DALLAS—Attorney General Loretta E Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulting in charges against 243 individuals, including 46 … Read More
NEW YORK – Attorney General Eric T. Schneiderman today announced a settlement with Aspen Dental Management, Inc., an East Syracuse-based company that provides business support and administrative services to seven independently owned dental practices that maintain 40 offices in New … Read More
The U.S. Justice Department charged 243 people, including 46 doctors, nurses and other medical professionals, with defrauding the Medicare system of $712 million through false billing. Attorney General Loretta Lynch announced the charges Thursday in Washington, calling the case the … Read More
In 2012, Connecticut filed a civil lawsuit against nearly 30 players in an elaborate scheme to defraud Medicaid. The state has since recovered millions of dollars in settlement funds and a number of dental offices have been shuttered. Dentists have … Read More
TYLER, Texas – The former Chief Financial Officer of Shelby Regional Medical Center has been sentenced to federal prison in the Eastern District of Texas, announced U.S. Attorney John M. Bales today. Joe White, 68, of Cameron, Texas, pleaded guilty … Read More
McALLEN — Federal agents Tuesday arrested the owner and an employee at a defunct Mission-based durable medical equipment supplier, accusing them of overbilling the government for unnecessary adult diapers. A federal grand jury this month indicted Veronica Vela and Cynthia … Read More
Two House committees have requested a review of the Centers for Medicare & Medicaid Services’ Fraud Prevention System, according to a letter sent to the Government Accountability Office. Bipartisan leaders on the House Energy and Commerce and House Ways and … Read More
WESLACO -Several Medicare busts are happening across the Valley. Four investigations are coming to a close. Court documents were filed a week ago and unsealed today. All four separate indictments have different charges all dealing with medical fraud Source: Several … Read More
A new fraud alert released by the Office of the Inspector General highlights the agency’s renewed interest in physician compensation arrangements that could violate anti-kickback regulations if payments do not reflect fair market value. Source: OIG fraud alert targets physician compensation agreements
Most Medicaid payments Texas made to providers for full vials of Herceptin from 2010 through 2012 were incorrect and resulted in overpayments of approximately $566,000 (Federal share). Copies can also be obtained by contacting the Office of Public Affairs at … Read More
An inspector general’s fraud alert on Tuesday warned referring physicians of fines and prison time that can result from accepting kickbacks disguised as medical directorships, the latest sign of rising interest in punishing individual doctors instead of just corporations for … Read More
Texas owes the U.S. government $133 million for unallowable orthodontic Medicaid treatments from 2008 to 2010, according to a new report by the Office of Inspector General (OIG). Many of the claims were improperly approved because they did not have … Read More
The United States Attorney`s Office for the Northern District of Georgia announced that it has reached a settlement with Dennis Jaffe and Dennis B. Jaffe D.M.D., P.C., to pay $324,327.05 to settle health fraud claims — specifically that Jaffe violated … Read More
Connecticut will recover nearly $300,000 from another batch of dentists and their practices accused of committing Medicaid fraud, state investigators say. Source: Trio settles CT Medicaid fraud suit
HOUSTON — Texas should repay at least $133 million in Medicaid funding misspent on unnecessary dental and orthodontic procedures, according to a federal audit. Source: Feds say Texas should repay $133 million in Medicaid funds misspent on dental care | … Read More
ATLANTA, Ga. (WJCL) — An Atlanta-based dentist has pleaded guilty to criminal charges and settled with the Attorney General’s office for more than $324,000.Attorney General Sam Olens announced Friday the conclusion of a multi-part investigation into Dr. Dennis B. Jaffe’s … Read More
Update, 1:10 p.m. Recent scandals and newspaper headlines were not the reason that Kyle Janek stepped down from the agency, Janek told reporters a few minutes ago.Gov. Greg Abbott did not pressure Janek to resign, he added, and Janek initiated … Read More
AUSTIN – Nearly six months after a scandal over a $110 million no-bid contract rocked the Texas Health and Human Services Commission, Gov. Greg Abbott said Friday that executive commissioner Kyle Janek would resign July 1.Former second-in-command Chris Traylor will … Read More
Governor Greg Abbott today announced that Texas Health and Human Services Commission Executive Commissioner Dr. Kyle Janek has expressed his intention to resign, effective July 1, 2015. Governor Abbott simultaneously announced his intention to appoint Chris Traylor as Executive Commissioner … Read More
