Medicaid scam arrests in New York City have revealed an elaborate scheme of false Medicaid billings – all in a shameless exploitation of the indigent who needed shoes. In the indictment this week, investigators said that between October 2012 and … Read More
By Editorial Board The critical report released Monday by a “strike force” deployed by Gov. Greg Abbott to investigate the health agency’s $110 million no-bid contract with 21CT, an Austin technology company, makes our conclusion unavoidable. While the report did … Read More
You have to feel for the healthcare fraudsters out there. It’s not as easy as it once was to rake in millions of insurance dollars on false claims scams. These days, you really have to work for your money–or at … Read More
Over the past year, false claims prosecution under the “worthless services” theory has picked up traction. Now that the Department of Justice (DOJ) plans to simultaneously prosecute civil and criminal whistleblower claims, this legal approach may take on an even larger … Read More
An advisory opinion released last week by the U.S. Department of Health and Human Services Office of Inspector General (OIG) advises labs not to enter exclusive agreements with physician practices that would cover patient fees for certain insurance plans. This … Read More
A man is facing charges after police say he broke into the Office of the Inspector General. It’s employees who you expect to find inside the Office of the Inspector General. But last Sunday, police said it was Robert Burkhart … Read More
A state contracting scandal that dealt Republican Gov. Greg Abbott the first crisis of his administration escalated Monday with a scathing state report about Texas’ health commissioner, who responded by giving no indication he would resign. An outside investigation ordered … Read More
A comprehensive state contracting reform bill unanimously passed the Texas Senate Tuesday and heads the House, where it is likely to sail through and ultimately give Gov. Greg Abbott the chance to approve fixes to a massive state purchasing system … Read More
AUSTIN — The Texas Health and Human Services Commission needs “significant changes” in its leadership or management structure, according to a committee appointed by Gov. Greg Abbott. The panel’s much-anticipated report, released Monday, is the latest blow for a troubled … Read More
A multimillion-dollar software contract for the Texas Health and Human Services Commission was blasted in a report from a “strike force” committee appointed by Gov. Greg Abbott, reports the Texas Tribune. “The report’s findings are deeply troubling,” said Abbott in … Read More
WHITLEY COUNTY, Ky. (WKYT) – A Whitley County dentist entered a plea in a Medicaid fraud case. The State Attorney General says Ronald Hungerbuhler billed medicaid for dental exams he should have performed on patients at a local nursing home, … Read More
As the Health and Human Services Commission continues to face fierce criticism for contracting problems, one pressing question remains unanswered: Will Executive Commissioner Kyle Janek keep his job? A few legislators have called for his ouster, but most state leaders … Read More
12:11 p.m. update: The multimillion-dollar, no-bid state deals with Austin tech firm 21CT “skirted the limits” of the law and was a “policy fiasco” that illustrates the need for changes in the leadership structure at the Health and Human Services … Read More
Governor Greg Abbott issued the following statement regarding the report released today by the strike force he deployed to conduct a review of the Texas Health and Human Services Commission: “When I deployed the strike force, I had confidence they … Read More
Leadership problems at the Texas Health and Human Services Commission in the wake of a contracting scandal that resulted in forced resignations leave the agency too vulnerable to consolidate at this time, according to a report released Monday by Gov. Greg … Read More
by Terri Langford and Aman Batheja, The Texas Tribune FBI agents have interviewed employees at the Texas Health and Human Services Commission about its problematic contract with Austin firm 21CT, Executive Commissioner Kyle Janek told The Texas Tribune, marking the first … Read More
Recent stories in the news seem to suggest that health care fraud is running rampant. We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in Greensboro for alleged Medicaid fraud, and, … Read More
Ohio’s Medicaid office searched for ways to continue paying hundreds of healthcare services providers after uncovering "credible allegations of fraud," violating the Affordable Care Act. The state agency came up with "good cause" to continue funneling money to providers strongly … Read More
A plan to privatize Terrell State Hospital is dead following a scathing audit that raps the state health commission for bypassing its own contracting procedures.The Texas Health and Human Services Commission canceled the deal — which was still being negotiated … Read More
