HOUSTON: The Texas Health and Human Services Commission has selected UnitedHealthcare Community Plan of Texas as one of the seven managed care organizations to administer the Medicaid managed care program STAR+PLUS. UnitedHealthcare will serve members in eight service areas: Bexar, … Read More
The Pennsylvania Attorney General is suing a Langhorne-based dental clinic alleging predatory lending that targeted elderly patients and swindled them out of more than $500,000. The lawsuit alleges Infinity Dental Management knowingly used Medicare as a prop in the scheme … Read More
Dentist. Leader. Mother. Wife. Teacher. Ironwoman. Author. Olympic competitor. Cancer survivor. The titles Linda Edgar, D.D.S., holds seem endless. In the season of life where many are winding down, Dr. Edgar is just getting started in many ways. Or at … Read More
Bento is stepping in to fill an forthcoming gap once Massachusetts implements its medical loss ratio for dental insurers. Bento offers self-funded insurance coverage options to reduce inefficiencies and unnecessary costs. Massachusetts established a first-of-its-kind law last year that requires … Read More
BOSTON–(BUSINESS WIRE)–An estimated 68.5 million adults in the United States do not have dental insurance, according to new data released today by CareQuest Institute for Oral Health®. This data, which comes from the third annual State of Oral Health Equity … Read More
A federal jury in Nashville has convicted Doctor Benjamin T. Toh, 68, of Chicago, Illinois, for his role in a more than $9.5 million health care fraud conspiracy, announced United States Attorney Henry C. Leventis for the Middle District of … Read More
Sinn Féin spokesperson on Health David Cullinane TD has called on the Government to work with the Dental Council and the Health Information and Quality Authority to tackle unregistered dentistry. The TD for Waterford said that unregistered practice is a … Read More
On August 28, the United States Attorney for the Eastern District of Washington announced that Lincare Holdings, Inc. agreed to pay $29 million to settle charges that it violated the False Claims Act (FCA) by overbilling Medicare and Medicare Advantage … Read More
The Alliance of the American Dental Association is hosting an advocacy breakfast in conjunction with SmileCon to share updates from the American Dental Political Action Committee on legislative progress. The event, which is sponsored by ADPAC, will take place from … Read More
BOSTON, Sept. 1, 2023 /PRNewswire/ — DentaQuest, part of Sun Life U.S., is contributing $50,000 to several organizations across Florida to aid response and recovery in the wake of Hurricane Idalia. The contributions include $25,000 to the Florida Disaster Fund, which assists Florida’s communities as they respond to and recover during … Read More
With demand high for dentures now that Kentucky’s Medicaid program has agreed to cover them for adults, Dr. Bill Collins, the dentist at Red Bird Mission dental clinic in Clay County, is providing them as fast as he can. But … Read More
AILSA CHANG, HOST: The federal government has put five states on notice that they make it too hard for people to stay on Medicaid. States share the expense of Medicaid with the federal government, and it’s often among their biggest … Read More
JEFFERSON CITY, Mo. (AP) — Children in many states are being wrongly cut off from Medicaid because of a “glitch” in the automated systems being used in a massive eligibility review for the government-run health care program, a top Medicaid … Read More
BROWNSVILLE, Texas — The operators of a durable medical equipment company based in Harlingen have been indicted for allegedly defrauding Medicare, according to U.S. Attorney Alamdar S. Hamdani. Maria Luisa Yzaguirre, 43, and Jeremiah Yzaguirre, 44, both of Harlingen, are … Read More
Everything was going according to plan. In September 2020, subpoenas were served to executives at four Texas banks who Austin real estate investor Nate Paul — a friend of Attorney General Ken Paxton — believed had information about an illegal … Read More
The Texas Medical Association (TMA) is now 4-0 on its legal challenges to the Biden administration’s rocky implementation of the No Surprises Act, which bans surprise out-of-network medical bills and outlines processes to resolve payment disputes between providers and payers. … Read More
The growth of managed care over the last several years has changed fundamental aspects of the Medicare and Medicaid programs. This significant shift transformed how the government pays for and covers health care for approximately 100 million enrollees. The OIG … Read More
Ranjan Rajbanshi, D.D.S., 46, of Bakersfield and Santa Barbara, pleaded guilty [Monday] to stealing $500,000 in COVID-19 relief money, U.S. Attorney Phillip A. Talbert announced. According to court records, Rajbanshi ran a dental practice in Bakersfield and Santa Barbara. From … Read More
TEMPE, Ariz.–(BUSINESS WIRE)–Align Technology, Inc. (Nasdaq: ALGN), a leading global medical device company that designs, manufactures, and sells the Invisalign® System of clear aligners, iTero™ intraoral scanners, and exocad™ CAD/CAM software for digital orthodontics and restorative dentistry, today announced that … Read More
Texas House impeachment managers have submitted nearly 4,000 pages of exhibits providing new and exhaustive details of their allegations of abuse of office by suspended Attorney General Ken Paxton ahead of his impeachment trial. The Senate, which is conducting the … Read More
