Media

Federal prosecutors are moving fraud enforcement into the C-suite, according to Assistant Attorney General Leslie R. Caldwell. Just as the Department of Justice has pursued charges at against executives for financial fraud, healthcare executives will be held accountable for fraud … Read More

MOBILE, AL (WALA) – Alabama Attorney General Luther Strange arrested Mobile dentist, William Gerard Eastburn, on one count of filing false claims with the Alabama Medicaid Agency and one count of first-degree theft of property. The Attorney General’s Medicaid Fraud … Read More

In March, Attorney General Pam Bondi announced she had nailed someone for Medicaid fraud. The culprit was a 49-year-old home-health worker from dirt-poor Gadsden County, accused of bilking the state out of $13,000. For her crime, Melissa Letica Simmons was … Read More

Medicaid provides health insurance to about 500,000 Iowans. For decades, the government program has been operated by the state, which is not beholden to shareholders. Spending has been held down by reducing fraud, paying lower reimbursements to providers and giving … Read More

The auditors worked in a non-descript, three-story brick building near a warehouse district in Menands, a couple miles north of the state Capitol.Their surroundings were ordinary, including hand-me-down state government furnishings. But their job was a crucial one: auditing the … Read More

Dentistry has gone corporate. Instead of hanging out their shingles and building practices or working under an established dentist and eventually becoming a partner, dental-school graduates are increasingly opting to work for corporately run chains, according to studies by the … Read More

The consequence for involvement in the $116 million fraudulent Medicare billing scheme at Riverside General Hospital promises to be steep – the equivalent of a death sentence – for the oldest of a dozen defendants who were convicted at trial … Read More

May 19, 2015 — Significantly more Californians visited the emergency room (ER) for dental-related problems after the state cut dental benefits for adults enrolled in Medicaid, according to a new journal article. The authors hope policymakers will consider adding comprehensive … Read More

Thank you, Matt [Kelly].  It is a pleasure to be here to kick off day two of Compliance Week’s 10th annual conference.  This conference represents a great opportunity for corporate executives, compliance officers, auditors and in-house and outside counsel to … Read More

As the Legislature gears up for Round 2 of its battle to pass a budget and figure out what to do about Medicaid expansion and health coverage for the poor, the Republicans in Tallahassee who want to sabotage Obamacare have … Read More

HARLINGEN, Texas, May 18, 2015 /PRNewswire/ — Nestled within its 900-plus pages of legalese, the Patient Protection and Affordable Care Act, or ACA, requires healthcare providers participating in federal programs to have an effective compliance program in place. For providers without … Read More

LOS ANGELES (AP) — A California dentist who treats children under Medicaid billed for more than 1,000 services a day for almost 100 days in 2012. Another provided 33 procedures — including multiple stainless steel crowns and baby root canals … Read More

Judges: State botched fraud case, must pay $400K in feesAUSTIN, Texas (AP) – A panel of judges has determined that Texas regulators so badly botched a Medicaid fraud investigation of a dentist that they’re responsible for paying the nearly $400,000 … Read More

Texas regulators entered a courtroom late last year claiming they should be able to keep more than $300,000 confiscated from a Corpus Christi dentist they claimed defrauded the state through a Medicaid billing scheme. Source: State’s decisive legal loss could … Read More

May 12, 2015 — The Small Smiles dental chain has agreed to pay $39 million according to the proposed settlement filed in bankruptcy court in Nashville, TN. The lawsuits included claims for alleged “unnecessary, inappropriate, unsafe, and excessive dental procedures” … Read More

In the three minutes it will take you to read this editorial, 570,681 tax dollars will be misspent. According to Iowa’s Medicaid fraud investigators, Kimberly Krum of Colfax has bilked state and federal taxpayers out of almost $2 million. But … Read More

What’s that thundering coming from the Health and Human Services Commission building? It’s the sound of Executive Commissioner Kyle Janek’s top people running out the door. Since December — when the commission began burning in the spotlight because of millions of dollars … Read More

A physician who ran a medical house call service in Dallas and an employee of that business were arrested Friday on charges alleging that they participated in a $5.2 million Medicare fraud scheme. Source: Dallas doctor, employee arrested in alleged … Read More

With billions of dollars in hospital aid at stake, health care officials are anxious for state leaders to resolve the federal government’s concerns about extending a program that helps cover the staggering cost of caring for uninsured and needy Texans. … Read More

A Houston doctor and a group home owner were arrested on charges related to their alleged participation in a $5.2 million Medicare fraud scheme involving false claims for mental health treatment. Assistant Attorney General Leslie R. Caldwell of the Justice … Read More

