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
Nearly one-third of Medicaid fraud criminal convictions the federal government obtained last year involved home health aides, the Inspector General for Health & Human Services reports. Thirty percent of the 2014 cases involved home health aides, while certified nursing aides … Read More
AUSTIN – A renewed effort to evaluate state contracting oversight could end up illustrating an uncomfortable reality, former lawmakers and government watchdogs say: even the strictest of safeguards will not work if not taken seriously by agency officials. Despite an … Read More
Health care providers who say they’ve been unfairly targeted by Texas Medicaid fraud investigators tallied a win Tuesday when the Senate passed a bill to crack down on that office and give doctors room to push back against bogus fraud … Read More
The Senate passed a bill Tuesday that seeks to revamp the state agency that investigates fraud, waste and abuse in Medicaid and other state health services. The Office of Inspector General at the Health and Human Services Commission is supposed … 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
AUSTIN — A new bill to curb alleged abuses of an organization that is itself supposed to police abuses got Texas Senate approval Tuesday. Senators voted 30-0 to pass Senate Bill 207 by state Sen. Juan “Chuy” Hinojosa, D-McAllen, which … Read More
State Rep. John Kuempel, chairman of the House General Investigating and Ethics Committee, launched an official inquiry Monday into contracting practices at 11 state agencies.Kuempel requested information on contracts at the Health and Human Services Commission, where questions surrounding a $20 million, … Read More
Gregg Cox, the Travis County prosecutor who oversees the embattled Public Integrity Unit, on Monday rejected a request from the Department of Public Safety to re-open an investigation into controversial border security contracts, telling Director Steve McCraw the unit does … Read More
Three years ago, a company called Geo Care Inc. failed to win a contract from the Texas Health and Human Services Commission to privatize the Kerrville State Hospital, one of the state’s 10 psychiatric facilities. So the company’s lobbyist, Frank … Read More
In August 2013, a lobbyist for a national company that privatizes state prisons emailed a bold proposal to Kyle Janek, the top official over a Texas health agency that at the time was facing scrutiny for a spate of gruesome … Read More
AUSTIN — A discussion about restructing the Texas health agency morphed into a heated argument about President Obama’s health care law in the state Senate on Wednesday, as Democrats frustrated at not getting a committee hearing on a Medicaid expansion plan … Read More
A Texas senator on Wednesday requested that the embattled Public Integrity Unit of the Travis County District Attorney’s office re-open its investigation into $20 million in no-bid border security contracts awarded by the Department of Public Safety to the private … Read More
The Texas Senate on Wednesday tentatively approved a measure to partially consolidate the state’s massive health and human services system. Under Senate Bill 200 by Jane Nelson, R-Flower Mound, three of the state’s five health and human services agencies — the … Read More
The Colorado Department of Health Care Policy and Financing (State agency) lacked sufficient internal controls to ensure that Medicaid claims submitted by providers and paid by the State agency during fiscal year (FY) 2011 correctly included National Provider Identifiers (NPIs) … Read More