Good morning, Mr. Chairman and distinguished Members of the Subcommittee. Thank you for the opportunity to testify about fraud, waste and abuse in our Medicare program. My experience working in law enforcement and private practice has taught me that, notwithstanding … Read More
The State agency did not always comply with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud between July 1, 2011, and June 30, 2013. Of the 401 cases … Read More
Improper Medicare payments and fraud populated the Office of Inspector General’s (OIG) list of the top 25 unimplemented recommendations, according to a report from the watchdog agency that offered insight into where the Centers for Medicare & Medicaid Services (CMS) still … Read More
A package of bills to overhaul the state’s clunky health and human services system drew more than three hours of testimony before a Senate panel on Monday, the latest airing of concern across varied interest groups who fear losing access … Read More
More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control (HCFAC) Program, Attorney General Eric Holder and HHS Secretary Sylvia M. Burwell announced today. The government’s health … Read More
by Edgar Walters, As the state’s largest health agency reels from a scandal over how it awarded contracts to private vendors, lawmakers on Wednesday said they are slowing down on their ambitious — and controversial — plan to restructure it. A … Read More
AUSTIN – After months of downplaying his involvement in a no-bid state contract that collapsed in scandal last December, a former lobbyist for the company that got the deal is changing his story. The lobbyist, James Frinzi, acknowledged in a … Read More
March 17, 2015 — Four clinics of Texas’ Smile Magic chain have agreed to pay $4.5 million to settle Medicaid fraud charges. The whistleblower lawsuit claimed the clinics used paid recruiters to target parents in grocery store parking lots and … Read More
The former lobbyist for Austin tech company 21CT — whose canceled Medicaid anti-fraud contract is shrouded by scandal and criminal investigations — testified last month that he was referred to work for the company by Jack Stick, the disgraced former … Read More
by Terri Langford On a rainy day in February three years ago, about 30 men and women recently hired by the state filed into a dull government classroom to begin a week of training for their new positions. Texas funnels a … Read More
Members of the Texas Senate will likely propose significant additions to a bill introduced this week on agency contracting now pending before the Senate Finance Committee. Sen. Jane Nelson, R-Flower Mound, introduced Senate Bill 20 to address what she called … Read More
A Pullman dentist found guilty of medicaid fraud has submitted a request for a new trial and says he has conclusive evidence proving he provided the fillings the state argued were never completed. Alfred Fairbanks, 69, a dentist at Today’s … Read More
AUSTIN (KXAN) — Rep. Tony Dale, R-Cedar Park, has filed House Bill 3108 relating to the collection of unpaid tolls. KXAN has learned the bill, filed on Wednesday, will hold both the Texas Department of Transportation and its vendor, Xerox, … Read More
AUSTIN – The Texas Senate’s top budget writer on Monday proposed sharply limiting the use of the popular and controversial Cooperative Contracts purchasing program, signaling that a promised tightening of restrictions for outsourcing by state agencies may be even more … Read More
ALBUQUERQUE, N.M. State officials would have to follow certain procedures before cutting off government funding for health care providers suspected of Medicaid fraud or overbilling under a measure passed Tuesday by the New Mexico Senate. The legislation sponsored by Senate … Read More
AUSTIN — The office of Texas Attorney General Ken Paxton has ruled that the state does not have to release public records related to a scandal over a $110 million no-bid Medicaid fraud detection contract because doing so would interfere … Read More
AUSTIN — The Texas health commission’s new inspector general has brought with him a team of aides from the private sector, ushering in a new era of leadership at the embattled agency in charge of rooting out waste, fraud and … Read More
A new report out from the GAO suggests that state IT systems may not be up to snuff when it comes to judging Medicaid eligibility. The March 2 report says that even while some states have recently updated Medicaid Management … Read More
The United States Court of Appeals for the Seventh Circuit recently issued an interesting decision concerning the definition of “referral” in the context of federal anti-kickback laws. See U.S. v. Patel, No. 14–2607, 2015 WL 527549 (7th Cir. 2015). In … Read More
(Tribune News Service) — The popular state purchasing program that played a role in a $110 million no-bid contract now engulfed in scandal is likely to be revamped during this year’s legislative session, officials predicted this week. “We’re going to … Read More
(Bloomberg) — New York state is seeking to extend a contract with Computer Sciences Corp. to run its Medicaid computer system because a deal for Xerox Corp. to take over the program is stalled. The length of the extension is … Read More