The company at the center of a state contracting scandal, Austin data analytics firm 21CT, has dismissed its $90 million defamation lawsuit against James Frinzi, the firm’s former lobbyist turned newspaper whistle-blower. Source: 21CT drops lawsuit against fired lobbyist James … Read More

States are wasting millions of taxpayer dollars under ObamaCare by failing to regularly check the eligibility of recipients under the law’s massive Medicaid expansion, critics say. Source: States wasting millions by keeping ineligible recipients on ObamaCare’s Medicaid rolls, critics say … Read More

While the Medicaid Recovery Auditor (RAC) program has continued to struggle to return funds to the Medicare program, state Medicaid Fraud Control Units (MFCUs) continue to see significant financial returns. Released at the end of April, the U.S. Department of … Read More

A Topeka man was ordered yesterday to repay the Kansas Medicaid program for charges relating to home health care fraud, Kansas Attorney General Derek Schmidt said. Source: Topeka man to repay Kansas Medicaid program for home health care fraud

AUSTIN — The Texas Health and Human Services Commission again has fallen behind on a major data project that now has cost taxpayers $12 million over the past decade even though officials have not yet even chosen a contractor.Two weeks … Read More

A Pullman dentist will serve 90 days in the Latah County Jail after being convicted of intentionally submitting false claims to Idaho Medicaid for dental work he did not provide. Alfred Fairbanks, 69, was sentenced to five years in prison, … Read More

The contracting reforms that Gov. Greg Abbott issued in January appear to have had such limited impact that they probably would not have prevented the 21CT scandal that prompted them. Public-Information records from 13 state agencies suggest that such policies … Read More

CARSON CITY — An audit of the state Medicaid program released Monday identified more than $1 million in overpayments and improper billings. Legislative Counsel auditors identified $780,000 in overpayments for behavioral health claims, and $285,000 in overpayments and improper billings … Read More

AUSTIN — The second-in-command at the Texas Health and Human Services Commission has decided to retire, continuing a year of change at the state’s biggest bureaucracy. Chris Traylor plans to step down May 31, the agency announced in a newletter … Read More

U.S. Also Elects to Intervene Against Novartis Pharmaceuticals Corporation in Claims that Novartis Gave Kickbacks to Accredo in Exchange for Increased Refills of Exjade Drug, and Understated Exjade’s Serious and Potentially Life-Threatening Side Effects to Patients Accredo Admits to Conduct … Read More

In June 2014, Phil Hermanson resigned as the KanCare inspector general, amid scrutiny of his lack of experience, past bankruptcy and driving under the influence. The resignation brought an end to one saga only to begin another, more protracted one. … Read More

After years of criticism that it is soft on fraud, the Minnesota Department of Human Services has dramatically intensified efforts to combat illegal overbilling in the state’s publicly funded health insurance program Source: Minnesota’s crackdown on Medicaid fraud yields millions … Read More

A Florida federal judge has endorsed a whistleblower’s use of extrapolation in False Claims Act litigation against nursing homes to prove potentially vast liability based on a small billing sample, the latest setback for defense counsel seeking to curtail the … Read More

JACKSONVILLE, Fla. — First Coast News has confirmed that state investigators have launched a Medicaid Fraud inquiry into the practice of controversial Jacksonville dentist Dr. Howard Schneider. The State Attorney General’s Office confirmed to First Coast News that a criminal … Read More

By M.B. Pell and Kristina CookeNEW YORK/SAN FRANCISCO, April 29 (Reuters) – A doctor who took kickbacks from a Pennsylvania hospice involved in a multimillion-dollar fraud. An Ohio psychiatrist who billed for treating no-show patients. A Georgia optometrist who claimed he … Read More

NCI Inc. has won a $14 million contract to provide program integrity services to the Centers for Medicaid and Medicare Services.NCI’s AdvanceMed business was awarded the Zone Program Integrity Contractor contract for Zone 3, which seeks to identify and reduce … Read More

The state’s massive health and human services system would be partially consolidated under a bill heard by the House Human Services Committee on Monday evening. Under House Bill 2304 by Four Price, R-Amarillo, three of the state’s five health and human … Read More

HOUSTON—William Owuama, 56, and Marla Owuama, 47, have been sentenced following their convictions related to a healthcare fraud scheme in which Mr. Owuama’s Company billed Medicare and Medicaid for more than $9 million, announced U.S. Attorney Kenneth Magidson. Both pleaded … Read More

Last week, state Comptroller Tom DiNapoli released an audit identifying at least $513 million in “improper” Medicaid payments — plus another $361 million in “questionable” transactions — over four years. Good work, Tom — but the true amount is likely … Read More

AUSTIN – A sophisticated software program crunched through a sea of Texas hospital records in July 2013, instantaneously comparing payment records against Medicaid rules to identify $4.4 million in questionable spending and start a process that eventually returned the money … Read More