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...]

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...]

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...]

$90 Million Software Identifies $41 Million in Potential Medicaid Fraud in 2014

texas state emblem in capitol

The Austin American Statesman reported this weekend that the Texas Health and Human Services Commission Office of Inspector General is finalizing a deal with an Austin company for Medicaid fraud detection software. The company involved, 21CT, is primarily a defense contractor and their "Torch" software that detects Medicaid fraud was only developed at the request of OIG in 2012 per the … [Read more...]

“We Have Lost Confidence in Your Office” – OIG Under the Gun at Sunset Commission Hearings

sunset commission2

The Texas Sunset Commission held public hearing both Wednesday and Thursday this week on the Health and Human Services Commission as well as its beleaguered Office of Inspector General.  Sunset and HHSC staff testified on Wednesday about the recent Sunset Commission staff report on HHSC which was scathing about the performance of OIG.  Public testimony was heard yesterday. Loss of … [Read more...]

Accountant Tells Tale of New Hampshire Dentist Charged with Medicaid Fraud over $781

Texas Medicaid fraud

TDMR is republishing this very descriptive and apt blog post. A Senseless Fraud Prosecution Victimized Doctor And Patients by Larry M. Elkin, CPA, CFP® In the complicated world of medical and dental care, billing mistakes happen. Add a complicated government program such as Medicaid, and they are practically inevitable. Yet a New Hampshire dentist recently discovered that mistakes … [Read more...]

New Mexico Senator Proposes Forefront State Legislation to Provide Due Process to Providers Accused of Fraud

court of law

From the blog of Knicole Emanuel, a NC Medicaid attorney. Whew…the election is over. No more political ads, emails, and other propaganda… Ok, so we have our new elected officials, now our new elected officials need to pass some new legislation protecting providers when it comes to “noncredible allegations of fraud.” Due Process…It’s such a fundamental part of our society that we rarely … [Read more...]

Document Shows Bankruptcy of Medicaid Providers With Alleged Overpayments Viable State Strategy

US Capitol in Washington

This past week, the Texas Health and Human Services Commission published on their website a circular about the process for audits being done by the Centers for Medicare and Medicaid Services (CMS) on Medicaid providers in Texas. All Medicaid providers in the state can be subjected to federal Medicaid Integrity Program audits. The circular is entitled "HHS Guidance for Resolution of CMS Medicaid … [Read more...]

Outside Firm Being Brought in to Review OIG Investigative, Sampling and Extrapolation Processes

wilson testimony

The latest edition of the Texas Health and Human Service Commission's online newsletter InTouch says that OIG is bringing in an outside firm to review its investigative, sampling and extrapolation processes in light of the recent scathing Sunset Commission staff report on OIG. No company was named. Inspector General Doug Wilson is quoted: "It's our duty to safeguard taxpayer dollars, and we … [Read more...]

Agenda for Sunset Commission Public Hearings on HHSC Now Online

sunset commission2

The Sunset Commission has set out their agenda for the upcoming public hearings on the Texas Health and Human Services Commission to be held on Wednesday and Thursday, November 12 and 13. Meeting materials will be available on the Sunset Commission website, Friday, November 7. The meeting will be broadcast live on the Internet on the Senate website. Persons with disabilities who plan to … [Read more...]

Texas Rangers Investigating OIG and Firing of Actuary

hhsc rangers2

The Texas Rangers are now investigating the Health and Human Services Commission Office of Inspector General and the firing of actuary Brad Nelson per a story in the Houston Chronicle. The Commission requested the investigation after Nelson was fired for allegedly fudging figures relating to the investigation of Dr. Rachel Trueblood, causing OIG to settle for $39,000 rather than the $16 million … [Read more...]

Another Legal Win for Medicaid Dentist: Appeals Court Tells OIG To Return Payment Hold Monies

Court room

The 3rd Texas Court of Appeals has agreed with a Travis County District Court judge and has issued a ruling that the Office of the Inspector General should return over $1.2 million in withheld Medicaid funds to Harlingen Family Dentistry.  TDMR received a copy of the decision this morning and the Austin American Statesman has already published the story. Appeal over a year old Back in … [Read more...]

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