Since the expiration of COVID-19-related provisions requiring states to keep residents enrolled in Medicaid, an estimated 2.1 million Texans have lost their coverage. Texas has by far the highest number of uninsured in the country and has removed significantly more … Read More
The Centers for Medicare and Medicaid Services (CMS), Texas’ partner in administering Medicaid and Children’s Health Insurance Program (CHIP), released a Final Rule to better streamline the application, eligibility determination, enrollment, and renewal processes it regulates across states and public … Read More
HOUSTON – A judge sentenced a Houston-area mental health clinic owner to prison after prosecutors say she was the ringleader of medical fraud for decades, resulting in millions of dollars. According to the U.S. Attorney’s Office for the Southern District … Read More
To maximize efficiencies in OIG operations, the agency’s Fraud Analytics team develops algorithms that leverage data analytics to fight fraud, waste and abuse in Texas Medicaid delivery. During the second quarter of fiscal year 2024, Fraud Analytics received 182 data … Read More
Another suit involving Medicare fraud on behalf of long-term care facilities was recently settled. The case included sixty nursing homes receiving kickbacks. Four businesses were named as the defendants and all of them agreed to settle and pay the federal … Read More
An orthodontist in Texas, who has been arrested for multiple offenses since 2017, was arrested on April 16 for allegedly sexually assaulting a woman in 2016, according to a story published on KTAB/KRBC. Dr. Victor Lee, of Lee Orthodontics in … Read More
Former Ole Miss football player Joel Rufus French is facing conspiracy charges related to a $70 million Medicare fraud scheme. The 46-year-old made his initial appearance in Oxford last week. The indictment in Florida accuses French of paying kickbacks and … Read More
U.S. and state authorities recently filed a lawsuit in U.S. District Court for the District of Connecticut against two dentists and the practices they operated in Connecticut for allegedly engaging in a Medicaid kickback scheme. The U.S. Attorney’s Office for … Read More
Millions of Americans have been disenrolled from Medicaid plans after the federal government stopped offering continuous coverage to recipients during the pandemic. Altogether, at least 19.6 million Medicaid enrollees were taken off their plans, according to a new Kaiser Family … Read More
The Health and Human Services Department’s inspector general told lawmakers on Tuesday that her office declines investigating “300 to 400 viable fraud cases” involving Medicare and Medicaid each year “because we don’t have the agents to work them.” “We’re struggling … Read More
CHICAGO, April. 14, 2024 — Model legislation officially approved by the National Council of Insurance Legislators (NCOIL) ensures that when enacted by state legislatures, patients with dental insurance will get more value out of their dental plans. The American Dental … Read More
An angered mom revealed that her children were scheduled for surgery that she did not consent to after agreeing to have their school’s dental program clean their teeth. In a TikTok video, Alicia McQueen questioned if she was overreacting after … Read More
Tens of thousands of Texas newborns have been kicked off Medicaid during unwinding so far (image via Getty Images) Ninety-five thousand newborns, twice as many toddlers and preschoolers, and more than 1.3 million Texas children overall have been kicked off … Read More
After a decade of resistance to expanding Medicaid in Mississippi, Medicaid expansion bills have passed both houses with two-thirds majorities, where Magnolia State Republicans have a supermajority in the legislature. While some wrangling about work requirements remains, the state is … Read More
A dentist in Florida is being investigated for his connection to an alleged multimillion-dollar scheme to defraud Medicaid that has been dubbed the “tooth fairy heist,” according to a story published on April 9 by WOKV.com. In South Florida, the … Read More
JUPITER, Fla. (CBS12) — A detox facility owner from Jupiter was sentenced to four years in federal prison for defrauding the Federal Employees Health Benefits Program (FEHBP) of over $4 million to fund his “lavish lifestyle.” The charges were brought … Read More
EL PASO, Texas (KFOX14/CBS4) — Students from the Socorro Independent School District will join dental professionals from the Borderland community for a free dental services workshop at Socorro High School on Friday and Saturday. Students from Socorro ISD’s Dental Health … Read More
DENVER — Pediatrician Patricia Braun and her team saw roughly 100 children at a community health clinic on a recent Monday. They gave flu shots and treatments for illnesses like ear infections. But Braun also did something most primary care … Read More
A woman in Pennsylvania who reportedly falsely claimed to hold an expanded function dental assistant license and worked briefly for three dentists has been arrested, according to a story published on April 7 in the Bucks County Courier Times. Rose … Read More
An Arizona doctor has copped to cooking the books in a multi-million dollar health insurance fraud case. Linh Cao Nguyen, a Peoria physician, entered a guilty plea on March 19 to hoodwinking healthcare benefit programs out of a hefty $3.7 … Read More
