attorney Kenneth Magidson. A jury convicted Tellison April 2, 2014, following three days of trial and less than two hours of deliberation. Today, U.S. District Judge Lee … [Read more...]

Texas CEO Magazine – Medicaid Waste, Fraud and Abuse in the World of Managed Care

To understand waste, fraud and abuse of taxpayer dollars in the Medicaid system, let’s begin with a couple of basics on what the role of Medicaid is in health care and how it works. Medicaid Basics Medicaid is a program for people who cannot afford health care that is dually funded by both the federal government and states. (Medicaid is different than Medicare, which has no state dollars and … [Read more...]

House Human Services Committee to Hear Testimony on SB 1803 Next Week

Austin Texas Capitol

The Texas House of Representatives Committee on Human Services has announced that it will be holding a public hearing on Wednesday, September 3rd, which will include hearing testimony regarding the effectiveness of SB 1803 and changes that should be made to the legislation to improve it.  TDMR had requested such a hearing. The Committee is chaired by Rep. Richard Peña Raymond. The official … [Read more...]

Texas DSO raises $2.5M to buy dental practices | Dr. Bicuspid

August 27, 2014 -- Newly formed dental service organization (DSO) Modern Dental Services (MDS) of Dallas has raised $2.5 million in private equity to purchase dental practices from older practitioners and use them as job opportunities for new dentists. Backed by 21 investors, MDS founders Matt Hale and David Lohmann want to "bridge the generational gap" in the dental industry, according to a … [Read more...]

State Again Sues “Reckless and Irresponsible” Xerox for Possible HIPAA Violations


The state is suing Xerox for a second time, afraid the company's recent actions in withholding a large number of documents relating to its tenure as the state's primary Medicaid claims administrator will lead to millions of dollars of federal fines against the state due to HIPAA violations. This morning HHSC issued a press release (see below) announcing that Xerox is being sued for failing to … [Read more...]

Texas settles $16M Medicaid fraud case for $39K | Dr. Bicuspid

August 26, 2014 -- Texas health officials have accepted a $39,211 settlement from an Austin dental practice that had been charged with improperly billing more than $16 million in orthodontic Medicaid claims. Glenn Wood, MD, who owns Carousel Pediatrics, disputed fraud allegations made against his clinics by Texas investigators. He claimed that losses of about $400,000 a month in Medicaid … [Read more...]

Janek accuses Xerox of “reckless” misuse of Medicaid data | Dallas Morning News

Texas Medicaid officials, already in a legal battle with Xerox Corp. over the company’s alleged failure to prevent widespread dental fraud, filed another lawsuit Tuesday accusing Xerox of improperly taking large quantities of medical records and not protecting patients’ confidentiality.The state Health and Human Services Commission said it filed a lawsuit in state district court in Austin seeking … [Read more...]

Mississippi State Medicaid Fraud Control Unit: 2014 Onsite Review Report (OEI-09-13-00700) 08-25-2014

SummaryWHY WE DID THIS STUDYOIG oversees the activities of all State Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit compliance with Federal grant requirements.HOW WE DID … [Read more...]

State Settles $16 Million Medicaid Fraud Case for Less Than $40,0000


In a stunning reversal of their previous hard-line stance, State regulators have settled a high profile "fraud" case for less than a penny on the dollar. Trueblood Dental Associates, an Austin dental practice with four locations and a high percentage of Medicaid patients, was originally charged with over $16 million dollars (Letter from OIG re Final Notice of Overpayment 7-31-2013) in Medicaid … [Read more...]

Doug Wilson Tells Senators “We lift payment holds all the time.” Really?


Texas Health and Human Services Commission Inspector General Doug Wilson told Sen. Judith Zaffirini and other members of the Senate Committee on Health and Human Services at their August 14th hearing on Medicaid fraud, waste and abuse that his agency lifts payment holds on an ongoing basis when the provider produces evidence otherwise. This is certainly not the situation when the State Office … [Read more...]


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