WHY WE DID THIS STUDY Prior to passage of the Patient Protection and Affordable Care Act (ACA), if a State terminated the participation of a provider from its Medicaid program, the provider could potentially participate in another State’s Medicaid program, … Read More
Some healthcare providers dropped by state Medicaid programs because of fraud or quality problems were still participating in other states’ programs, contrary to requirements in ObamaCare, according to an inspector general report. The Affordable Care Act requires that a state … Read More
AUSTIN — Even as they left nearly $18 billion unspent, Texas lawmakers ordered a $350 million cut this year to Medicaid pay for therapists who perform one of health care’s most exacting jobs.In a two-year budget that was flush enough … Read More
August 5, 2015 — Dentists working in a dental service organization (DSO) are more satisfied with the amount of hours worked during a week, but less so with their income, compared with dentists working with dentist-owned-and-operated practices (DOOs), according to … Read More
The transition from a reactive approach to relying on claims data to better predict and prevent fraudulent payments has led to significant progress in fighting Medicare and Medicaid fraud, former Centers for Medicare & Medicaid Services (CMS) Administrator Don Berwick told the … Read More
What GAO Found GAO identified four key issues facing the Medicaid program, based on prior work. Access to care : Medicaid enrollees report access to care that is generally comparable to that of privately insured individuals and better than that … Read More
Texas Attorney General Ken Paxton was arrested and booked in Collin County around 10:30 a.m. Monday on three counts of felony securities law violations that allegedly took place before he became a statewide official in January. Source: Ken Paxton arrested, … Read More
President Barack Obama gave Medicare and Medicaid, the federal and state health care entitlements for the elderly and poor, respectively, a clean bill of financial health in his weekly addresson Saturday as he marked the programs’ 50th birthday. “Today, we’re often … Read More
Enrollment in private insurance plans has soared as the government has tried control costs and improve care for Medicare and Medicaid beneficiaries. Source: As Medicare and Medicaid Turn 50, Use of Private Health Plans Surges – The New York Times
July 29, 2015 — Spending for dental care will grow 60% during the next decade, according to a new report in Health Affairs. Spending for dental services was $97.3 billion in 2007 and is projected to grow from $114.5 billion … Read More
HOUSTON—Dr. Dennis B. Barson Jr., 42, has been ordered to federal prison following his convictions related to a conspiracy to defraud Medicare of $2.1 million in less than two months, announced U.S. Attorney Kenneth Magidson. A federal jury convicted Barson … Read More
A Michigan resident was sentenced to 80 months in prison late yesterday for his leading role in a $12.6 million Medicare fraud and tax fraud scheme. Eleven other individuals have been convicted in this case. Assistant Attorney General Leslie R. Caldwell … Read More
Newly released documents show the federal government attempted to collect $16.7 million from the state after alleging four New Mexico companies that provide in-home health care services didn’t comply with the rules for submitting Medicaid reimbursement claims. In June 2012, … Read More
A Dallas-area woman has pleaded guilty in a $1.6 million Medicaid scam over false claims using the names of legitimate counselors. Brenda Ward of Cedar Hill faces up to 10 years in federal prison and a $250,000 fine. Ward on … Read More
The former CEO of Summit Point in Battle Creek is facing criminal charges for spending more than half a million dollars in public funds on a fortuneteller. Summit Pointe is a Community Mental Health Authority, contracted through the State, that … Read More
Patients who say they received bad treatment from dentists are speaking out about the lack of oversight by the Texas State Board of Dental Examiners. Four years ago, News 8 began revealing cases of patient recruiting, poor quality of care … Read More
Government report concludes money sent to unchecked addresses and PO boxes. VIDEO Source: Investigation Reveals $60 Billion Lost in Medicare Fraud Video – ABC News
NEW YORK (AP) >> The owner of a Brooklyn medical supply business was sentenced to up to 21 years in prison in a Medicaid fraud scheme. Source: Medicaid scammer draws 7-21 years in prison
Alabama’s Medicaid fraud investigation unit collected hundreds of thousands of dollars from the trust fund accounts of dead nursing home and foster care residents until federal inspectors in 2012 told them to stop, a federal report shows. Source: Inspectors: Medicaid … Read More
Doctors with independent primary care practices in Texas are increasingly being courted by private equity firms looking for investments, and offering leverage in the consolidating health care industry. Some doctors fear losing their independence, but others say it’s a market … Read More
July 14, 2015 — U.S. Sen. Charles Grassley (R-IA) has sent letters to key government agencies, asking how many criminal and civil cases have been brought against dentists suspected of fraudulent treatment and billing practices involving Medicaid patients. “Some dentists … Read More
