Texas lawmakers are exploring ways the state could provide more access to health care for 1.9 million uninsured poor people without acquiescing to guidelines set under the Affordable Care Act, sometimes referred to as Obamacare. They’re calling it the “Texas … Read More
AUSTIN — Texas state government ultimately is to blame for hundreds of millions of dollars of Medicaid spending wasted on braces and orthodontic work that were not medically necessary, according to federal auditors. The audit report, released last week, concludes … Read More
A federal audit has found a Texas state agency to blame in an ongoing fight with Xerox Corp. over who is responsible for hundreds of millions of Medicaid dollars potentially misspent on unnecessary dental and orthodontic procedures. The Austin American … Read More
The HHS OIG’s contractor self-disclosure program provides a means for contractors to self-disclose potential violations of the False Claims Act and various Federal criminal laws involving fraud, conflict of interest, bribery or gratuity. The Federal Acquisition Regulation (FAR) requires certain … Read More
Texas is “ultimately responsible” for millions of misspent Medicaid dollars, according to a new federal audit, because a state agency failed to properly oversee the contractor that reviewed the medical necessity of Medicaid claims. For nearly five years, the Texas … Read More
Not all of the Medicaid direct medical service costs that the Kansas Department of Health and Environment, Division of Health Care Finance (State agency), claimed for school-based health services (SBHS) were reasonable, adequately supported, or otherwise allowable in accordance with … Read More
The Nebraska Department of Health and Human Services, Division of Finance and Support (State agency), did not always comply with Federal Medicaid requirements for billing drug manufacturers for rebates for physician-administered drugs. To collect these rebates, States submit to the … Read More
August 11, 2014 — In the latest development in the ongoing Texas Medicaid scandal, a federal report has laid the responsibility for hundreds of millions of dollars spent on dental and orthodontic procedures that may have been medically unnecessary squarely … Read More
A federal auditor has laid responsibility for hundreds of millions of dollars spent on dental and orthodontic procedures that may have been medically unnecessary squarely on the state agency that oversaw the program. The Texas Health and Human Services Commission … Read More
Gov. Rick Perry has come a long way since 2012, when he went from presidential front-runner to punch line in the blink of an eye and his campaign staff disintegrated into warring factions that eventually met in separate buildings. He … Read More
The Idaho Department of Health and Welfare (State agency) did not ensure that Molina Medicaid Solutions (Molina) implemented adequate information system general controls over the State agency’s Medicaid Management Information System (MMIS). We identified 21 reportable weaknesses, which we consolidated … Read More
AUSTIN — Looking to cultivate national supporters ahead of a possible 2016 presidential run, Gov. Rick Perry has formed a federal political action committee aimed at helping like-minded Republicans in the Nov.4 elections. Perry launches RickPAC federal campaign fund – … Read More
t was the summer of 2002 and it appeared that Democrat Tony Sanchez might be gaining traction in his campaign against Gov. Rick Perry by depicting the incumbent — who had received $1 million in insurance company money in his … Read More
The California Department of Health Care Services (State agency) did not always comply with certain Federal requirements when claiming Federal reimbursement at the 90-percent rate for family planning services provided under the Family Planning, Access, Care, and Treatment (FPACT) program … Read More
AUSTIN — When Baylor Regional Medical Center in Plano was accused of protecting a neurosurgeon whose patients died or were maimed, it got some outside help from Attorney General Greg Abbott. Abbott has intervened in three federal cases on the … Read More
TYLER — A federal jury took less than two hours on Thursday to find a Dallas businessman who plunged his rural hospital chain into ruin guilty of health-care fraud and conspiracy. Dr. Tariq Mahmood, 63, was convicted on 15 fraud … Read More
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
