Medicaid rate cuts for therapy providers, which state lawmakers authorized during the recent legislative session in an effort to control Medicaid spending, have prompted a lawsuit against the state by some providers and patients who question the data the state … Read More
The Texas Health and Human Services Commission made $377 million in Medicaid electronic health record incentive payments to hospitals in 2011 and 2012, but at least $12.5 million of that was made in violation of state and federal regulations, according … Read More
From March 2011 through September 2013, Washington failed to suspend Medicaid payments to 48 providers being investigated for credible allegations of fraud, according to a report from the Office of Inspector General. Source: OIG report: Washington needs better policies for suspending providers … Read More
At Texas Senior Medicare Patrol, program director Barbara McGinity regularly hears troubling stories from elderly victims targeted by medical scams. There was the 90-year-old San Antonio woman who wanted to buy a bedside commode and called a company advertising such … Read More
PHOENIX — A prosecutor says an executive who oversaw procurement for the Arizona Medicaid program may have skimmed more than $10 million through an elaborate scheme over the past nine years.A judge on Thursday ordered 63-year-old Michael Veit held on … Read More
Alarmed by the tens of billions of dollars in Medicare and Medicaid fraud and overpayments annually that are draining the federal health care system, the Obama administration has quietly stepped up its auditing and enforcement efforts to crack down on … Read More
Law360, New York (September 3, 2015, 10:12 AM ET) — Recent Office of the Inspector General physician guidance, personnel and budget increases, and a Third Circuit decision, all point to the same thing -— physicians who participate in Medicare and … Read More
The Health and Human Services Commission (HHSC) is asking for comments on a proposed new advisory committee structure. In response to Sunset legislation approved during the most recent legislative session, HHSC conducted a comprehensive analysis of 132 existing advisory committees. This … Read More
Cancer Care Group, P.C. agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR). Cancer … Read More
Republican Iowa Gov. Terry Branstad is defending the companies selected to manage the state’s $4.2 billion Medicaid program, despite reports that all four have been involved in high-priced fraud settlements, according to the Des Moines Register. Earlier this month, the … Read More
The chief operating officer of the Texas Health and Human Services Commission announced Monday that he will be stepping down to return to the private sector. John Scott, who has served in the role since January, was credited as the … Read More
Bryan Black is the new press officer for the Office of Communications. He joins HHSC following his service as the communications director at the Texas Department of Agriculture. During Black’s tenure at TDA, he transformed the department into a premier … Read More
AUSTIN – Texas Health and Human Services Executive Commissioner Chris Traylor today announced John Scott is stepping down as chief operating officer of The Health and Human Services Commission (HHSC). Scott joined HHSC in January, where he served as the … Read More
McALLEN — A Pharr woman pleaded guilty Friday for her role in connection with a federal healthcare insurance fraud scheme, prosecutors said. Martha Lidia Flores admitted to engaging in a kickback scheme of exchanging referrals of Medicare beneficiaries for money … Read More
Channel 8’s Byron Harris announced Friday that he’ll retire in October. Ed Bark posted a solid story Monday about the investigative reporter and his 40 years at the TV station. I’d like to go in a slightly different direction. Harris … Read More
Law360, New York (August 27, 2015, 2:12 PM ET) — A Texas federal judge recused himself Wednesday from a False Claims Act suit against a medical center, days after the defendants revealed his cousin could be a key witness. The … Read More
AUSTIN — A lawsuit that sought to block deep cuts in what Medicaid pays for disabled children and poor elderly Texans’ therapies has delayed the rate changes for a month but otherwise forced no change in the state’s plans. On … Read More
A Texas jury on Tuesday acquitted a former Cancer Prevention and Research Institute of Texas executive of a felony charge that he deceived the agency’s executive director and general counsel to get an $11.04 million grant approved for a pharmaceutical … Read More
A McAllen area doctor accused in June of filing fraudulent Medicare claims involving deceased patients faces new charges after he continued to file false claims, federal investigators said. Source: Doctor accused of filing claims for dead patients faces new charges … Read More
Another 100 Florida hospitals — 17 of which are in the Tampa Bay area — will be audited by the state to determine whether they’re receiving more in Medicaid payments than legally allowed, Gov. Rick Scott said Monday. They join … Read More
Empire State Home Care Services has agreed to pay $6 million as part of a settlement with the New York state attorney general to resolve allegations of improper Medicaid billing. Source: Brooklyn Medicaid Fraud Case Settled
On the streets of Managua, the shuttle bus wrapped in a giant ad for free health care stood out. “Medicare for people living abroad,” it proclaimed above the image of a cheerful older woman playing golf. But Medicare, the American … Read More
Los Angeles, California – The owner and operator of three medical clinics located in Los Angeles pleaded guilty today to submitting more than $4.5 million in fraudulent claims to Medicare. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s … Read More
August 17, 2015 — California legislators took the first step in resolving oral health disparities by hiring the state’s first dental director, Jayanth Kumar, DDS, MPH. Dr. Kumar, who officially started the position on August 1, will create and implement a … Read More
Health care fraud is one of the government’s costliest problems. It’s a hall of mirrors where billions of dollars are lost to swindlers looking to cash in on the millions of transactions generated by insurance-paying agencies every day. Last year, … Read More
Acting state Comptroller Marc Larkins hired a friend to oversee the multimillion-dollar Medicaid Fraud Division, angering longtime employees who feared the perception of cronyism in the watchdog office, NJ Advance Media has learned. The Comptroller’s Office is intended to be … Read More
A district court judge on Wednesday handed state Medicaid regulators another decisive courtroom loss, adding one more notch to the Health and Human Service Commission’s Office of Inspector General’s unenviable losing streak pursuing dentists and orthodontists it claims have bilked … Read More
August 13, 2015 — The number of large dental practices is growing, along with their profits and the number of people they employ, according to a new research brief by the ADA Health Policy Institute. The trend in recent years … Read More
Home health agencies providing pediatric therapy services, along with the mothers of five children in Travis and Williamson counties, turned to the courts Tuesday to stop Texas officials from imposing program cuts totaling $350 million.Most of those receiving the speech, … Read More
Fresh off a House Subcommittee hearing in which legislators grilled the Centers for Medicare & Medicaid Services regarding Part D fraud controls, the Government Accountability Office (GAO) released a report this week noting that four state Medicaid programs spent $33 million in 2011 … Read More
SOUTHINGTON — A local dentist who resides in Southbury was arrested today for defrauding Medicaid, according to the Department of Justice. Thomas L. Derienzo, 58, of Bucks Hill Road, is accused of billing Medicaid for more expensive procedures than he … Read More
Months after he was put on paid administrative leave amid an investigation into the Texas Health and Human Services Commission’s contracting procedures, Cody Cazares, the former chief of staff to the commission’s top lawyer, has left the agency. Cazares, the former chief … Read More
The CMS has awarded SafeGuard Services a contract worth up to $300 million to help prevent and identify Medicare fraud. SGS is a subsidiary of Hewlett-Packard Enterprise Services and performs data analysis, investigations and medical reviews to detect, prevent, deter … Read More
DALLAS – Alexis C. Norman, 47, of Midlothian, Texas, appeared in federal court this morning before U.S. Magistrate Judge David L. Horan and pleaded guilty to one count of health care fraud, announced John Parker, U.S. Attorney for the Northern … Read More
In January, Stuart Bowen took charge of a state office rocked by accusations of corruption, incompetence and inefficiency. Responsible for ferreting out fraud amid the programs and procedures of the sprawling Health and Human Services Commission, the office of Inspector General … Read More
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
