Recent stories in the news seem to suggest that health care fraud is running rampant. We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in Greensboro for alleged Medicaid fraud, and, … Read More
Ohio’s Medicaid office searched for ways to continue paying hundreds of healthcare services providers after uncovering "credible allegations of fraud," violating the Affordable Care Act. The state agency came up with "good cause" to continue funneling money to providers strongly … Read More
A plan to privatize Terrell State Hospital is dead following a scathing audit that raps the state health commission for bypassing its own contracting procedures.The Texas Health and Human Services Commission canceled the deal — which was still being negotiated … Read More
Good morning, Mr. Chairman and distinguished Members of the Subcommittee. Thank you for the opportunity to testify about fraud, waste and abuse in our Medicare program. My experience working in law enforcement and private practice has taught me that, notwithstanding … Read More
The State agency did not always comply with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud between July 1, 2011, and June 30, 2013. Of the 401 cases … Read More
Improper Medicare payments and fraud populated the Office of Inspector General’s (OIG) list of the top 25 unimplemented recommendations, according to a report from the watchdog agency that offered insight into where the Centers for Medicare & Medicaid Services (CMS) still … Read More
A package of bills to overhaul the state’s clunky health and human services system drew more than three hours of testimony before a Senate panel on Monday, the latest airing of concern across varied interest groups who fear losing access … Read More
More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control (HCFAC) Program, Attorney General Eric Holder and HHS Secretary Sylvia M. Burwell announced today. The government’s health … Read More
by Edgar Walters, As the state’s largest health agency reels from a scandal over how it awarded contracts to private vendors, lawmakers on Wednesday said they are slowing down on their ambitious — and controversial — plan to restructure it. A … Read More
AUSTIN – After months of downplaying his involvement in a no-bid state contract that collapsed in scandal last December, a former lobbyist for the company that got the deal is changing his story. The lobbyist, James Frinzi, acknowledged in a … Read More
March 17, 2015 — Four clinics of Texas’ Smile Magic chain have agreed to pay $4.5 million to settle Medicaid fraud charges. The whistleblower lawsuit claimed the clinics used paid recruiters to target parents in grocery store parking lots and … Read More
The former lobbyist for Austin tech company 21CT — whose canceled Medicaid anti-fraud contract is shrouded by scandal and criminal investigations — testified last month that he was referred to work for the company by Jack Stick, the disgraced former … Read More
by Terri Langford On a rainy day in February three years ago, about 30 men and women recently hired by the state filed into a dull government classroom to begin a week of training for their new positions. Texas funnels a … Read More
Members of the Texas Senate will likely propose significant additions to a bill introduced this week on agency contracting now pending before the Senate Finance Committee. Sen. Jane Nelson, R-Flower Mound, introduced Senate Bill 20 to address what she called … Read More
A Pullman dentist found guilty of medicaid fraud has submitted a request for a new trial and says he has conclusive evidence proving he provided the fillings the state argued were never completed. Alfred Fairbanks, 69, a dentist at Today’s … Read More
AUSTIN (KXAN) — Rep. Tony Dale, R-Cedar Park, has filed House Bill 3108 relating to the collection of unpaid tolls. KXAN has learned the bill, filed on Wednesday, will hold both the Texas Department of Transportation and its vendor, Xerox, … Read More
AUSTIN – The Texas Senate’s top budget writer on Monday proposed sharply limiting the use of the popular and controversial Cooperative Contracts purchasing program, signaling that a promised tightening of restrictions for outsourcing by state agencies may be even more … Read More
ALBUQUERQUE, N.M. State officials would have to follow certain procedures before cutting off government funding for health care providers suspected of Medicaid fraud or overbilling under a measure passed Tuesday by the New Mexico Senate. The legislation sponsored by Senate … Read More
AUSTIN — The office of Texas Attorney General Ken Paxton has ruled that the state does not have to release public records related to a scandal over a $110 million no-bid Medicaid fraud detection contract because doing so would interfere … Read More
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 … Read More
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 … Read More
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 … Read More
(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 … Read More
(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 … Read More
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 … Read More
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. … Read More
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 … Read More
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 … Read More
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 … Read More
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 … Read More
February 20, 2015 — CSHM, the owner of the Small Smiles dental chain that was excluded from the Medicaid program last year, has filed for Chapter 7 bankruptcy, according to documents filed in the U.S. District Court for the District … Read More
AUSTIN — The drunken-driving trial of a former Texas health commission lawyer has been rescheduled for April, once again delaying a high-stakes and hotly anticipated test for a man who recently became infamous as part of a state contracting scandal. … Read More
AUSTIN – Fighting for his job after weeks of revelations about contracting irregularities and questionable tuition payments, Texas health commissioner Kyle Janek publicly apologized during a Wednesday legislative hearing in which state senators took turns angrily asking why they should … Read More
Earlier this month, the Texas Tribune’s Terri Langford had a great story about a couple of $2,800 chairs that former Health and Human Services Commission lawyer Jack Stick ordered for himself and Doug Wilson, his old boss at the Office … Read More
INDIANAPOLIS — Prosecutors have struck plea agreements with six former employees of a central Indiana dental clinic in connection with a Medicaid fraud investigation. The Herald Bulletin reports (http://bit.ly/19sGDsv ) dentist Paul Pangallo faces a March 30 sentencing hearing after … Read More
HOUSTON—Aliksandr Beketav, 53, Mikhail Shiforenko, 43, Alexsandr Voronov, 46, and Daniela Gozes-Wagner, 32, have been arrested following the return of a federal indictment alleging a health care fraud conspiracy and conspiracy to commit money laundering, announced U.S. Attorney Kenneth Magidson. … Read More
AUSTIN – Two months after a massive no-bid contract erupted in scandal, eventually forcing four Texas health officials to resign, state senators finally got a chance Thursday to grill the first nominee that Gov. Greg Abbott has picked to help … Read More
Three years ago, when the Texas Health and Human Services Commission wanted software that investigators in its Office of Inspector General could use to track down Medicaid fraud, it asked the federal government to foot most of the $20 million bill. In its … Read More
Gone are the sales quota-like performance standards imposed by Jack Stick, the embattled former general counsel of Texas’ Health and Human Services Commission. And the agency is still debating what to do with the $2,800 black leather executive chair he … Read More
AUSTIN, TEXAS (Texas House of Representatives) – After Speaker Straus released committee assignments last Wednesday, Rep. Richard Peña Raymond, Chairman of the House Committee on Human Services, began work with his nine member committee setting the first hearing date for … Read More
