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
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