Texas Health and Human Services Executive Commissioner Kyle Janek, M.D., announced today he is stepping down from his position effective July 1 to make way for new leadership as the agency prepares for major reorganization. “I’ve been honored to lead … Read More
The federal government paid almost $10 million in medicaid benefits to 200 dead people, according to a new report from the Government Accountability Office. And that’s just the tip of the iceberg. In just four states in fiscal year 2011, … Read More
HHS’ Office of Inspector General recovered $1.8 billion from healthcare providers and programs in the first six months of fiscal 2015, according to the OIG’s Semiannual Report to Congress. Here are five takeaways from the OIG’s report. 1. In the … Read More
From the Office of Inspector General of Department of Health and Human Services http://oig.hhs.gov [Matt Moore] I’m Matt Moore, an audit manager in Dallas, speaking with Eugena Newton, a senior auditor who is also in our Dallas office. Eugena, your … Read More
DALLAS — Texas paid $191,410,707 for unallowable orthodontic services from 2008 through 2010, according to a federal investigation to be released on Thursday. And officials say the federal government wants a large portion of it back. The findings are in … Read More
Our opinion: If the state itself minimizes fraud in Medicaid, what hope is there of controlling its costs?The challenge for New York’s $62 billion Medicaid program has long been to root out waste, fraud and abuse. But what to do … Read More
WASHINGTON—Starting Aug. 1, providers considered at “high risk” for defrauding state Medicaid programs will undergo a criminal background check that includes fingerprinting. By March 2016, all of a states’ Medicaid and CHIP providers must be ranked as having a limited, … Read More
Federal and state agencies should take more steps to prevent Medicaid fraud, such as fraudsters using the identities of deceased patients or providers to receive Source: Medicaid Anti-Fraud Efforts Criticized
The recent Kellogg Brown & Root Servs., Inc. v. United States ex rel. Carter Supreme Court decision is a very glass half-full/half-empty ruling for healthcare providers. Source: Supreme Court decision expands False Claims Act liability for providers
Lawmakers sailed off into the sunset Monday hailing the conservative budget they had passed to fund Texas for the next two years — one that, when it comes to delivering health care to the neediest Texans, likely won’t stay afloat. … Read More
The Centers for Medicare and Medicaid Services on Monday released enormous sets of data on hospital and physician reimbursement in 2013, its latest effort to enlist the public in identifying suspect billing and trends in health care utilization. Source: CMS … Read More
Who are “Medicaid people” ? During a recent meeting of the Tompkins county legislature, Lansing representative Mike Sigler stated his opposition to a statewide single-payer health insurance plan by commenting, “I work hard for my health insurance,” and adding, “Medicaid … Read More
A prominent U.S. senator is asking the Centers for Medicare & Medicaid Services to investigate Medicare Advantage plans that may have inflated their risk scores to receive higher reimbursements. In her letter to CMS Acting Administrator Andy Slavitt, Sen. Claire … Read More
A medical loss ratio (MLR) may sound like a tricky concept, but in essence it’s just a number that tells health plans how much of their premium revenue they have to spend on taking care of patients. A recent CMS … Read More
The former owner of a Los Angeles-based medical supply company was sentenced today to seven years in prison for his role in a fraud scheme that resulted in $3.3 million in fraudulent claims to Medicare. Assistant Attorney General Leslie R. … Read More
Florida pediatric dentist Dr. Howard Schneider is being sued by nearly 50 patients for allegedly extracting kids’ teeth for no reason, and in some cases hitting or choking them.Brandi Motley took to her 6-year-old daughter, Bri’el, to Schneider to have one … Read More
ANDERSON — A former employee at the Anderson Dental Clinic was given a one-year suspended prison sentence Tuesday for her role in issuing a prescription using the name of a dentist who had left the practice. Deborah Davis, 56, was … Read More
Attorney General Eric Schneiderman announced Wednesday arraignment, guilty plea and sentencing of Patricia Power, 63, of 4883 Rushmore Road, Farmington. Power pleaded guilty for petit larceny based upon criminal charges filed by Schneiderman’s office. The mother of a disabled adult … Read More
The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs) (OEI-06-15-00010, April 2015). Although the MFCUs reported another strong … Read More
WHY WE DID THIS STUDY The Department of Health and Human Services (HHS) OIG is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCUs or Units or Unit). This MFCU Fiscal Year (FY) 2014 Annual Report highlights … Read More
Law360, New York (May 26, 2015, 7:36 PM ET) — The Centers for Medicare and Medicaid Services put forth a proposal Tuesday that would update the way managed care organizations are regulated for the first time in a decade in … Read More
