Houston – A Houston couple is set to appear before a federal judge Friday on allegations they were involved in a multi-million dollar home health fraud scheme. Caroline Zamora, 63, and Rommel Zamora, 59, were indicted Mar. 1. According to … Read More
A New Jersey woman was arrested on Friday for using pharmacies she controlled to bill insurance companies for non-existent prescriptions, according to the DOJ. Aysha Khan, a 33-year-old from Kinnelon, controlled a network of pharmacies in New Jersey, New York, … Read More
Florida Attorney General Ashley Moody’s Medicaid Fraud Control Unit (MFCU) announced the arrest of a man who stole hundreds of thousands of dollars from a state taxpayer-funded program. MFCU charged Carlos Cabrera with Medicaid provider fraud. Cabrera ran Angels on … Read More
CORPUS CHRISTI, Texas — A former business manager for a San Antonio nursing home has been sentenced to 10 years in prison for misappropriating funds from Medicaid recipients, a press release from Attorney General Ken Paxton’s Medicaid Fraud Control Unit … Read More
A New York City man was arraigned on three felony charges for allegedly practicing dentistry without a license in White Plains, N.Y. Cesar Masso, 78, allegedly operated his false practice out of a White Plains storefront set up as East … Read More
We hosted our 2023 Texas State of Reform Health Policy Conference recently, bringing together thought leaders, legislators, and policy experts into multi-silo conversations about the future of healthcare in Texas. Too often, those with good ideas for reforming healthcare don’t … Read More
A proposed class action alleges Wells Fargo, Conduent State & Local Solutions, Inc. and Conduent Business Services, LLC regularly refuse to refund New Mexico EPPICard users whose accounts have been subject to fraud. The 19-page lawsuit was filed by two … Read More
Lillian Hamilton, a Virginia Medicaid enrollee and 21-year-old tattoo shop manager from Hampton Roads, is still trying to get her wisdom teeth removed after years of living with a constantly swollen jaw, the pain from which has resulted in multiple … Read More
Nearly 12 years ago, a nonprofit centered on substance abuse prevention in Lyon County, Nev., broadened its services to dental care. Leaders with the Healthy Communities Coalition were shocked into action after two of their food pantry volunteers used pliers … Read More
WHITE PLAINS, N.Y. (PIX11) — A Queens man was arraigned Friday on multiple felony charges for allegedly practicing dentistry without a license out of a storefront in White Plains, officials said. Cesar Masso, 78, was arrested on March 9 for … Read More
CHARLOTTE — Federal agents are working to seize two properties owned by a North Carolina woman after she was accused of committing healthcare fraud. In the civil forfeiture documents, the FBI is seeking the forfeiture of two Charlotte properties: One … Read More
VIRGINIA BEACH, Va. (WAVY) — A former Navy officer who orchestrated a scheme to illegally to take information from seniors to defraud Medicare out of more than $2 million will serve more than five years in prison. 37-year-old Jordan Thomas … Read More
The United States Dental Insurance market report considers the major factors accountable for driving the growth of the United States Dental Insurance Industry, in addition to the key hindrances and challenges. In the initial segment of the report, the market … Read More
On March 10, 2023, the Honorable Katherine A. Crytzer of the United States District Court for the Eastern District of Tennessee at Knoxville sentenced Dr. Clarence (“Buzz”) Nabers, a 56 year old Knoxville dentist, to six months in prison followed … Read More
Texas lawmakers are facing a choice: approve $3.3 million in state funds to end a lawsuit accusing Attorney General Ken Paxton of improperly firing four whistleblowers or reject an out-of-court settlement — potentially adding millions of dollars in costs while … Read More
A 43-year-old Houston woman has been charged for conspiracy to commit and committing health care fraud, announced U.S. Attorney Alamdar S. Hamdani. Rose Davies is made her initial appearance before U.S. Magistrate Judge Dena H. Palermo at 2 p.m. on … Read More
Since Jan. 1, about 16% of dentists reported they have dropped out of some dental insurance networks, according to insights from the ADA Health Policy Institute’s February Economic Outlook and Emerging Issues in Dentistry Poll. On average, the dropped networks … Read More
Two employees of a Morgantown dental office were indicted by a federal grand jury earlier this week for allegedly collecting nearly $30, 000 in combined COVID-related unemployment benefits. Amanda J. Kincell, 42, of Fairview, and Casey Fike, 39, of Morgantown, … Read More
Have you had trouble getting dental care lately? If so, you’re not alone. Vermonters with low incomes, in particular, face a crisis in access to oral health care. Thousands of Medicaid patients in Vermont struggle to find a dentist who … Read More
Last November, Tiayana Hardy gave birth to her first child, a baby girl named Laylani. “She came a week before her due date, but I can’t complain about that,” said Hardy. “She was born healthy, she’s an easy baby, and … Read More