A dental practice in the U.K. declined to take a man who weighed about 320 lbs as a new patient because he exceeded the weight limit of its dental chairs, according to a story recently published in Norwich Evening News. … Read More
Gov. Jim Justice has approved a bill that aims to make dentures more accessible to Medicaid recipients. With Justice’s signature Tuesday, House Bill 4933 will become effective July 1. Medicaid currently covers diagnostic, preventative and restorative dental services, with the … Read More
Centene appears to be crying foul to Texas over the state’s scoring of its Medicaid proposal. Asked for her reaction at Barclay’s Global Healthcare Conference last month to unfavorable news, CEO Sarah London said they were “disappointed” and have received … Read More
AUSTIN (Nexstar) — Texas Health and Human Services accidentally removed 350 seniors from the state’s Medicare Savings Program, the agency confirmed, costing some lower income Texans as much as $200 a month out of their Social Security checks. Last summer, … Read More
An impossible task. That’s what Randy Fritz was faced with in the summer of 1999. As executive assistant to then-Texas Health Commissioner William “Reyn” Archer III, Fritz had 10 months to create from scratch a new statewide health insurance program … Read More
The patient’s teeth appeared to be well cared for, but dentist James Mancini did not like the look of his gums. By chance, Mancini knew the man’s physician, so he raised an alert about a potential problem—and a diagnosis soon … Read More
XENIA — A Greene County woman is looking for answers after being left at a standstill with her health insurance company. As reported on News Center 7 at 5:30, Xenia resident Veronica Ray learned she lost her United Healthcare insurance … Read More
An owner of a durable medical equipment (DME) company was sentenced Tuesday to three and a half years in prison and ordered to forfeit $1.8 million for his participation in a healthcare fraud kickback conspiracy. According to court documents and … Read More
PHOENIX — Two business partners were recently indicted for allegedly attempting to defraud Arizona’s Medicaid program of over $9.4 million through their company. Kenneth Harrison, 44, and Courtney Haywood, 38, both of Las Vegas, Nevada, face 30 felony counts related … Read More
Legislation funds oral health training, dental research programs President Joe Biden signed a $1.2 trillion spending bill into law March 23 that will fund the government through Sept. 30, finalizing the overdue second tranche of bills and avoiding the threat … Read More
A former employee at a dental practice in New York has been accused of stealing more than $400,000 from the business, according to a story published March 26 in Syracuse.com. Carla Fisher-Schmitt, 44, was charged with felony grand larceny for … Read More
A new Forbes Advisor study shedding light on Americans’ top financial worries has revealed Texas has the fifth highest health care costs in the nation. Forbes Advisor’s annual report compared all 50 states and Washington, D.C. across nine different metrics … Read More
The ADA is responding to a request for information on Medicare Advantage data from the Centers for Medicare and Medicaid Services by emphasizing the importance of increasing data transparency and reporting from insurers. A letter from the ADA to CMS … Read More
A symposium hosted by the American Dental Association in June will equip dental professionals with the knowledge and skills they need to play a pivotal role in addressing chronic health conditions. Dentistry’s Role in Complete Health, taking place June 21-22 … Read More
TYLER, Texas — A partnership with Tyler ISD and Tyler Junior College Dental Hygiene Program has allowed several local elementary students to receive needed dental care at no charge. Clarkston, Douglas, and Owens elementary school students have all benefited from … Read More
Former Georgia Insurance Commissioner John W. Oxendine on Friday pleaded guilty to conspiracy to commit health care fraud and agreed to pay $699,864 in restitution to health insurers in connection with an alleged money laundering scheme. Mr. Oxendine, of Johns … Read More
A Maryland firm that oversees the nation’s largest independent network of primary care medical practices is facing a whistleblower lawsuit alleging it cheated Medicare out of millions of dollars using billing software “rigged” to make patients appear sicker than they … Read More
NILES, MI – A Niles couple pleaded guilty to two felony counts each of Medicaid fraud, according to a Thursday announcement by Michigan Attorney General Dana Nessel. Gregory Barney, owner of the Highland Counseling Center in Niles and a licensed … Read More
LOUISVILLE, Ky. (WDRB) — Police arrested a southern Indiana man for allegedly running a dentist office without a license. Seymour Police said on Tuesday, officers received a tip about 31-year-old Fredy Felipe Pascual, alleging he was doing dental work “possibly … Read More
The U.S. Health and Human Services Office for Civil Rights appears poised to re-implement its audit program that randomly checks covered entities and business associates for compliance with the Health Insurance Portability and Accountability Act. The HIPAA compliance audit program … Read More
