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
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
