Texas Court Strikes Down Medicaid Payment Hold Rules – Law360

Law360, Dallas (November 25, 2014, 5:55 PM ET) -- A Texas appeals court on Tuesday invalidated three Texas Health and Human Services Commission rules related to payment holds imposed during Medicaid fraud investigations, holding they violate due process rights. The Third Court of Appeals invalidated rules authorizing the Office of Inspector General to impose a pre-payment or post-payment hold … [Read more...]

Court: State wrongly withholding millions from dentists – Houston Chronicle

AUSTIN - Texas officials have been illegally withholding millions of dollars from dozens of dentists and orthodontists based on only the suspicion of minor wrongdoing, an appeals court ruled Tuesday, dealing another blow to the state's beleaguered unit charged with rooting out Medicaid fraud and abuse. The 3rd District Texas Court of Appeals ruled the state only can withhold payments for … [Read more...]

Texas Medicaid regulators hit with legal setback | www.mystatesman.com

The Texas agency charged with investigating health care fraud suffered a serious setback Tuesday, when a state appeals court ruled that the Health and Human Services Commission’s Office of Inspector General’s expansive use of a key tactic — withholding Medicaid payments from doctors it investigates — was illegal. The 3rd Court of Appeals found the agency had improperly expanded a law allowing … [Read more...]

Court Sides with Medicaid Dentists and Negates HHSC-OIG Rules on Medicaid Payment Holds for Program Violations

Scales of Justice in the Courtroom

Today, the Texas 3rd Court of Appeals overturned a lower court decision and negated Health and Human Services Commission rules that allow for the Office of Inspector General to place Medicaid payment holds in certain circumstances, basically for only program violations not fraud,  and then keep the funds to offset alleged overpayments by the provider. A copy of the decision is here - 3rd Court … [Read more...]

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...]


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