State and federal welfare programs are plagued with fraud and abuse, endangering the safety nets created to help the neediest among us. Their sheer size makes them vulnerable, and it is up to the states to ensure these programs and … Read More
TYLER, Texas – A 63-year-old Dallas County, Texas, physician, has been sentenced to federal prison for health care fraud and identity theft violations in the Eastern District of Texas, announced U.S. Attorney John M. Bales. Tariq Mahmood, 63, of Cedar … Read More
Now, with the HHS OIG amendment to HHS regulation (42 CFR §1007.19), State Medicaid Fraud Control Units are empowered to use Federal matching funds to acquire data mining tools and technology themselves to improve their efforts in identifying and analyzing … Read More
WHAT WE FOUND For fiscal years 2011 through 2013, the Unit reported 10 criminal convictions, 63 civil judgments and settlements, and recoveries of over $63 million. We identified one issue of significant noncompliance with applicable laws, regulations, or policy transmittals … Read More
April 10, 2015 — Children enrolled in the Children’s Health Insurance Program (CHIP) had higher rates of dental access and more checkups than privately insured children, but fewer in the program actually visited dentists, according to a new federal report … Read More
Criminal investigators looking into Texas’ no-bid contract with Austin tech firm 21CT are now delving into allegations that the former state official in charge of billions of dollars in technology contracts abused her position when she urged companies vying for … Read More
Law360, Dallas (April 09, 2015, 6:58 PM ET) — A Texas appellate court on Thursday largely affirmed dismissal of a suit brought by Pharmserv Inc. challenging the state Health and Human Services Commission’s Medicaid payment hold rules, but remanded the … Read More
On March 25, 2015, a bipartisan group of U.S. Senators reintroduced the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (“PRIME Act” or “Act”)[1] following the lead of the U.S. House of Representatives, which tapped the bill for reconsideration … Read More
The Iowa Department of Human Services (State agency) did not always use the correct Federal medical assistance percentages (FMAPs) when processing claim adjustments reported to the Centers for Medicare & Medicaid Services. Of the 1.1 million claims we reviewed, the … Read More
AUSTIN, TEXAS (Attorney General) – Texas Attorney General Ken Paxton has resolved an enforcement action against New Jersey-based pharmaceutical product manufacturer Glenmark Generics Inc. USA. The agreement resolves the State’s investigation under the Texas Medicaid Fraud Prevention Act (“TMFPA”) against … Read More
We have seen many Medicare fraud scams – phony providers who commit identity theft and bill for services never performed, surgeons performing unnecessary procedures, providers overbilling and “patient recruiters” paying homeless people to seek treatment they don’t need. Another scheme … Read More
by Edgar Walters, The Texas Tribune It’s been a tough year so far for Kyle Janek, the head of the state’s embattled Health and Human Services Commission — and it’s only April. Two separate government-issued reports have criticized Janek’s leadership. … Read More
Now, with the HHS OIG amendment to HHS regulation (42 CFR §1007.19), State Medicaid Fraud Control Units are empowered to use Federal matching funds to acquire data mining tools and technology themselves to improve their efforts in identifying and analyzing … Read More
Attorney General Kathleen G. Kane has charged three Pennsylvanians with Medicaid fraud. According to court papers, Catrina Abbot, 33, of Philadelphia is accused of submitting false time sheets that netted her more than $3,000 through fraudulent Medicaid claims. Abbott is facing multiple … Read More
April 2, 2015 — Dentists and other private healthcare providers cannot sue to force states to raise their Medicare reimbursement rates, according to a U.S. Supreme Court ruling issued on March 31. This ruling means that dentists and other healthcare … Read More
Contract High is an occasional series looking at how Texas outsourced crucial state services for two decades — and got smoked. Amid a gusher of news in recent months over a handful of troubled state contracts, lawmakers have vowed to … Read More
As criminal investigators and legislators continue to scrutinize millions of dollars in no-bid technology deals, the state’s top health agency is now dealing with collateral damage from the fiasco: the collapse of a database project that has been in the … Read More
Law360, Dallas (April 03, 2015, 3:38 PM ET) — A Texas appeals court on Thursday dismissed defamation claims against AOL Inc. and a reporter brought by a Dallas-area dentist who claimed an online article falsely represented to the public that … Read More
AUSTIN, Texas (AP) – A state contracting scandal that has cost top Texas health officials their jobs and dealt new Republican Gov. Greg Abbott an early test was enabled by a lack of ethics and accountability, a state audit concluded … Read More
AUSTIN – The official responsible for ensuring that the Texas health commission follows outsourcing laws instead helped the agency to break its own rules on a $110 million no-bid contract, according to a long-awaited audit released Thursday. The official, Arnold … Read More
