FBI at Health Commission Asking About 21CT | The Texas Tribune

HHSC Executive Commissioner Kyle Janek

by Terri Langford and Aman Batheja, The Texas Tribune FBI agents have interviewed employees at the Texas Health and Human Services Commission about its problematic contract with Austin firm 21CT, Executive Commissioner Kyle Janek told The Texas Tribune, marking the first time an official with direct knowledge of the federal probe has confirmed it. “I can tell you what I know. I’ve heard … [Read more...]

Xerox and HHSC Both Fouling Up Like Crazy on Contracts Again

xerox -hhsc

These two organizations can't seem but foul up in Texas. Both are again under the gun for their contract performance - Xerox with the Texas Department of Transportation (TXDOT) and the Health and Human Services Commission for contract irregularities with privatizing the Terrell State Hospital. Xerox got TXDOT contact while in Medicaid mess Xerox is taking heat because it is fouling up the … [Read more...]

Is Health Care Fraud on the Rise? Or Just the Accusations?? | Williams Mullen – JDSupra

Recent stories in the news seem to suggest that health care fraud is running rampant.  We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in Greensboro for alleged Medicaid fraud, and, in Charlotte, a man was charged with Medicaid fraud and sentenced to three years under court supervision and ordered to pay $3,153,074. … [Read more...]

Ohio ignored hundreds of Medicaid fraud cases, gave funds to shady providers | WashingtonExaminer.com

Ohio's Medicaid office searched for ways to continue paying hundreds of healthcare services providers after uncovering "credible allegations of fraud," violating the Affordable Care Act. The state agency came up with "good cause" to continue funneling money to providers strongly suspected of fraud in 321 of the 401 cases that arose between July 2011 and June 2013, according … [Read more...]

Texas Ditches Plan to Privatize Terrell State Hospital | The Texas Tribune

A plan to privatize Terrell State Hospital is dead following a scathing audit that raps the state health commission for bypassing its own contracting procedures.The Texas Health and Human Services Commission canceled the deal — which was still being negotiated — immediately following the Wednesday release of a report by Texas State Auditor John Keel, commission spokeswoman Stephanie Goodman … [Read more...]

House Ways and Means Subcommittee on Oversight Hearing

Good morning, Mr. Chairman and distinguished Members of the Subcommittee. Thank you for the opportunity to testify about fraud, waste and abuse in our Medicare program. My experience working in law enforcement and private practice has taught me that, notwithstanding improvements in enforcement techniques over the past ten years, Medicare remains vulnerable to criminals intent on stealing. Further, … [Read more...]

Ohio Did Not Always Comply With the Requirements of the Affordable Care Act in its Review of Cases of Credible Allegations of Medicaid Fraud Audit (A-05-14-00008) 03-09-2015

The State agency did not always comply with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud between July 1, 2011, and June 30, 2013. Of the 401 cases for which it found credible allegations of fraud by Medicaid providers, the State agency provided good cause to not suspend payments in 321 cases. For the remaining 80 cases, the … [Read more...]

OIG: CMS not doing enough to fight fraud, waste and abuse – FierceHealthPayerAntiFraud

Improper Medicare payments and fraud populated the Office of Inspector General's (OIG) list of the top 25 unimplemented recommendations, according to a report from the watchdog agency that offered insight into where the Centers for Medicare & Medicaid Services (CMS) still needs to take action to eliminate fraud, waste and abuse. The OIG cited previously identified problems with … [Read more...]

Pay Up or Go Bankrupt: The Smile Magic Settlement


The news that Smile Magic Dental clinics recently settled with the Texas Health and Human Services Commission Office of Inspector General over allegations of Medicaid fraud confirms what TDMR has been saying for a long time – that the purpose of the large volume of orthodontic and dental fraud allegations against Medicaid dentists has been to either force them into bankruptcy or extort large … [Read more...]

Overhaul of Texas health and human services draws ire at… | www.mystatesman.com

A package of bills to overhaul the state’s clunky health and human services system drew more than three hours of testimony before a Senate panel on Monday, the latest airing of concern across varied interest groups who fear losing access to services and transparency under a centralized agency. The controversial plan to consolidate five similar but distinct agencies into one was curtailed last … [Read more...]

HHS announce over $27.8 billion in returns from joint efforts to combat health care fraud

More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control (HCFAC) Program, Attorney General Eric Holder and HHS Secretary Sylvia M. Burwell announced today.  The government’s health care fraud prevention and enforcement efforts recovered $3.3 billion in taxpayer dollars in Fiscal Year (FY) 2014 from individuals and companies that … [Read more...]

Post-Scandal, Lawmakers Changing Gears on Health Agency | The Texas Tribune

by Edgar Walters, As the state’s largest health agency reels from a scandal over how it awarded contracts to private vendors, lawmakers on Wednesday said they are slowing down on their ambitious — and controversial — plan to restructure it. A panel of lawmakers and citizens last year recommended that the state’s five health and human services agencies, including … [Read more...]


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