(Reuters) – A federal judge on Friday sentenced a Detroit-area doctor who admitted performing unnecessary procedures on hundreds of cancer patients to 45 years in prison, prosecutors said. Dr. Farid Fata, 50, who pleaded guilty in September to more than … Read More
HOUSTON—Six Houstonians have been arrested on wide-ranging charges involving a $12 million conspiracy to commit health care fraud and to pay kickbacks, announced U.S. Attorney Kenneth Magidson. The arrests were made in conjunction with a search warrant executed at a … Read More
Six Houstonians are in custody on wide-ranging charges involving a $12 million conspiracy to commit healthcare fraud and to pay kickbacks, announced U.S. Attorney Kenneth Magidson. The arrests were made in conjunction with a search warrant executed at a downtown … Read More
NEW YORK (Reuters) – Walgreen Co has reached a $22.4 million settlement with the New York attorney general resolving claims that a unit improperly billed the government for reimbursement for a pediatric drug. The settlement, disclosed in court papers filed … Read More
Washington, DC–(ENEWSPF)–July 6, 2015. AstraZeneca LP has agreed to pay the United States and participating states a total of $46.5 million, plus interest, to resolve allegations that it knowingly underpaid rebates owed under the Medicaid Drug Rebate Program, the Justice … Read More
The U.S. Department of Health and Human Services inspector general is asking a Maryland state health agency to refund $34.2 million in federal dollars it received for a waiver program that the watchdog said was wrongly applied, it said in … Read More
The U.S. Department of Health and Human Services Office of Inspector General has created a new team of attorneys focused solely on litigation involving Medicare and Medicaid fraud. The new team was announced at the American Health Lawyers Association’s annual … Read More
Thirty people have been charged with Welfare Fraud for illegally obtaining over $324,000 in public assistance benefits administered through the Orange County Department of Social Services—mostly Medicaid.The enforcement action was the result of the collaborative efforts of the Orange County … Read More
A number of states still do not report required quarterly data about services provided to Medicaid beneficiaries enrolled in managed care—information that’s crucial to running Medicaid and protecting it from fraudsters, according to a study HHS’ Office of Inspector General … Read More
The Office of the Inspector General at HHS announced Tuesday the creation of a new litigation team that will concentrate on identifying and fining Medicare and Medicaid fraud. The team’s creation is intended to put further pressure on physicians, drugmakers … Read More
WASHINGTON, DC – House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Oversight and Investigations Subcommittee Chairman Tim Murphy (R-PA) today sent a letter to Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt in their continued oversight … Read More
On Tuesday, representatives from the United States Department of Health and Human Services Office of Inspector General (OIG) announced the creation of an OIG litigation team that will focus specifically on civil monetary penalties and exclusion cases. The announcement was … Read More
Walgreen Co will pay $2.55 million to settle charges by New York’s attorney general that a pharmacy unit improperly billed Medicaid for costly drugs to treat hemophilia patients, without proof that it actually delivered the drugs to those patients. Attorney … Read More
Attorney General Joseph A. Foster announced on June 25, 2015, that the Medicaid Fraud Control Unit (MFCU) of the Department of Justice had reached a settlement with Dr. Eyad Almahayni, DMD, to resolve allegations about his dental practice, according to a … Read More
An investigation by state Inspector General Catherine Leahy Scott found that a former top official with the state Office of the Medicaid Inspector General improperly accepted gifts, including air travel and a job offer, from a Texas corporation that has a … Read More
The federal government is calling McAllen a hotspot for potential Medicare fraud and abuse. The Department of Health and Human Service Office of Inspector General released a report today detailing the growing problem. Source: HHS OIG: McAllen a Medical Fraud … Read More
DALLAS The case of a troubled Texas hospital system shows how a federal, $24 billion stimulus program that distributes funds to help computerize health-care records has been vulnerable to fraud. It also highlights the challenges in recouping the money that … Read More
On June 9, 2015, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Fraud Alert focused on compensation arrangements paid to physicians. See, “Physician Compensation Arrangements May Result in Significant Liability” [link:https://oig.hhs.gov/compliance/alerts/guidance/Fraud_Alert_Physician_Compensation_06092015.pdf]. The Fraud … Read More
Joe White didn’t use elaborate methods to bilk a federal stimulus program: He simply lied on application forms. But getting back the nearly $18 million in tax money that the feds plowed into the rural Texas hospital chain he managed … Read More
