A close, long-standing friend of Gov. Mike DeWine registered early this year to lobby on behalf of a giant Medicaid provider — just before Attorney General Dave Yost accused the company of ripping off tens of millions of taxpayer dollars. … Read More
October 7, 2021 The OIG Audit Division conducted an audit of special investigative unit (SIU) activities at Aetna Better Health of Texas, a Medicaid and Children’s Health Insurance Program managed care organization. MCOs are required to establish an SIU to … Read More
New York (AP) —18 former NBA players have been charged with stealing the league’s health and welfare benefit program from about $ 4 million, according to a charge in New York on Thursday. Federal prosecutors have planned a press conference … Read More
A Rockville woman was sentenced Friday to 12 months in prison for defrauding the District of Columbia’s Medicaid program out of more than $813,000 through false billing, authorities said. Mahsa Azimirad, 41, was the office manager for Universal Smiles, a … Read More
Three generic pharmaceutical manufacturers, Taro Pharmaceuticals USA, Inc., Sandoz Inc. and Apotex Corporation, have agreed to pay a total of $447.2 million to resolve alleged violations of the False Claims Act arising from conspiracies to fix the price of various … Read More
WASHINGTON – Mahsa Azimirad, the former office manager for Universal Smiles, a Washington, D.C.-based dental practice, was sentenced today to 12 months in prison on a federal charge of health care fraud stemming from a scheme in which she was … Read More
US Attorney for the Southern District of New York Audrey Strauss announced that nine suspects have been indicted for operating an over $20 million health care fraud scheme at fraudulent medical offices in Manhattan, Brooklyn, and Queens. It is alleged … Read More
A former Insys Therapeutics sales representative, whose trial had commenced, pleaded guilty in the Southern District of Ohio to conspiracy to defraud the United States for her involvement in a scheme to pay kickbacks to a doctor to induce him … Read More
CLARKSVILLE, TN (CLARKSVILLE NOW) – A federal jury has finished its deliberations in the case of Dr. Samson Orusa, 59, of Clarksville, who was convicted last month of federal drug charges, healthcare fraud, money laundering, and illegally distributing oxycodone at … Read More
AWorcester dental office manager has pleaded guilty to participating in a Medicaid fraud scheme, the U.S. Attorney’s office of Massachusetts announced on Tuesday. