Seven durable medical equipment companies cost the Medicare system $2 billion in payments, the National Association of ACOs (NAACOS) told the federal government in recent months. But it’s unclear just how problematic that will be for accountable care organizations. The … Read More
New Yorkers with zero healthcare experience are allowed to care for their elderly or disabled relatives and friends — potentially earning more than $43,000 a year — under a $6 billion Medicaid program that’s been rife for fraud, abuse and … Read More
A 19-year-old TikTok user took DIY beauty to the extreme by attempting to perfect her smile using nothing but a nail file. Her at-home dentistry escapade prompted some viewers to admit to doing the same, according to a story recently … Read More
Duane Morris Takeaways: On February 6, 2024, in In Re Delta Dental Antitrust Litigation, No. 1:19-CV-06734, MDL No. 2931 (N.D. Ill. Feb. 6, 2024). roughly 240,000 dentists and dental practices sought class certification in the U.S. District Court for the … Read More
In 2022, the inspector general of the Department of Health and Human Services published areportwarning thatMedicare’s payment rates for urinary catheters were too high. The report stated that lowering the costs for these products could save Medicare millions.But despite this … Read More
The ADA thanked two members of the U.S. Senate for introducing S 3597, the Promoting Dental Health Act, which would reauthorize the oral health promotion and disease prevention activities of the Centers for Disease Control and Prevention through 2028. ADA … Read More
The Santa Clara County (Calif.) Superior Court this week sentenced the last of 15 defendants convicted of running a massive statewide insurance scam in which they set up a telemarketing company to push overpriced and unneeded prescriptions and medical devices … Read More
Some significant changes are coming for Wisconsin. Wisconsin lawmakers passed a health care package that will address the ongoing workforce shortage issues afflicting dentistry. Gov. Tony Evers signed the bills into law Jan. 31. The Wisconsin Dental Association supported several … Read More
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,783 for an individual in 2024) and provided states with an enhanced federal matching rate (FMAP) … Read More
The House Committee on Energy and Commerce chair is asking the Government Accountability Office to study the state of consolidation and vertical integration in the dental and vision benefits industries. The request is the result of ongoing advocacy by the … Read More
Atlanta, GA, Feb. 06, 2024 (GLOBE NEWSWIRE) — Benevis, a leading dental healthcare and orthodontics delivery organization committed to providing quality care to underserved communities, announced today a call to action for primary care physicians and clinicians across the care … Read More
OIG auditors found a behavioral health services provider double-billed the state for telemedicine visits and improperly submitted claims for facility fees that were not provided. The improper payments totaled $45,412 for errors uncovered during the audited period, from June 2021 … Read More
COCKE COUNTY – An investigation by special agents with the Tennessee Bureau of Investigation Medicaid Fraud Control Division has resulted in the indictment and arrest of a Newport man. In September 2023, TBI received information from the Department of Intellectual … Read More
World Oral Health Day is March 20, and the FDI World Dental Federation will begin a three-year campaign to shed light on the multifaceted aspects of oral health under the unifying theme of “A Happy Mouth Is …” In the … Read More
Sun Life U.S. is relaunching its grant program in 2024 as the Sun Life Health Access grant program, aligning with the company’s commitment to broadening access to care for underserved communities. Initially launched in 2016 as Team Up Against Diabetes, … Read More
The U.S. District Court for the Northern District of California issued a default judgment against a practice and a dentist who unlawfully withdrew more than $85,000 of employees’ retirement funds, preventing the workers from accessing their savings. On January 2, … Read More
States now have a template they can use to change the way dental insurance works. The National Council of Insurance Legislators said Wednesday that its Health Insurance & Long Term Care Insurance Issues Committee has approved a model act that … Read More
SAN DIEGO – Imperial County dentist Javad Aghaloo, 50, Indio, was sentenced in federal court Jan. 26, to 37 months in prison for defrauding Medicare and covering it up. His former billing manager, Melissa Rosas, 42, Calexico, was sentenced to … Read More
BOSTON, Feb. 1, 2024 /PRNewswire/ — DentaQuest, part of Sun Life U.S., today announced a $25,000 contribution to the University of Oklahoma College of Dentistry. The donation is supporting the college’s Indigent Care Fund, which helps provide dental care for … Read More
The Texas Supreme Court seemed inclined to send a $16 million Medicaid fraud judgment back to a trial court rather than let the judgment against Dr. Richard Malouf stand. Malouf, who founded All Smiles Dental Center, billed the state hundreds … Read More