Attorneys for four former employees who sued after Texas Attorney General Ken Paxton fired them asked the state Supreme Court on Wednesday to take up their whistleblower case again, worried that their $3.3 million settlement agreement may be falling apart. … Read More
Arkansas is one of the many states taking part in unwinding continuous Medicaid, which is expected to decrease Medicaid rolls of more than one million citizens. During the pandemic, enrollment in Medicaid grew by more than 25 percent as a … Read More
The Biden administration wants to make sure states are doing all they can to minimize the number of Medicaid enrollees who wind up uninsured once states regain the ability to drop ineligible recipients next month. The Department of Health and … Read More
A former Pennsylvania physician was sentenced in federal court following his conviction for healthcare fraud on Tuesday. John Keun Sang Lee, 80, was sentenced to five years of probation by United States District Judge W. Scott Hardy, according to a … Read More
A federal judge has ruled that a now-shuttered Wisconsin substance abuse center and its CEO owe the state and federal government more than $2 million in a Medicaid fraud case. Online court records show U.S. District Judge J.P. Stadtmueller ruled … Read More
The day began with a mantra they all knew. “I am quick. I am sharp. I am bright. I am smart. I am rich and good looking, and I am a major blessing. Now point to your neighbor and say, … Read More
Dr. Brian Hyatt stepped down as chairman of the Arkansas State Medical Board Thursday in a special meeting following “credible allegations of fraud,” noted in a letter from the state’s office of Medicaid inspector general. Members of the board met … Read More
A Houston-based medical company care hospital has agreed to pay more than $21 million to settle a federal lawsuit alleging it defrauded Medicare for years. Cornerstone Hospital Medical Center was a long-term care hospital that specialized in “providing extended medical … Read More
A Northwest Arkansas psychiatrist under investigation for Medicaid fraud was also named as a defendant in two lawsuits filed earlier this year alleging criminal misconduct toward patients. Dr. Brian T. Hyatt of Rogers was informed on February 24 that his … Read More
A former Oklahoma City physician, charged in 2016 with 29 felony counts and one misdemeanor, pleaded guilty last week to Medicaid fraud and multiple drug offenses. Harvey Jenkins operated Aria Orthopedics in south Oklahoma City, where he prescribed large volumes … Read More
DentaQuest, part of Sun Life U.S., recognizes and celebrates National Children’s Dental Health Month, a time when oral health professionals, health care providers and educators work together to promote the benefits of good oral health to children and their support … Read More
Letter urges agency to exercise its ‘oversight abilities’ inreporting of medical loss ratios The American Dental Association is asking the Centers for Medicare & Medicaid Services to improve the transparency of Medicaid managed care plans and how they report medical … Read More
An investigation by Attorney General Paxton’s Medicaid Fraud Control Unit has led to the sentencing for health care fraud of two individuals in federal court in Del Rio, Texas. Melody Ann Villarreal and Oscar Gutierrez, Jr. were both found guilty … Read More
A former personal care assistant received a suspended jail sentence and fines after admitting that she did not provide services for which her employer billed Medicaid. Kayla MacArthur, 29, of Berlin, pleaded guilty in 6th Circuit Court in Concord on … Read More
The Texas Health and Human Services Commission (HHSC) confirmed on Friday that it is actively hiring and recruiting additional staff ahead of Medicaid redeterminations. In a statement to State of Reform, HHSC said Medicaid eligibility renewals would begin in April … Read More
The Texas Primary Care Consortium (TPCC) outlined its 2023 policy priorities during a virtual presentation on Thursday, placing legislative efforts around maternal healthcare, Medicaid modernization, and transition to value-based payments at the forefront. Led by the Texas Medical Home Initiative … Read More
A dental hygienist and dental assistant have won $15,706 in back wages to be paid by the North Texas dentists who fired them for raising concerns about COVID-19 safety measures in spring 2020 following a federal whistleblower investigation conducted by … Read More
A federal grand jury has indicted an Oakland County doctor on a charge of healthcare fraud, alleging she ran a scheme to submit bogus claims to Medicare. According to a criminal complaint authored by an FBI special agent, Dr. Sangita … Read More
Damian Williams, the United States Attorney for the Southern District of New York, announced today that KEYON DOOLING and ALAN ANDERSON were sentenced to 30 months and 24 months in prison, respectively, for their roles in a scheme to defraud … Read More
Conduent Inc., the company that runs the New Mexico Medicaid program’s management information system, on Tuesday announced it has again been selected by the New Mexico Human Services Department for a new contract. The new Conduent management information system is … Read More
