HHSC Dismisses Suggestions from Stakeholders on Changes to THSteps Caries Risk Assessment

Last Friday, the Health and Human Services Commission sent out a notice that it had "updated its Medicaid Medical and Dental Policy web page by posting stakeholder comments and HHSC responses for the THSteps Diagnostic Dental Services policy in development." TDMR had earlier promoted that providers should respond to the invitation to comment.  The agency wrote it had received comments from MCNA … [Read more...]

Arkansas Attorney General Announces Arrest for Medicaid Fraud Worth $846. Man Held on $2,500 Bail.

LITTLE ROCK, Ark. (Arkansas AG) – Arkansas Attorney General Leslie Rutledge announced the arrest of a Pulaski County man by the Attorney General’s Medicaid Fraud Control Unit. Myron Thrash, 35, of Little Rock was arrested on one count of Medicaid fraud. Thrash was booked into the Pulaski County Jail where he is being held on a $2,500 bond. He is accused of billing for services not rendered … [Read more...]

Nation’s Second-Largest Nursing Home Pharmacy to Pay $9.25 Million to Settle Kickback Allegations

Washington, DC - The nation’s second-largest nursing home pharmacy, PharMerica Corp., has agreed to pay $9.25 million to resolve allegations that it solicited and received kickbacks from pharmaceutical manufacturer Abbott Laboratories in exchange for promoting the prescription drug Depakote for nursing home patients.  PharMerica is headquartered in Louisville, Kentucky. “Elderly nursing home … [Read more...]

Texas Attorney General Civil Medicaid Fraud Unit Spent Over $6 Million And Used Up To 21 Lawyers Per Case On Questionable Medicaid Dental Cases

A document received from an open records request filed in early September shows that the Civil Medicaid Fraud division of the Office of Attorney General (OAG) has expended some 20,953 staff legal hours against 16 dentists and dental practices accused of Medicaid fraud from as far back as early 2012. TDMR filed the request because the Civil Medicaid Fraud unit is at odds with the current … [Read more...]

Audit Uncovers $124.7 B of Overpayments and Fraud in Medicare and Medicaid 

Congress and the President have two months to hammer out a budget before the country teeters on another fiscal cliff. One big issue is the $85 billion in spending cuts on defense and domestic programs imposed by the sequester. Some Republicans want roughly half of that restored for defense while Obama wants a similar amount  reinstated for domestic programs. Imagine how easy that would be if … [Read more...]

FBI: Houston Clinic Manager Guilty of Health Care Fraud

HOUSTON—The owner and operator of Elite P Care Medical Services has been convicted of conspiracy to commit health care fraud and health care fraud in a $1 million fraud scheme, announced United States Attorney Kenneth Magidson. Verona Spicer, 46, pleaded guilty today before United States District Judge Kenneth Hoyt. Spicer admitted that she hired a physician to sign patient medical documents at … [Read more...]

Jack Stick: I was ‘the whipping boy’

Jack Stick says he’s “the whipping boy,” the guy who became the face of the 21CT contract scandal as Texas officials pointed fingers and scrambled to save their own jobs. “I think in December of last year, people began to feel seriously threatened and scared,” Stick said during his first sit-down interview with reporters since he was forced to resign late last year from his job as top lawyer of … [Read more...]

Medicaid Cuts to Therapy Services For Disabled Kids Softened 

Following an outcry from dozens of state lawmakers, Texas’ top health agency announced Thursday it will make less drastic cuts than originally planned to a therapy program for children with disabilities, even if that means spending more than lawmakers budgeted for the program. Texas Health and Human Services Executive Commissioner Chris Traylor said in a letter to Texas Senate leadership that … [Read more...]

ADA brief: More children in Medicaid seeing a dentist – Dr. Bicuspid

The gap in dental care utilization in the U.S. narrowed between children enrolled in Medicaid and those with private dental benefits from 2005 to 2013, but a large gap remains between adults in those categories, according to a new research brief by the ADA Health Policy Institute. Source: ADA brief: More children in Medicaid seeing a dentist … [Read more...]

State health commission investigative leader visits RGV 

EDINBURG — The new head of the state health agency’s investigative division visited with stakeholders in Hidalgo County Wednesday to learn about local healthcare issues and promote his vision. Stuart Bowen Jr., inspector general for the Texas Health and Human Services Commission, took over Feb. 26 following his appointment by Gov. Greg Abbott and subsequent Senate confirmation. “I consider … [Read more...]

HHS-OIG: Medicare paid $30 million for untraceable ambulance rides

Medicare spent more than $30 million during the first half of 2012 on ambulance transports for patients that appear to be ghosts on paper, according to a new report released by the Office of Inspector General (OIG) Tuesday. The report revealed that ambulance companies were reimbursed for providing transportation to beneficiaries that did not receive Medicare services at any origin or … [Read more...]

Anatomy of a fraud bust: Collaboration creates efficiency

With more large-scale, multi-million dollar fraud schemes surfacing across the country, enforcement officials are utilizing Medicare Fraud Strike Force teams to dismantle entire fraud operations. Source: Anatomy of a fraud bust: Collaboration creates efficiency … [Read more...]


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