May 1, 2014 — Chances are every six months an appointment shows up on your patient’s calendar that it is time for their biannual visit to the dentist. They didn’t make this appointment because they had an aching tooth or … Read More
by Becca Aaronson, The Texas Tribune May 2, 2014 Part two of two. For nearly five years, a state contractor allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on … Read More
by Becca Aaronson, The Texas Tribune May 1, 2014 Part one of two. In 2010 and 2011, Antoine Dental was among Texas’ top-billing Medicaid providers for orthodontic services, collecting more than $1 million annually for putting braces on poor children. … Read More
by Becca Aaronson, The Texas Tribune May 2, 2014 Part two of two. For nearly five years, a state contractor allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending … Read More
HOUSTON—Jeffery Parsons, of Crockett, and David Edson, of Palm Harbor, Florida, have been charged in a 13-count indictment alleging a conspiracy to pay kickbacks to several area personal care home owners and patient advocates, announced United States Attorney Kenneth Magidson … Read More
HOUSTON – Yolanda Nowlin, 42, has been ordered to federal prison for 11 years following her multiple convictions in relation to a large health care fraud conspiracy, announced United States Attorney Kenneth Magidson. A federal jury in Houston convicted Nowlin … Read More
The Washington Times reported yesterday that ACS/Xerox is being sued in a class action by Nevada residents who purchased health insurance from the state health insurance exchange that was set up by the company. The state government contracted with ACS/Xerox … Read More
Even after Gov. Rick Perry stripped funding for the agency that prosecutes state public corruption cases, his emissaries worked to swap the resignation of embattled Travis County District Attorney Rosemary Lehmberg for restoration of the money, several sources told The … Read More
Two entities have paid the U.S. Department of Health and Human Services Office for Civil Rights (OCR) $1,975,220 collectively to resolve potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. These major enforcement actions … Read More
A $48 million budget proposal from the Missouri House of Representatives would cover adult dental care for 300,000 Medicaid recipients. The Senate Appropriations Committee agreed to the additional $48 million in Medicaid spending last week, according to a report by … Read More
AUSTIN, Tex. — The last nine months of Rick Perry’s tenure as the longest-serving governor of Texas were supposed to be a political victory lap. Greg Abbott, the Republican state attorney general, and Wendy Davis, the Democratic state senator, both … Read More
Gov. Rick Perry, Florida Gov. Rick Scott and Louisiana Gov. Bobby Jindal today sent a letter urging President Barack Obama to take meaningful steps to strengthen and improve the Medicare Advantage program. The program, which offers an alternative health insurance … Read More
AUSTIN — A Texas judge was expected to seat a grand jury Monday in an investigation into whether Gov. Rick Perry abused his power by vetoing funding for public corruption prosecutors last year. Special State District Judge Bert Richardson was … Read More
WHY WE DID THIS STUDY OIG oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews … Read More
When Gov. Rick Perry announced last summer that he wouldn’t run for re-election, he said he was committed to spending his last 18 months in office working to create more jobs and opportunity in Texas. It’s a pledge he has … Read More
April 4, 2014 — The Indiana attorney general has filed Medicaid fraud and other criminal charges against three dentists and six others at a dental office in Anderson. The charges allege that Anderson Dental Center owner Sally Metzner, the dentists, … Read More
CSHM, which owns 54 Small Smiles dental clinics in the U.S., has agreed to sell the chain after the company was recently excluded from participating in the Medicaid and Medicare programs by the U.S. Department of Health and Human Services … Read More
Nothing about Texas Medicaid spending on dental or orthodontia. Medicaid Integrity Program Report for Fiscal Year 2013.
