Media

When investigators suspected that Houston’s Riverside General Hospital had filed Medicare claims for patients who weren’t treated, they moved to block all payments to the facility. Then politics intervened. Rep. Sheila Jackson Lee, a Texas Democrat, contacted the federal official … Read More

INDIANAPOLIS, Ind. (Dec. 11, 2014)– Charges have been filed against an Indianapolis dentist for falsely billing the State’s Medicaid program for dental treatments she allegedly did not perform. Dr. Bernice Avant, D.D.S., has been charged with one count of Medicaid fraud, … Read More

State administrators cannot withhold Medicaid payments from physicians suspected of program violations without evidence of fraud, a Texas appeals court has ruled. Appellate judges also struck down a rule that enabled the Texas Health and Human Services Commission (THHSC) to … Read More

WHY WE DID THIS STUDY Examining access to care takes on heightened importance as enrollment grows in Medicaid managed care programs. Under the Patient Protection and Affordable Care Act, States can opt to expand Medicaid eligibility, and even States that … Read More

Ten people – including three Brooklynites – were arrested and charged for their roles in an alleged $70 million scheme to defraud Medicaid and Medicare by submitting phony claims to the programs through three sham medical clinics, including one based … Read More

CMS Attempts to Curb Medicare Fraud The Centers for Medicare and Medicaid Services (CMS) is issuing new rules to help prevent Medicare fraud and abuse by barring physicians with unpaid debt from re-entering the system and ejecting providers who have … Read More

Rite Aid Corporation, a Delaware corporation and national retail drugstore chain with its principal place of business in Camp Hill, Pennsylvania, has paid the United States $2.99 million to resolve allegations that it violated the False Claims Act by inappropriately … Read More

The Corporate Whistleblower Center says, “We think there are enormous opportunities for in-home healthcare, or managers at hospice companies to cash in on lucrative federal whistleblower rewards, if they possess well documented proof the employer is overbilling Medicare, or Medicaid … Read More

A Florida owner and operator of multiple physical therapy rehabilitation facilities was sentenced in federal court in Tampa today to serve 11 years in prison for his role in organizing a $28.3 million Medicare fraud scheme involving physical and occupational … Read More

Texas and the federal government tentatively resolved a high-stakes health care funding inquiry on Monday, averting a major disruption to hospital funding. The Texas Health and Human Services Commission and the federal Centers for Medicare and Medicaid Services reached the … Read More

Following a South Florida Medicare and Medicaid fraud scandal that knew no borders, Coral-Gables-based HMO Florida Healthcare Plus is laying the groundwork to continue servicing its members in 16 counties. Earlier this year, 11 South Florida residents were indicted on … Read More

December 2, 2014 — A Texas appeals court has invalidated several rules related to payment holds imposed during Medicaid fraud investigations, saying they violate due process rights. The Third Court of Appeals invalidated rules that authorized the Texas Office of … Read More

The State agency complied with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud. In addition, the Surveillance and Integrity Review Section implemented its policies and procedures to address … Read More

It’s been 20 months since the Jindal administration canceled a nearly $200 million Medicaid claims processing contract amid allegations of improprieties in the way it was awarded. During that time, the administration has not sought any new proposals from private … Read More

The state health agency’s top lawyer, instrumental in steering more than $110 million in contracts to an Austin tech company, is a former business partner with that company’s lobbyist, state records show. Records show that beginning in 2002 Jack Stick, … Read More

Judge rightfully reins in anti-fraud unit after abusive action By Chris TomlinsonNovember 26, 2014 Doctors, dentists and other health care providers who care for the state’s most disadvantaged got some much needed relief Tuesday from an over-zealous, politically motivated anti-fraud … Read More

Law360, Dallas (November 25, 2014, 5:55 PM ET) — A Texas appeals court on Tuesday invalidated three Texas Health and Human Services Commission rules related to payment holds imposed during Medicaid fraud investigations, holding they violate due process rights. The … Read More

AUSTIN – Texas officials have been illegally withholding millions of dollars from dozens of dentists and orthodontists based on only the suspicion of minor wrongdoing, an appeals court ruled Tuesday, dealing another blow to the state’s beleaguered unit charged with … Read More

The Texas agency charged with investigating health care fraud suffered a serious setback Tuesday, when a state appeals court ruled that the Health and Human Services Commission’s Office of Inspector General’s expansive use of a key tactic — withholding Medicaid … Read More

As Texas’ top health officials steer $110 million in no-bid contracts to an Austin tech company they say is revolutionizing Medicaid fraud investigations, the state’s top contract manager says those contracts are too loosely written and raise questions about what … Read More

