Why States are Ineffective at Fighting Medicaid Fraud

Texas Medicaid fraud

There is a primary reason why states around the nation have trouble fighting Medicaid fraud. States inept fighting fraud Both the KCBS videos from California we posted and the recent Sunset Commission report on Texas HHSC-OIG highlight that state agencies can talk about Mediciad fraud but when it comes to dealing with it, there is a significant problem of ineptitude and … [Read more...]

HHSC Ditching Anti-Fraud Initiative Started by Stick

jack stick testifying feat

The following is republished from the Texas Tribune: When Jack Stick became the deputy inspector general of the Texas Health and Human Services Commission in 2012, he saw an opportunity to help investigators beef up their production in bringing potential fraud cases forward. For the first time, general investigators — who review whether recipients of food stamps, Children’s Medicaid and other … [Read more...]

Governor Abbott Appoints New HHSC-Inspector General

stuart bowen

PRESS RELEASE FROM THE GOVERNOR: Today, Texas Governor Greg Abbott announced the appointment of Stuart W. Bowen, Jr., as Inspector General for the Texas Health and Human Services Commission for a term to expire Feb. 1, 2016. The inspector general works to prevent, detect and investigate fraud, abuse and waste in state health and human services programs. Bowen previously served for nearly … [Read more...]

What Real Medicaid Fraud Looks Like

medicaid fraud

David Gibson, CEO from Reflective Medical, one of the companies that demonstrated their Medicaid fraud detection software to HHSC back in 2010 and 2011, sent TDMR links to a couple of YouTube videos that show the kind of fraud that exists today not only in Texas, but around the country. California Medi-Cal fraud expose appalling  The videos are from KCBS in Los Angeles and detail the results … [Read more...]

Influential State Senator Tells Janek to Resign Immediately for Good of Texas

HHSC Executive Commissioner Kyle Janek

Today, Sen. John Whitmire sent a letter to HHSC Executive Commissioner Kyle Janek suggesting he resign immediately for "the best interest of the State of Texas." "Enough is enough" The Austin American Statesman quoted Whitmire as telling them, “Enough is enough. I think he’s lost credibility to run this agency." and "“I think Kyle has conflicted himself out of being able to run his agency. … [Read more...]

In 2011 More Medicaid Children in Texas Received Dental Care Than National Average

children health insurance program

The Texas Health and Human Services Commission sent out a report today that a study has found that in 2011 more children enrolled with the Texas Children’s Health Insurance Program (CHIP) had received dental care than the national average.  - Download Texas Children’s Health Insurance Program (CHIP) Dental Quality of Care Measures report. Texas average 66%, national 48% In the calendar year … [Read more...]

Texas “Insiders” Entitlement Program Pays Off: Free College for Janek’s Aide!

HHSC Executive Commissioner Kyle Janek

In an era when Texas government is supposed to be efficient, cost-effective and mindful of taxpayer dollars, a miracle to be emulated by other states thanks to the Perry administration, the media continues to uncover incredible betrayals of public trust and misuse of public funds at HHSC.  Thank god for the media. Friday it was revealed by both the Texas Tribune and Houston Chronicle that at … [Read more...]

Dentaquest, MCNA Recover $303,000 in Fraud, Abuse from $1 Billion Revenues in 2014

Texas Medicaid fraud

Today, HHSC-OIG issued a report detailing amounts recovered by state managed care organizations for certain fraud and abuse in state fiscal year 2014. 22 MCOs recover $3.8 million  The report entitled "HHSC OIG Annual Report on Certain Fraud and Abuse Recoveries by Managed Care Organizations (MCOs) - SFY 2014" shows that  22 MCOs recovered and kept some $3,883,524.81. There is no … [Read more...]

UPDATE: OIG Executive Hired by Stick Has Been Demoted and Had Salary Cut

jack stick testifying feat

A former aide to Jack Stick, hired by Stick when he was the OIG deputy inspector general for enforcement, has now been demoted and seen his salary cut, according to a late breaking story in the Austin American Statesman.  The Texas Tribune has also reported the story. The ever-increasing scandal involving Stick who resigned as HHSC's chief counsel before Christmas, has now engulfed Cody … [Read more...]

HHSC: Not Just Xerox and 21CT, but Big Trouble with an AT&T Contract Too

THHSC building

While Texas is in drought,  the bad news floodgates have opened even wider at HHSC with a further state report about inept and costly contract mismanagment.  This time with AT&T. Ballooned from $1 million to $110 million Today, the Dallas Morning News jumped on the recent media bandwagon with a story about the newly released State Auditor's report that outlines huge cost overruns for … [Read more...]

Health Chief Says He Was Misled on No-Bid Deal | The Texas Tribune

HHSC Executive Commissioner Kyle Janek

*Editor's note: This story has been updated throughout. Texas Health and Human Services Commission chief Kyle Janek said Tuesday he was misled in briefings on a no-bid, $110 million deal handed to an Austin company for unproven software to detect Medicaid fraud. Janek said the Office of Inspector General, the commission’s audit arm, should have alerted him that its contract with 21 … [Read more...]

Dental Medicaid Providers to Get Their Day in Court – OIG Nonsuits Cases

justice for texas medicaid providers

TDMR has learned today that OIG administrative actions against a number of dental providers that have been accused of "credible allegations of fraud" have been nonsuited by OIG. The affected providers include Antoine Dental Center, M&M Orthodontic, Harlingen Family Dentistry, Herrscher, National Orthodontix and RGV Smiles. "Nonsuit" means "to terminate a legal action without an actual … [Read more...]

Attend our important seminar to be held on Friday, February 27 at the Knapp Medical Center in Weslaco, near Harlingen.