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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

If Texas wants to keep receiving billions of federal dollars to help hospitals care for uninsured patients, state lawmakers may have to look again at expanding Medicaid coverage for impoverished adults, some political observers say. That’s because in 2016, Texas will have to … Read More

Dr. Dennis B. Barson Jr., 44, and his medical clinic administrator, Dario Juarez, 54, have been convicted on all counts as charged in a conspiracy to defraud Medicare of $2.1 million in less than two months, announced U.S. Attorney Kenneth … Read More

Medicaid has long been the second biggest drain  on Illinois taxpayers behind the public-pension crisis  – mostly due to the fact that more than half (51.3%) of state Medicaid recipients were ineligible to receive it, according to previous audits . In fact, … Read More

From the blog of Knicole Emanuel, a NC Medicaid attorney. Whew…the election is over. No more political ads, emails, and other propaganda… Ok, so we have our new elected officials, now our new elected officials need to pass some new … Read More

Daybreak Venture, LLC, the general partner of 74 skilled nursing and long-term-care facilities throughout Texas, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 24, 2014. … Read More

ALBANY—Visiting Nurse Services, the nation’s largest nonprofit home-health care company, will pay $35 million to the federal Medicaid program to settle a civil suit alleging it enrolled more than 1,700 people into Medicaid plans who were ineligible.The lawsuit, filed by … Read More

WHAT WE FOUND We identified 94 general dentists and 1 oral surgeon in Indiana with questionable billing. These providers are extreme outliers when compared to their peers. Medicaid paid these providers $30.5 million for pediatric dental services in 2012. These … Read More

Federal officials are planning a wide range of audits into billing and government spending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly expanding under … Read More

A former Medicaid fraud investigator has won his federal whistleblower suit against his former employer, the Florida Attorney General’s office. According to court records, Ballenger Charles repeatedly told federal authorities the AG’s office was not investigating Medicaid providers only recipients. … Read More

A Nampa home health care service operator has been ordered to reimburse the state, perform 40 hours of community service and pay court costs and fines after pleading guilty to Medicaid fraud. The Idaho Attorney General’s office says 66-year-old Cline … Read More

Federal authorities say a former Parkland Memorial Hospital employee illegally used information from thousands of patients to defraud Medicare and Medicaid. Viju Mathew, 49, of Garland has agreed to plead guilty to a federal fraud charge and is scheduled to … Read More

AUSTIN – The Texas Rangers have opened a criminal investigation into a recently fired state employee whose alleged falsification data could cost the state the chance to recoup millions of dollars from dentists and orthodontists of Medicaid fraud, officials confirmed … Read More

A Stillwater-based dental company has agreed to pay more than $5 million in civil claims stemming from allegations that it submitted false Medicaid claims. Ocean Dental PC, which operates 28 clinics in seven states, did not admit any liability in … Read More

In another setback for the state health agency charged with rooting out Medicaid fraud, an appeals court Thursday said almost $1.26 million was improperly withheld from a dental practice even after state regulators acknowledged that no fraud had taken place. … Read More

On October 22, 2014, the Department of Justice (DOJ) announced that DaVita Healthcare Partners, Inc. (DaVita), a provider of dialysis services, has agreed to pay the U.S. Government $350 million for allegedly violating several provisions of the False Claims Act … Read More

David Feinwachs was general counsel for the Minnesota Hospital Association. Until 2010 when he was fired. His firing ended a 30 year career with the hospital association. He was fired because he began asking questions about why the four HMOs … Read More

Oct 27 (Reuters) – The United States on Monday joined a lawsuit accusing New York City and Computer Sciences Corp of defrauding Medicaid into making millions of dollars of improper reimbursements by exploiting a computerized billing system that the company … Read More

A key legislator with oversight of the state’s Health and Human Services Commission has asked that agency’s Office of Inspector General to review all Medicaid fraud cases handled by an actuary who admitted recently to falsifying numbers on at least … Read More

It appears other states besides Texas are having problems with their Medicaid fraud investigations. Jury found innocent Per a news report in the Concord Register, a New Hampshire orthodontist, after a two day trial, was found innocent of 45 counts of … Read More

Last year’s shake-up of behavioral health providers in New Mexico drew comparisons to the Salem witch trials and injustices perpetrated by rulers of the Roman Empire on Wednesday at a hearing where a state lawmaker unveiled proposed legislation that would … Read More

ANCHORAGE – An Anchorage personal-care provider was raided by federal agents Tuesday night, as part of a joint investigation with state prosecutors into alleged Medicaid fraud at the facility. Kevin Donovan, assistant special agent in charge of the FBI’s Anchorage … Read More

The federal government wants Texas to pay back more than $30 million for incorrectly claimed Medicaid reimbursements. An audit to be released Wednesday by the Office of Inspector General within the U.S. Department of Health and Human Services describes how … Read More

Last Updated: Tuesday, 21 October 2014 06:10 Read Complete Document (pdf, 522.97 KB) October 20, 2014 – Observers often cite fraud as an important contributor to high health care spending, particularly in federal programs. This report describes how CBO estimates the … Read More

Washington, DC—(ENEWSPF)—October 20, 2014. A federal jury in Houston today convicted the president of Riverside General Hospital (Riverside), his son, and two others for their participation in a $158 million Medicare fraud scheme involving false claims for mental health treatment.  … Read More

October 17, 2014 — The U.S. Federal Trade Commission (FTC) and Texas business groups are urging the rejection of new rules proposed by the state dental board regarding dental service organizations (DSOs), saying they would restrict dentists’ ability to contract … Read More

This summer, state regulators settled a Medicaid fraud case against an Austin dentist for literally pennies on the dollar. Although the Texas Health and Human Services Commission’s Office of Inspector General had initially accused Rachel Trueblood of bilking the government … Read More