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
March 11, 2014 — Church Street Health Management (CSHM), which operates 70 Small Smiles dental clinics in 22 states and the District of Columbia, has been excluded from participation in the Medicaid and Medicare programs for a minimum of five … Read More
Enrollment in the Health Insurance Marketplace continued to rise in February to a five-month total of 4.2 million. As in January, the percent of young adults who selected a Marketplace plan was 3 percentage points higher than it was from … Read More
WASHINGTON — The share of Americans without health insurance is dropping to the lowest levels since President Barack Obama took office, but sign-ups under his health care law lag among Hispanics — a big pool of potential beneficiaries. With just … Read More
LUBBOCK, TX (KCBD) – A Lubbock dentist is voicing concerns about patient privacy and complaining about “Big Brother” after the FBI seized his patient records on Thursday morning. The FBI executed multiple search warrant around 8 a.m. Thursday at the … Read More
In a highly unusual move, a judge working for the Texas Health and Human Services Commission last week overturned findings of an outside judge — essentially changing a finding of innocence to one of guilt. The case is particularly unusual … Read More
March 5, 2014 — A Texas judge has upheld payment holds on Medicaid payments for Houston dental clinic Antoine Dental Center (ADC), citing credible evidence of Medicaid fraud. The clinics billed about $8.1 million for orthodontic services in less than … Read More
When Steve Aragon’s daughter invited him to speak to her students for career day, he wasn’t sure what he was going to say. He was lined up behind a judge, a SWAT team member and a zoologist. But when it … Read More
Attorney General Eric Holder and HHS Secretary Kathleen Sebelius today released the annual Health Care Fraud and Abuse Control (HCFAC) Program report showing that for every dollar spent on health care-related fraud and abuse investigations through this and other programs … Read More
HOUSTON—Augustine Ihenacho Nnadi, aka Austin, 60, of Houston, has been arrested for accepting a bribe in exchange for assistance in an ongoing health care fraud case, announced United States Attorney Kenneth Magidson. The FBI arrested Nnadi this morning shortly after … Read More
EDINBURG — Sitting at an old picnic table in front of a dilapidated house, María Díaz, a hotel housekeeper, tells stories of the rejection that comes with living in impoverished Texas colonias. The trash on her street is not picked … Read More
Dr. Chang Ho Lee, 68, of Palisades Park, N.J., pleaded guilty today to health care fraud and agreed to forfeit more than $3.4 million in fraud proceeds. Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. … Read More
Hundreds of North Texas Nigerian-Americans are caught up in the biggest home health care frauds ever uncovered by U.S. law enforcement. Federal indictments were issued in 2012 against those who allegedly profited the most from half a billion dollars in … Read More
BEAUMONT, Texas – A Center, Texas couple now living in Elgin, Texas, has pleaded guilty to federal violations in a health care fraud scheme in the Eastern District of Texas, announced U.S. Attorney John M. Bales today. Cathy Harvill, 57, … Read More
