No-bid Texas Medicaid fraud contracts raising questions | www.mystatesman.com

As Texas’ top health officials steer $110 million in no-bid contracts to an Austin tech company they say is revolutionizing Medicaid fraud investigations, the state’s top contract manager says those contracts are too loosely written and raise questions about what taxpayers are receiving in return.“It’s just so generic,” said Mary Cheryl Dorwart, a top contract official at the Department of … [Read more...]

Government turns up the heat with the False Claims Act – 5 action steps for healthcare providers | DLA Piper – JDSupra

Forbes magazine has dubbed 2014 “The Year of the Whistleblower.”  For healthcare providers, this designation has translated into millions of dollars in fines and penalties and the initiation of criminal investigations. Just last month, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), settled a whistleblower-initiated lawsuit filed against a healthcare provider for $350 … [Read more...]

Justice Department Recovers Nearly $6 Billion from False Claims Act Cases in Fiscal Year 2014

First Annual Recovery to Exceed $5 Billion; Over 700 Whistleblower Lawsuits for Second Consecutive Year The U.S. Department of Justice obtained a record $5.69 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending September 30, Acting Associate Attorney General Stuart F. Delery and Acting Assistant Attorney General … [Read more...]

Gov. Perry Appoints Tillman and Zimmerman to Texas State Board of Dental Examiners

Gov. Rick Perry has appointed David Tillman of Aledo and Jason Zimmerman of Keller to the Texas State Board of Dental Examiners. The board oversees licensing and regulation of dental care providers in Texas, and enforces Texas laws regulating the practice of dentistry. Tillman is a general dentist in private practice in Fort Worth. He is a fellow of the American and International colleges of … [Read more...]

Extendicare to Settle Nursing Home Fraud, Negligence Claims for $38M

One of the nation’s largest nursing home chains will pay $38 million to settle federal claims that the company inappropriately billed for physical therapy and provided poor care that was “effectively worthless,” the Department of Justice reported. The agreement reached in October 2014 is the largest failure of care settlement with a nursing chain in DOJ history and involves the attorneys … [Read more...]

Feds allege Georgia pair defrauded Medicaid-Medicare for millions

Two Georgia health care clinic operators are wanted on 24 federal charges of health care fraud after law enforcement officials said the pair bilked Medicaid and Medicare of millions in false claims. Miguel Angel Hernandez and Maria del Pilar Moreira also face an additional charge of conspiracy to commit health care fraud, U.S. Attorney Sally Yates’ office said Wednesday. The defendants’ … [Read more...]

Medicaid inspector general to leave Cuomo administration

ALBANY—The state's Medicaid Inspector General, James Cox, will join a number of first-term Cuomo appointees who are departing the administration. Cox, who was appointed in July 2011 by Governor Andrew Cuomo to head the Office of Medicaid Inspector General, emailed a memo to his department on Tuesday announcing his departure, saying the office would conduct a national search for his replacement. … [Read more...]

TDMR Requests External Review of All OIG Cases Based on Sunset Commission Public Hearings

THHSC building

In a letter to the Texas Sunset Advisory Commission, TDMR President Gregory Ewing has recommended, based on the testimony in the public hearings held last week, that all pending OIG cases be stayed for external review. All pending cases should be stayed pending external review of case tampering The letter in part reads: After hearing the testimony of Ms. Arlene Wohlgemuth and the attendant … [Read more...]

CFO Pleads Guilty to HITECH Act Fraud – GovInfoSecurity

A former CFO at a now-shuttered hospital has pleaded guilty to submitting false documents so the medical center could receive $785,000 in payments under the HITECH Act  electronic health records financial incentive program. Some legal experts predict that more federal prosecutions of HITECH Act fraud  under the EHR "meaningful use" program are likely. On Nov. 12, Joe White, 67, of … [Read more...]

Texas nearing $90M deal on Medicaid fraud detection software | Dr. Bicuspid

November 18, 2014 -- The Texas agency charged with investigating Medicaid fraud is finalizing a $90 million contract for Medicaid fraud detection software. of software licenses and services from the company, 21CT, according to a statesman.com story . Austin-based 21CT is a federal defense contractor that had no experience with Medicaid before 2012, when the company was asked to use its Torch … [Read more...]

OIG “All Messed Up” – Videos from Texas Sunset Advisory Commission Public Hearings Online

Austin Texas Capitol

Last Thursday, November 13th, the Texas Sunset Advisory Commission held public hearings about its staff report on the Texas Health and Human Services Commission that was released in October. The Commission heard over nine straight hours of submissions from various individuals and organizations from across the state on the 15 major issues delineated in the report. The two issues relating to the … [Read more...]

Department of Health and Human Services OIG Releases 2015 Work Plan | The National Law Review

The United States Department of Health and Human Services ("HHS") Office of Inspector General ("OIG") released its Fiscal Year 2015 Work Plan ("2015 Plan") on October 31, 2014. OIG releases a work plan annually to identify the new and ongoing investigative, enforcement and compliance activities that it will undertake during that fiscal year ("FY"). Takeaways From OIG's Work Plan When … [Read more...]

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