In April, we commemorate National Minority Health Month, a time to raise awareness about health disparities that persist among racial and ethnic minorities. This year’s theme – “Prevention is Power: Taking Action for Health Equity” – embodies the ambitious goal … Read More
by Terri Langford, The Texas Tribune April 3, 2014 A special prosecutor investigating whether Gov. Rick Perry abused his authority when he eliminated state funding of the Texas public integrity unit — which investigates government corruption and is housed in … Read More
Pharmaceutical manufacturer Teva Pharmaceuticals USA Inc. and a subsidiary, IVAX LLC, have agreed to pay the government and the state of Illinois $27.6 million for allegedly violating the False Claims Act by making payments to induce prescriptions of an anti-psychotic … Read More
DALLAS — Dr. Nicolas Alfonso Padron, 54, of Garland, Texas, was sentenced this morning by U.S. District Judge David C. Godbey to 57 months in federal prison and ordered to pay $9,484,111 in restitution to the Centers for Medicare and … Read More
DALLAS — Two Grand Prairie, Texas, men, convicted at trial in October 2013 on conspiracy and health care fraud charges related to their operation of A Medical House Calls, a physician house-call company in North Texas, were sentenced this morning … Read More
The Idaho Department of Health and Welfare (State agency) did not implement adequate information system general controls over its Medicaid claims processing system. We identified 19 reportable weaknesses, which we consolidated into 5 findings and grouped into access controls, configuration … Read More
The New Jersey Department of Human Services (State agency) generally claimed Federal reimbursement for Disproportionate Share Hospital (DSH) payments that did not exceed hospital-specific limits. DSH payments may not exceed hospitals’ uncompensated care costs for providing services to patients who … Read More
March 28, 2014 — Some 23 New York state general dentists and six orthodontists received $13.2 million in Medicaid payments in 2012 for services that appeared unnecessary or may not have been performed at all, according to a new report … Read More
With a high-profile legal settlement with Carousel Pediatrics, a children’s health provider, under its belt, the Texas Health and Human Services Commission’s Office of Inspector General says its ramped-up efforts to rein in Medicaid fraud have started to pay off. … Read More
Gov. Rick Perry today released the following statement on attacks by the Obama administration over the failures of Obamacare: “Yet again, the Obama Administration would rather point fingers at other people than accept any of the responsibility for Obamacare’s failure. … Read More
A new security risk assessment (SRA) tool to help guide health care providers in small to medium sized offices conduct risk assessments of their organizations is now available from HHS. The SRA tool is the result of a collaborative effort … Read More
The NY Times, in conjunction with the Texas Tribune, has published an article on the recent $3.75 million settlement between Carousel Pediatrics and the Texas Health and Human Services Commission Office of the Inspector General and its affect on the … Read More
Questionable Billing for Medicaid Pediatric Dental Services in New York March 26, 2014 Lucia Fort, a program analyst for the Office of Evaluation and Inspections, is interviewed by Meridith Seife, the Deputy Regional Inspector General for the Office of Evaluation and … Read More
The Baylor Regional Medical Center at Plano, accused of protecting a neurosurgeon who allegedly killed and maimed patients, gained an ally this week in Texas Attorney General Greg Abbott. Abbott filed motions to intervene in three separate federal court suits … Read More
Private contractors should be held to the same accountability as the agencies that contract them, says University of Baltimore law professor Kimberly Brown. “From Abu Ghraib to Blackwater, a string of scandals has heightened public awareness that highly sensitive federal … Read More
Carousel Pediatrics, a chain of Austin clinics originally accused of defrauding the government of $18 million in Medicaid payments, has agreed to repay $3.75 million for what regulators called a “pattern of billing errors” over four years. The settlement allowed … Read More
The American Academy of Implant Dentistry (AAID) has filed a federal lawsuit challenging the constitutionality of regulations by the Texas State Board of Dental Examiners that limit dentists from advertising themselves as “specialists.” The AAID, which has won similar suits … Read More
by Alexa Ura, The Texas Tribune March 17, 2014 Carousel Pediatrics, which has been the subject of a multiyear investigation in Texas, has settled its Medicaid fraud case with the Health and Human Services Commission’s Office of Inspector General, agreeing to … Read More
Several patient recruiters, including a medical clinic owner, were sentenced today for their participation in a health care fraud scheme involving Flores Home Health Care Inc., a defunct home health care company. Acting Assistant Attorney General Mythili Raman of the … Read More
The Big Conversation If the University of Texas System regents tap Gov. Rick Perry favorite Kyle Janek as their next chancellor, they won’t get pushback from the president of the system’s flagship campus. “I’ve known Kyle for a long … Read More
The Travis County Clerk’s Office has recently put its court records online. In the public interest, we are publishing here the record of Jack Stick’s DWI case. The following are the meanings of the prefixes used in the entries. Event … Read More
Gov. Rick Perry has reappointed Douglas Wilson of Pflugerville as inspector general of the Texas Health and Human Services Commission (HHSC) for a term to expire Feb. 1, 2015. The inspector general works to prevent, detect and investigate fraud, abuse … Read More