PRINCETON, NJ — A mental health provider in Princeton improperly billed and was paid more than $1.7 million in Medicaid funds, according to an audit report released by the New Jersey Office of the State Comptroller (OSC). The OSC is … Read More
CORPUS CHRISTI, Texas — Two individuals involved in a chain of physical therapy clinics across Texas have been charged with defrauding a compensation program for federal workers, according to a press release from the United States Attorney’s Office Southern District … Read More
In the evolving battle to safeguard the integrity of its Medicaid program, early this month at NAMPI 2023, the District of Columbia Department of Health Care Finance Division of Program Integrity showcased its strategic collaboration with Sandata Technologies, the pioneering … Read More
The Texas Office of the Attorney General (OAG) filed a lawsuit against Planned Parenthood that, depending on the ruling, could reportedly have “devastating consequences” for the abortion-providing organization. The case, which was heard on August 15 by U.S. District Judge … Read More
AUSTIN (Nexstar) — A new whistleblower complaint obtained by Nexstar claims technical glitches and disorganized leadership have caused issues in Texas’ administration of Medicaid and erroneously kicked thousands of children and pregnant women off of their health insurance. “The persistence … Read More
The Biden administration is working with Texas to restore tens of thousands of people to the state’s Medicaid rolls who had lost coverage erroneously, a senior CMS official said Tuesday. The Centers for Medicare & Medicaid Services worked with the … Read More
Minal Patel, 44, of Atlanta has been sentenced to 27 years in prison for orchestrating a scheme that defrauded Medicare of more than $463 million through unnecessary genetic and laboratory tests, according to a new statement from the U.S. Department … Read More
CHICAGO (CBS) – A Bolingbrook business owner is facing several years in prison after being charged with theft, fraud, and forgery for allegedly filing $2.46 million in false Medicaid claims. LaTeena Smith, 37, was charged with four counts of theft, … Read More
BOSTON — A Worcester woman was sentenced today for her participation in a scheme to defraud the Massachusetts Medicaid program, commonly known as MassHealth. Robin Cronin, 61, was sentenced by U.S. Senior District Court Judge Timothy S. Hillman to two … Read More
Guardian informed about 1,500 small businesses in Massachusetts that it will not sell policies to companies with fewer than 25 employees once the state’s medical loss ratio is implemented in January, the Boston Globe reported Aug. 11. Massachusetts established a … Read More
There’s nothing more aggravating than egregious examples of fraud in federal programs designed to benefit our most needy citizens. This unconscionable gaming of the welfare system — and abuse of taxpayers’ funds — hit home recently with the sentencing of … Read More
NEW ORLEANS, LOUISIANA – CRAIG L. LOVELACE, age 53, a resident of Destrehan, pled guilty to defrauding Medicare and Medicaid of approximately $11.4 million in medically unnecessary durable medical equipment (“DME”), announced U.S. Attorney Duane A. Evans. The government filed a bill … Read More
EAST LYME, Conn. (WTNH) — A man who formerly lived in East Lyme has pleaded guilty to charges of health care fraud and violating a federal anti-kickback statue, according to an announcement Thursday from the U.S. Department of Justice. Jeffrey … Read More
KANSAS, August 17 – TOPEKA – (July 31, 2023) – The Kansas Attorney General’s Medicaid Fraud and Abuse Unit (MFCU) recently prosecuted six Medicaid fraud cases recouping more than $42,600 in restitution from fraudsters, Kansas Attorney General Kris Kobach announced … Read More
BLUFFTON, Ind. (WNDU) – Another former employee of Landmark Recovery is coming forward about the potential for a federal complaint of Medicaid fraud against the treatment facility. Shelley Wilburn worked at the Bluffton facility as an alumni coordinator from January … Read More
The state of Texas has asked a federal judge to fine Planned Parenthood more than $1 billion for filing “thousands” of fraudulent Medicaid claims over multiple years — allegations the same Planned Parenthood affiliate has settled in the past. With … Read More
We’re learning more about NewFound Hope, the company behind the operation that is under state investigation. Both the state’s Medicaid agency and the Department of Health Services (DHS) are investigating NewFound Hope. Records show dozens of people have been housed … Read More
Medicaid in Texas covers close to 6 million people, everyone from cancer patients to pregnant people to kids across the state. That coverage means people have access to doctor’s appointments, hospital visits, nursing facilities and birth centers, without having to … Read More
To support the OIG’s belief that preventing fraud, waste and abuse is everyone’s responsibility, the agency provides training to stakeholders and collaborates with agency partners to improve best practices. Recently, the OIG collaborated with the HHS Procurement and Contracting Services … Read More
Pediatric dentists in Alaska say they are facing serious problems with Medicaid paperwork since the state changed its policies on service authorizations last year. Those providers are worried that kids in rural Alaska are losing access to care. “It’s worse … Read More
