The following article was published today in the Texas Tribune, authored by Christine Ayala and Jay Root. UPDATE: The same article was republished in the New York Times with the title “A Texas Official’s D.W.I. Case Is Being Seen in … Read More
AUSTIN – Call it the billion-dollar blame game. Six years after auditors discovered signs that some Texas orthodontists were putting unneeded braces on teeth of the state’s poorest children, an army of lawyers are battling over who is liable for … Read More
The owner of a home health services company was sentenced to serve five years in prison for his leading role in a conspiracy to structure over $1.8 million in bank withdrawals to conceal a $4.5 million healthcare fraud scheme. Assistant … Read More
A New Orleans grand jury today indicted seven defendants for their roles in a $56 million Medicare fraud scheme that operated in New Orleans and surrounding communities. Thirteen defendants have now been charged in this case, three of whom pleaded … Read More
The facts of the auditor’s report released Thursday on the administration of Gov. Rick Perry’s Texas Enterprise Fund are, as the Tribune’s Aman Batheja termed it, “damning.” How bad? Eleven companies receiving a total of $223.3 million “either did not … Read More
he Alaska Department of Health and Social Services has filed a claim against the private company responsible for rolling out a Medicaid payment system that the state says is riddled with defects. In the claim filed Monday, the health department said … Read More
Erin Fair Taylor’s job isn’t easy. That’s because every day, she must figure out how to pay doctors. Taylor works for CareOregon, which is playing an active part in Oregon’s effort to overhaul its Medicaid system. As such, it’s her … Read More
AUSTIN — The Texas Health and Human Services Commission (HHSC) plans to re-issue a request for proposals (RFP) for a major data project this fall. The original procurement was canceled so the state could make revisions to help lower the … Read More
September 22, 2014 — Even after months of debate, Missouri lawmakers still can’t settle the debate over how to fund the costs of a government-funded health plan that would provide dental care for almost 300,000 low-income adults in the state. … Read More
AUSTIN – Texas health officials abruptly have pulled the plug on a major data project amid concerns about its cost and suggestions the tentative contract winner was receiving inside information from state negotiators. The decision to end negotiations with Truven … Read More
ATLANTA, GA – The United States Attorney’s Office announced it has reached settlements with Banks-Jackson-Commerce Hospital and Nursing Home Authority d/b/a Banks Jackson Commerce Medical Center (BJC) and Dr. Narasimhulu Neelagaru that total over $500,000. “Kickbacks pervert our health care … Read More
The former owner of a Long Beach, California, medical supply company was sentenced today to serve 30 months in prison and ordered to pay $1,490,532 in restitution for his role in a scheme to provide unnecessary power wheelchairs to Medicare … Read More
Consumers saved $1 billion in 2013 and states receive more funding to continue to scrutinize rate hikes Health and Human Services Secretary Sylvia M. Burwell today released a new report showing that in 2013 alone, consumers benefitted from $1 billion … Read More
NORFOLK, Va. – W. Wayne Perry, Jr., 55, and his wife, Angela Perry, 52, formerly of Suffolk, Va., were convicted after a three-week trial late yesterday afternoon by a federal jury of one count of conspiracy to commit health care … Read More
by Alexa Ura, The Texas Tribune SAN ANTONIO — When Armando Rodriguez opened the front door of his home here on the city’s west side, Chris Ornelas of the Texas Organizing Project met him with one question. “What are some … Read More
WASHINGTON – Lewis J. Levine, 57, a chiropractor who practiced in Southeast Washington, pled guilty today to a federal charge of health care fraud for his role in a scheme involving fraudulent claims to the District of Columbia Medicaid program. … Read More
Preet Bharara, United States Attorney for the Southern District of New York, announced today that AKIM MURRAY, an employee of the Medicaid Reimbursement Unit of the New York City Human Resources Administration “HRA”, pled guilty before U.S. District Judge Richard … Read More
OIG SNAP Fraud Strategies Report Required by Senate Bill 8 is published by HHSC. This PDF file is available here:
Funding creates an estimated 4,750 new jobs; Helps newly insured access care Health and Human Services Secretary Sylvia M. Burwell announced today $295 million in Affordable Care Act funding to 1,195 health centers in every U.S. State, the District of … Read More
Signed into law in 1965, Medicaid ensures health coverage for nearly 60 million Americans today. Since the Medicaid program was established, the costs and responsibilities for administering it have been shared between the States and the Federal Government. However, a … Read More