Forbes magazine has dubbed 2014 “The Year of the Whistleblower.”  For healthcare providers, this designation has translated into millions of dollars in fines and penalties and the initiation of criminal investigations. Just last month, the Health Care Fraud Prevention and … Read More

First Annual Recovery to Exceed $5 Billion; Over 700 Whistleblower Lawsuits for Second Consecutive Year The U.S. Department of Justice obtained a record $5.69 billion in settlements and judgments from civil cases involving fraud and false claims against the government … Read More

Gov. Rick Perry has appointed David Tillman of Aledo and Jason Zimmerman of Keller to the Texas State Board of Dental Examiners. The board oversees licensing and regulation of dental care providers in Texas, and enforces Texas laws regulating the … Read More

One of the nation’s largest nursing home chains will pay $38 million to settle federal claims that the company inappropriately billed for physical therapy and provided poor care that was “effectively worthless,” the Department of Justice reported. The agreement reached … Read More

Two Georgia health care clinic operators are wanted on 24 federal charges of health care fraud after law enforcement officials said the pair bilked Medicaid and Medicare of millions in false claims. Miguel Angel Hernandez and Maria del Pilar Moreira … Read More

ALBANY—The state’s Medicaid Inspector General, James Cox, will join a number of first-term Cuomo appointees who are departing the administration. Cox, who was appointed in July 2011 by Governor Andrew Cuomo to head the Office of Medicaid Inspector General, emailed … Read More

A former CFO at a now-shuttered hospital has pleaded guilty to submitting false documents so the medical center could receive $785,000 in payments under the HITECH Act  electronic health records financial incentive program. Some legal experts predict that more federal … Read More

November 18, 2014 — The Texas agency charged with investigating Medicaid fraud is finalizing a $90 million contract for Medicaid fraud detection software. of software licenses and services from the company, 21CT, according to a statesman.com story . Austin-based 21CT is a … Read More

The United States Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released its Fiscal Year 2015 Work Plan (“2015 Plan”) on October 31, 2014. OIG releases a work plan annually to identify the new and ongoing investigative, enforcement … Read More

Federal False Claims Act cases are tough on defendants and their lawyers. The stakes are always high with the risk of treble damages, significant penalties per claim and the imposition of relator attorney fees. And the government and the whistleblowers … Read More

With round two of Obamacare enrollment here, New York’s policymakers should take stock of where the Empire State is and where it’s heading.Take the state’s Medicaid program. Post-Obamacare, Medicaid enrollment has grown by over 7 percent to 6.1 million people: … Read More

AUSTIN, Texas (AP) — The state office responsible for investigating Medicaid fraud and waste is finalizing a $90 million contract with an Austin company that has little experience with Medicaid spending. The inspector general’s office for the Texas Health and … Read More

The state office charged with investigating Medicaid fraud and waste, criticized this week by state auditors and legislators as dysfunctional and “broken,” is finalizing a $90 million contract with an Austin analytics company that had no experience with Medicaid before … Read More

AUSTIN — When Gov. Rick Perry tried to force a district attorney from office for drunken driving, he cited outrage at her behavior and a loss of confidence in her ability to do the job.But on his own staff, Perry … Read More

Gov.-elect Greg Abbott’s pick for Texas secretary of state voted for a local resolution last year endorsing the expansion of Medicaid — a central tenet of the federal Affordable Care Act that Abbott fiercely campaigned against. In a phone interview, Carlos Cascos, a Republican … Read More

Responding to an audit critical of the state’s network of health agencies, as well as the embattled Medicaid fraud investigative unit, a panel of state lawmakers this week endorsed an overhaul of the state’s umbrella health agency, the Health and … Read More

TDMR is republishing this very descriptive and apt blog post. A Senseless Fraud Prosecution Victimized Doctor And Patients by Larry M. Elkin, CPA, CFP® In the complicated world of medical and dental care, billing mistakes happen. Add a complicated government … Read More

Texas’ top health official told lawmakers Wednesday that they should combine the state’s five health departments into one “mega-agency.” A single, consolidated health commission would better serve the state’s most vulnerable populations, Health and Human Services Executive Commissioner Kyle Janek told the Sunset Advisory … Read More

AUSTIN – Texas officials voiced support Wednesday for a proposal to combine five big state health and human services agencies into a mega-agency so massive that it would have a bigger budget than many states. The agencies made their support … Read More

AUSTIN, November 11 – State Sen. Juan “Chuy” Hinojosa does not like the way the Texas Health and Human Services Commission Office of the Inspector General treats Medicaid providers and he wants to rein in the agency next session. “It … Read More