Editor’s note: This story has been updated throughout. A scathing state investigative report of the Texas Health and Human Services Commission’s much-maligned $20 million contract for fraud tracking software has revealed “operational defects” within the agency’s procurement process. According to the report, … Read More
The former state official who brokered lucrative, no-bid deals with Austin tech company 21CT broke purchasing rules, ignored other possible vendors and worked to promote the company to agencies in Texas and other states, a state audit confirmed Thursday. The … Read More
Two El Paso dental clinics are involved in a multimillion dollar lawsuit settlement.Smile Magic Dental Clinic was accused of defrauding Texas Medicaid. In March, they were ordered to pay $4.5 million to thestate as a settlement.Four offices were named in … Read More
The author of a controversial bill to consolidate five Texas’ health and human services agencies into one will scale back that plan for the second time following a scathing report this week that warned against it. The bill filed by … Read More
Medicaid scam arrests in New York City have revealed an elaborate scheme of false Medicaid billings – all in a shameless exploitation of the indigent who needed shoes. In the indictment this week, investigators said that between October 2012 and … Read More
By Editorial Board The critical report released Monday by a “strike force” deployed by Gov. Greg Abbott to investigate the health agency’s $110 million no-bid contract with 21CT, an Austin technology company, makes our conclusion unavoidable. While the report did … Read More
You have to feel for the healthcare fraudsters out there. It’s not as easy as it once was to rake in millions of insurance dollars on false claims scams. These days, you really have to work for your money–or at … Read More
Over the past year, false claims prosecution under the “worthless services” theory has picked up traction. Now that the Department of Justice (DOJ) plans to simultaneously prosecute civil and criminal whistleblower claims, this legal approach may take on an even larger … Read More
An advisory opinion released last week by the U.S. Department of Health and Human Services Office of Inspector General (OIG) advises labs not to enter exclusive agreements with physician practices that would cover patient fees for certain insurance plans. This … Read More
A man is facing charges after police say he broke into the Office of the Inspector General. It’s employees who you expect to find inside the Office of the Inspector General. But last Sunday, police said it was Robert Burkhart … Read More
A state contracting scandal that dealt Republican Gov. Greg Abbott the first crisis of his administration escalated Monday with a scathing state report about Texas’ health commissioner, who responded by giving no indication he would resign. An outside investigation ordered … Read More
A comprehensive state contracting reform bill unanimously passed the Texas Senate Tuesday and heads the House, where it is likely to sail through and ultimately give Gov. Greg Abbott the chance to approve fixes to a massive state purchasing system … Read More
AUSTIN — The Texas Health and Human Services Commission needs “significant changes” in its leadership or management structure, according to a committee appointed by Gov. Greg Abbott. The panel’s much-anticipated report, released Monday, is the latest blow for a troubled … Read More
A multimillion-dollar software contract for the Texas Health and Human Services Commission was blasted in a report from a “strike force” committee appointed by Gov. Greg Abbott, reports the Texas Tribune. “The report’s findings are deeply troubling,” said Abbott in … Read More
WHITLEY COUNTY, Ky. (WKYT) – A Whitley County dentist entered a plea in a Medicaid fraud case. The State Attorney General says Ronald Hungerbuhler billed medicaid for dental exams he should have performed on patients at a local nursing home, … Read More
As the Health and Human Services Commission continues to face fierce criticism for contracting problems, one pressing question remains unanswered: Will Executive Commissioner Kyle Janek keep his job? A few legislators have called for his ouster, but most state leaders … Read More
12:11 p.m. update: The multimillion-dollar, no-bid state deals with Austin tech firm 21CT “skirted the limits” of the law and was a “policy fiasco” that illustrates the need for changes in the leadership structure at the Health and Human Services … Read More
Governor Greg Abbott issued the following statement regarding the report released today by the strike force he deployed to conduct a review of the Texas Health and Human Services Commission: “When I deployed the strike force, I had confidence they … Read More
Leadership problems at the Texas Health and Human Services Commission in the wake of a contracting scandal that resulted in forced resignations leave the agency too vulnerable to consolidate at this time, according to a report released Monday by Gov. Greg … Read More
by Terri Langford and Aman Batheja, The Texas Tribune FBI agents have interviewed employees at the Texas Health and Human Services Commission about its problematic contract with Austin firm 21CT, Executive Commissioner Kyle Janek told The Texas Tribune, marking the first … Read More