A McAllen man was charged Wednesday in a federal indictment for an alleged scheme to defraud Texas Medicaid out of more than $2 million. Willie Chester Mitchell, 33, the owner of two Rio Grande Valley medical equipment companies, Illusion Medical … Read More
The Louisiana Department of Health & Hospitals State agency did not always pay Medicaid electronic health record EHR incentive payments in accordance with Federal and State requirements. The State agency made incorrect EHR incentive payments to 20 hospitals totaling $4.4 … Read More
Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, announced today that on September 3, 2014, Christopher Spivey, 30, pled guilty to submitting false and fraudulent bills in relation to personal assistant services in the Home Services … Read More
BALTIMORE — The ordinary looking office building in a suburb of Baltimore gives no hint of the high-tech detective work going on inside. A $100 million system churns through complicated medical claims, searching for suspicious patterns and posting the findings … Read More
WASHINGTON — If the 23 states that have rejected expanding Medicaid under the 2010 health care law continue to do so for the next eight years, they’ll pay $152 billion to extend the program in other states _ while receiving … Read More
Data mining is the process of identifying fraud through the screening and analysis of data. On May 17, 2013, the Department of Health and Human Services (HHS) issued the final rule "State Medicaid Fraud Control Units; Data Mining" (78 Fed. … Read More
State regulators in Texas last week agreed to settle allegations of Medicaid fraud against Trueblood Dental Associates, P.A. Brace yourself for the numbers: The state agreed to recover just $39,211 out of a $16,209,289 projected overpayment for dental claims in a … Read More
AUSTIN (KXAN) — You take the toll road to save time and you get a TxTag to save time paying your bill, but for many of you, dealing with TxTag has been anything but saving time. For two months, you’ve … Read More
August 29, 2014 — In the latest development in the ongoing Texas Medicaid scandal, the state Health and Human Services Commission (HHSC) has filed a second lawsuit against Xerox, claiming the company is refusing to turn over patient records. Without … Read More
Xerox, a company that worked on the Texas Medicaid program, may still have files that contain information about many current and former Medicaid clients. The company is being sued by the state and has refused to return the files. One … Read More
September 1 marks latest expansion of Medicaid managed careAn additional 134,000 people who are elderly or have disabilities are now getting their Medicaid services through STAR+PLUS managed care. The switch came September 1 as HHSC continued its expansion of managed … Read More
NEW YORK – Attorney General Eric T. Schneiderman today announced the arrests of four individuals for allegedly practicing dentistry without a license at two Brooklyn dental clinics, which are separately owned by a father and his son who are licensed … Read More
Law360, New York (August 11, 2014, 2:39 PM ET) — The state of Texas has reached a $19.5 million settlement with Taro Pharmaceuticals USA Inc. to resolve allegations that the drug company fraudulently reported inflated drug prices to the Medicaid … Read More
Fraud in Medicaid constitutes a scam amounting to more than a billion dollars and a newly installed computer system is assisting to ferret out the criminals. As per Kaiser, about $28 billion is paid by Texas to provide care for … Read More
ABINGDON, VIRGINIA – A Wise, Va. dentist has admitted to obtaining hydrocodone by fraud and to illegally distributing over 2,500 hydrocodone pills. Newton Carroll Mullins, 65, of Wise, Va., who operates a dental practice in Wise, Virginia, waived his right … Read More
The allegations state health regulators leveled against Rachel Trueblood two years ago were dramatic: The Austin dentist had billed the government for millions of dollars in unnecessary procedures and office time, they said. Regulators froze $100,000 of outstanding Medicaid payments … Read More
HOUSTON—Andrea Michelle Tellison, 47, has been ordered to federal prison for eight years following her convictions of 14 counts of health care fraud and seven counts of aggravated identity theft, announced United States Attorney Kenneth Magidson. A jury convicted Tellison … Read More
To understand waste, fraud and abuse of taxpayer dollars in the Medicaid system, let’s begin with a couple of basics on what the role of Medicaid is in health care and how it works. Medicaid Basics Medicaid is a program … Read More
August 27, 2014 — Newly formed dental service organization (DSO) Modern Dental Services (MDS) of Dallas has raised $2.5 million in private equity to purchase dental practices from older practitioners and use them as job opportunities for new dentists. Backed … Read More
The state is suing Xerox for a second time, afraid the company’s recent actions in withholding a large number of documents relating to its tenure as the state’s primary Medicaid claims administrator will lead to millions of dollars of federal … Read More