AUSTIN, Texas — A former Austin Dental Practice owner is sentenced to 36 months in federal prison after being convicted of wire fraud. In addition to prison time, 49-year-old Clinton Finch Herzog, of Pearland, has been ordered to pay $2,182,760.63 … Read More
CHICAGO, Jan. 30, 2024 – The National Council of Insurance Legislators (NCOIL) recently adopted model legislation (PDF) for a medical loss ratio (MLR) in dentistry, with language agreed to by the American Dental Association (ADA) and the National Association of … Read More
The Texas Supreme Court has temporarily halted depositions that were scheduled to begin Thursday in the whistleblower case against Attorney General Ken Paxton. The all-GOP court issued an order Tuesday blocking the depositions and giving the parties until Feb. 29 … Read More
A dentist who continued to do tooth extractions and implants after the dental board in Arizona barred him from doing them due to a patient dying after dental surgery has agreed to stop practicing, according to a story published on … Read More
Dental societies in nine states have introduced legislation in 2024 to implement a dental loss ratio. So far, societies in Illinois, Nebraska, New York, Oklahoma, Pennsylvania, Rhode Island, Virginia, Washington and West Virginia have introduced legislation, according to a Jan. … Read More
A pediatric dentist in Texas was sentenced on January 25 in U.S. court to 30 years in prison for reportedly using social media to coerce minors into recording sexual activity for him, according to the U.S. Department of Justice. Abiel … Read More
This year is shaping up to be a big one for legislation related to dental loss ratios. In 2024, nine state dental societies have already introduced legislation for dental loss ratios, which refers to the insurance premium revenue that is … Read More
HOUSTON, Texas — A 68-year-old man has admitted to orchestrating a $6 million Medicaid fraud scheme, according to U.S. Attorney Alamdar S. Hamdani. Rene Gaviola, of Houston, Texas, was the operator of Floss Family Dental Care clinic, where he submitted … Read More
SAN DIEGO (KYMA, KECY) – The U.S. Attorney’s Office said Javad Aghaloo, an Imperial County dentist, was sentenced in federal court on Friday to 37 months in prison for defrauding Medicare and then covering it up. Melissa Rosas, who was … Read More
36-year-old Ray Anthony Shoulders, of Fort Worth, Texas, was convicted on Monday on all counts of conspiracy to commit health care fraud and 12 counts of healthcare fraud, following less than an hour of jury deliberation. He awaits sentencing. U.S. … Read More
An alleged Medicaid fraud scheme in Killeen has led to two residents each being indicted on a felony theft charge. Karen Lea Bradley, 55, and Jason William McCaffery, 49, were indicted on Wednesday by a Bell County grand jury on … Read More
WILMINGTON, N.C. (WECT) – Former New Hanover County social worker Felicia Moore Jones pleaded guilty Wednesday, Jan. 24, to conspiring to defraud NC Medicaid. Per U.S. Attorney Michael Easley, over $400,000 in fraudulent billing took place as a result of … Read More
School districts across the state are facing financial challenges for the upcoming school year, and now Texas schools are confronted with a combined over $300 million loss in Medicaid reimbursements for the 2024-2025 school year. The Texas Health and Human … Read More
This week, the Office of the Attorney General (“OAG”) filed a motion to reconsider and a motion to enter judgment in litigation pertaining to an employment dispute with four former staff members. These filings challenged the judge’s ruling that depositions … Read More
This might not be something on the tip of your tongue in everyday conversation, but it’s important — especially when it comes to thinking about overall health. Your mouth is where the digestive process begins. It also is a key … Read More
Recently, OIG auditors found a managed care pharmacy based in Houston had dispensed prescriptions to Medicaid clients with errors in records, printed instructions and medication strength. Bemaj Pharmacy was found to comply with requirements to provide the correct medication in … Read More
A Miami woman has been left with severe brain damage after a botched dental surgery in Texas left her hospitalized after an alleged fentanyl overdose. The woman, Maria Lugo Querales, nearly died from the 2022 incident and now lives in … Read More
The increased adoption of medical loss ratio in the dental industry will have a major impact on dental insurance companies, DSOs and patients in 2024, according to two DSO executives. These two leaders in the dental industry recently connected with … Read More
Columbus LTACH, operating as Silver Lake Hospital, a long-term care hospital in Newark, New Jersey, along with certain investors, have agreed to a $30.6 million settlement to resolve accusations of healthcare fraud. U.S. Attorney Philip R. Sellinger announced the settlement, … Read More
Texas Insider Report: AUSTIN, Texas – Texas Attorney General Ken Paxton has announced that, in fiscal year 2023, the Office of the Attorney General (“OAG”) recovered more than $200 million from entities and individuals who defrauded the Texas Medicaid system … Read More
