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
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
