The Governor’s office may sue Xerox Corporation for the bungled rollout of a new system to process Medicaid claims. The Enterprise Medicaid Management System was supposed to replace the state’s antiquated 30 year old computer program. It went live on … Read More
ALBANY—New York State’s decision to award a $550 million Medicaid management contract to Xerox is being challenged by two companies who say the company’s recent history of Medicaid management in other states should disqualify it from running New York’s system. … Read More
Mobile, Alabama-based Infirmary Health System Inc. (IHS), two IHS-affiliated clinics and Diagnostic Physicians Group P.C. (DPG) have agreed to pay the United States $24.5 million to resolve a lawsuit alleging that they violated the False Claims Act by paying or … Read More
As Texas neared the end of a decade-long legal fight over homeowners’ insurance rates with Farmers Insurance Group in December, the company’s employees PAC gave $50,000 to the gubernatorial campaign of Attorney General Greg Abbott — the top lawyer in … Read More
After appointing Republican state Sen. Jane Nelson to chair the Senate Finance Committee, Lt. Gov. David Dewhurst has picked state Sen. Charles Schwertner, R-Georgetown, to replace her as the head the Senate Health and Human Services Committee. Dewhurst revealed that … Read More
Lt. Gov. David Dewhurst has appointed state Sen. Jane Nelson, R-Flower Mound, to chair the powerful Senate Finance Committee, setting the stage for Nelson to be one of the lead budget writers in 2015. Nelson replaces Tommy Williams, who resigned … Read More
The elevation of Texas Sen. Jane Nelson to be the Senate’s chief budget writer is imminent, according to a well-placed Capitol source. Lt. Gov. David Dewhurst is telling people he’s decided to name Nelson, R-Flower Mound, to be chairwoman of … Read More
More than 80,000 additional Texans have enrolled in Medicaid or the Children’s Health Insurance Program since the rollout of the Affordable Care Act last fall despite Republican state leaders’ decision not to expand eligibility to poor adults, according to federal … Read More
Today, Health and Human Services Secretary Sylvia M. Burwell announced a new innovative collaboration with states to improve care for Medicaid beneficiaries by accelerating efforts in reforming their health care systems to improve health and care while reducing costs. The … Read More
HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015. New health center sites will increase access to comprehensive, … Read More
GAO identified a gap in state and federal efforts to ensure Medicaid managed care program integrity. Federal laws require the states and the Centers for Medicare & Medicaid Services (CMS) to ensure the integrity of the Medicaid program, including payments … Read More
Work continues to move the Medicaid claims administration contract from Xerox to Accenture. HHSC is reviewing Accenture’s readiness to take over the contract, which also includes processing claims for the Children with Special Health Care Needs program and vendor drug … Read More
Summary Pennsylvania complied with the requirements of the Affordable Care Act to implement regulations (42 CFR § 455.23) for the review of cases for which there were credible allegations of Medicaid fraud. Pennsylvania Complied With the Requirements of the Affordable … Read More
DALLAS (CN) – A journalist’s false allegation of personal bankruptcy did not defame a dentist whose clinics were accused of fraud, a Texas appeals court ruled. Dr. Richard Malouf, the founder and former majority owner of All Smiles Dental Care, … Read More
The office of Attorney General Greg Abbott — the Republican gubernatorial candidate — is appealing a whistleblower’s lawsuit and $1.2 million verdict, arguing that an El Paso jury was wrong when it decided that the agency fired an employee in … Read More
June 19, 2014 — Colorado adults on Medicaid now have dental coverage, including an annual benefit of up to $1,000 in dental services. Previously, only emergency dental services were covered, according to Oral Health Colorado. The benefit enables adults age … Read More
Texas’ Republican leadership made sure the state didn’t expand its Medicaid program to poor, uninsured adults — an optional provision of the Affordable Care Act. But low-income parents here are increasingly getting covered by the joint state-federal insurer anyway — … Read More
The owner and operator of a Houston area ambulance company was sentenced today to serve 97 months in prison for her role in a $2.4 million Medicare fraud scheme. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal … Read More
June 6, 2014 — Illinois lawmakers have passed a bill to restore adult dental coverage for Medicaid patients after emergency room costs for dental problems mushroomed when the program was cut. The bill now goes to Gov. Pat Quinn for … Read More
Xerox Corp at the end of May was awarded a $500 million contract to revamp New York’s Medicaid system despite Texas suing the company and discontinuing their contract as chief Medicaid claims administrator in the state. The Rochester Democrat and … Read More
