New leadership takes over Texas health watchdog office – Houston Chronicle

AUSTIN -- The Texas health commission's new inspector general has brought with him a team of aides from the private sector, ushering in a new era of leadership at the embattled agency in charge of rooting out waste, fraud and abuse in health and human services in the state. Stuart Bowen, a former special inspector general for Iraq reconstruction who was confirmed by the state Senate last month, … [Read more...]

State Medicaid Systems Need Improvement – GAO | CivSource

A new report out from the GAO suggests that state IT systems may not be up to snuff when it comes to judging Medicaid eligibility. The March 2 report says that even while some states have recently updated Medicaid Management Information Systems (MIMS), there is no requirement for state officials to track the effectiveness of those systems. As such, it is unclear whether updates were actually … [Read more...]

A Physician May Violate Anti-Kickback Laws Even Without Steering Patients To A Specific Provider – Food, Drugs, Healthcare, Life Sciences – United States

The United States Court of Appeals for the Seventh Circuit recently issued an interesting decision concerning the definition of "referral" in the context of federal anti-kickback laws. See U.S. v. Patel, No. 14–2607, 2015 WL 527549 (7th Cir. 2015).  In the Patel matter, the United States charged a Chicago-area physician with violating and conspiring to violate the Anti–Kickback Statute, 42 U.S.C. … [Read more...]

Texas’ Controversial State Purchasing Program Likely to be Revamped, Officials Predict

(Tribune News Service) -- The popular state purchasing program that played a role in a $110 million no-bid contract now engulfed in scandal is likely to be revamped during this year's legislative session, officials predicted this week. "We're going to have to do something to make sure we have transparency and best practices," said state Rep. Gary Elkins of the Cooperative Contracts program, … [Read more...]

N.Y. Seeks Medicaid Contract Extension With Computer Sciences – Bloomberg Business

(Bloomberg) -- New York state is seeking to extend a contract with Computer Sciences Corp. to run its Medicaid computer system because a deal for Xerox Corp. to take over the program is stalled. The length of the extension is still being negotiated, though it will reflect the time needed for Xerox’s five-year, $500 million contract to be finished, Jeffrey Hammond, a state Health Department … [Read more...]

New Sheriff Arrives at Troubled Health Agency | The Texas Tribune

The new chief watchdog for the embattled Texas Health and Human Services Commission told lawmakers Monday he plans to right the department rocked by a contracting scandal by focusing not just on Medicaid and food stamp fraud, but all types of inefficiencies that waste taxpayer dollars in the $37 billion state social services empire. "This mission is fraud, waste and abuse. Not fraud, only," new … [Read more...]

Weslaco Health Care Compliance Seminar a Success – Seminars in Dallas, Houston To Be Held

Full seminar

This past Friday, TDMR and the Medicaid Providers Alliance held a successful health care compliance seminar at the Knapp Medical Conference Center in Weslaco. A room-capacity 72 dental providers attended and were informed that the Academy of General Dentistry had just a few days before approved the seminar for three hours of continuing education credit. Health care compliance programs … [Read more...]

Former Ethics Commission Director Joins HHSC

AUSTIN – Former Texas Ethics Commission Director David Reisman has joined the Texas Health and Human Services Commission as chief ethics officer. "I created this position to help increase our emphasis on ethical behavior," said HHSC Executive Commissioner Kyle Janek. "As public servants, we must hold ourselves and our programs to high standards. We want strong policies, a good … [Read more...]

Delaware legislators pan Medicaid efforts to reduce waste

DOVER, Del. (AP) - Legislative budget writers grilled Delaware Medicaid officials Wednesday on delays in a program aimed at reducing waste, fraud and abuse, and about the lack of access by thousands of Medicaid enrollees to the state’s only children’s hospital. With the state facing a tight budget year and the Joint Finance Committee trying to balance a $3.9 billion operating budget proposed by … [Read more...]

Former Owner of Houston Durable Medical Equipment Company Pleads Guilty in $5 Million Health Care Fraud Scheme

Washington, DC—(ENEWSPF)—February 24, 2015. A Miami man pleaded guilty today to health care fraud charges in connection with a $5 million scheme to defraud Medicare. Angel M. Mirabal, 62, of Miami, Florida, pleaded guilty to one count of conspiracy to commit wire fraud and health care fraud before U.S. District Judge Marcia G. Cooke of the Southern District of Florida.  A sentencing hearing is … [Read more...]

79-Year-Old NJ Woman Indicted for Stealing Elderly Cousin’s Nursing Home Fund to Buy $214,000 Worth of Lottery Tickets – Bergen Dispatch

Acting Attorney General John J. Hoffman and the Office of the Insurance Fraud Prosecutor (OIFP) announced that a 79-year-old woman was indicted today for allegedly stealing approximately $214,000 from an account she managed on behalf of her elderly cousin, using the stolen funds to purchase lottery tickets, most of which were scratch-offs, instead of paying her relative’s nursing home bill.Doris … [Read more...]

Texas dentist wins defamation suit against former office manager | Dr. Bicuspid

February 20, 2015 -- A Texas dentist has won a defamation lawsuit against a former office manager who had accused the dentist of improper billing practices.Texas dentist Sweeta Walia, DMD, of Premier Family Dental of Plano, won a judgment against former office manager Shelly Hamnett, who did not appear for an August 2014 court date.A judge in Collin County awarded Dr. Walia $35,000 in damages … [Read more...]

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