HOUSTON – Leonard Kibert M.D., 63, of Houston, has been charged in a 47-count indictment alleging a conspiracy to defraud Medicare of $2.9 million, announced United States Attorney Kenneth Magidson. Also charged in the indictment are Tsolak Gevorgyan, 28, Christopher … Read More
AUSTIN — As he gears up for a possible second presidential run, Texas Gov. Rick Perry is crisscrossing the country extolling a business-first philosophy he says made his state’s economy white-hot — and can work for the rest of America … Read More
Yesterday, HHS-OIG issued an audit entitled “Acute-Care Hospitals In Texas Did Not Always Reconcile Invoice Records With Credit Balances And Refund To The State Agency The Associated Medicaid Overpayments.” The federal auditors, in looking over eight acute care hospitals in Texas, … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the Texas Health and Human Services Commission (State agency). However, the seven remaining hospitals in our sample did not always … Read More
Deloitte Report for Texas As market pressures continue to mount, states are not only looking to derive more value from their managed care programs but also seeking to use these programs to address CMS’ Triple Aim: better health, better quality, … Read More
Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the availability of up to $300 million under the Affordable Care Act to help the nation’s community health centers expand service hours, hire more medical providers, and add oral health, … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the State agency. However, the seven remaining hospitals in our sample did not always reconcile patient account credit balances and … Read More
One doctor served prison time for health-care fraud. Another has been disciplined by regulators five times, on charges including dangerous overuse of anesthesia. A third devotes his practice to a controversial therapy that Medicare won’t cover. That didn’t stop Medicare … Read More
The Texas Health and Human Services Commission Office of Inspector General has published its annual report of Medicaid fraud and abuse recoveries by managed care organizations in the state. Well, it is a year behind. This one is for 2013. … Read More
Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a report from the inspector general of the Department of Health and Human Services. But in its reply to the findings, the Centers … Read More
May 28, 2014 — Two orthodontists have filed a civil rights lawsuit against the Arkansas State Dental Board of Examiners, seeking “declaratory and injunctive relief” and trying to change Arkansas’ Dental Practice Act, which prevents dental specialists from providing teeth-cleaning … Read More
HHSC yesterday sent out a notice that a new draft HHSC strategic plan has been issued to cover 2015 to 2019. They have invited public comment. Naturally, the report is 348 pages long and their first public hearing on the report … Read More
Texas has received federal approval to test an innovative idea that combines health services for people with both Medicaid and Medicare coverage into one plan, making it easier to get care and potentially saving money for the state and federal … Read More
A Texas dentist appointed by Gov. Rick Perry to a state board has resigned from the panel after being arrested on charges he secretly recorded an employee as she changed clothes. Dr. William Birdwell was a member of the Texas … Read More
May 27, 2014 — In the latest flurry of lawsuits in the Texas Medicaid scandal, eight dentists have filed suits claiming the state and attorney general (AG) “protected” Xerox because they feared a federal clawback for hundreds of millions of … Read More
Gov. Rick Perry has reappointed Cathleen Parsley of Austin as Chief Administrative Law Judge for the Texas State Office of Administrative Hearings for a term to expire May 15, 2016. The judge oversees hearings in contested cases to ensure they … Read More
May 20, 2014 — This year more than 181 million Americans won’t visit a dentist, nearly half of people older than 30 suffer from some form of periodontal disease, and about 1 in 4 children younger than age 5 already … Read More
May 20, 2014 — In the wake of a Texas lawsuit that claims Xerox wrongly approved Medicaid claims for orthodontic services that were not medically necessary, some of the dentists being pursued for orthodontic overpayments are now suing Texas for … Read More
The Obama administration’s efforts to crack down on bogus Medicare payments have ended up sweeping in too many “good actors” who get ensnared in a costly and tedious appeals process, House lawmakers said Tuesday. While tackling Medicare fraud is worthwhile, … Read More
The Texas Tech University System Board of Regents officially named state Sen. Robert Duncan, R-Lubbock, the sole finalist to be the system’s next chancellor in a press release issued Monday afternoon. Duncan is expected to start in his new position … Read More
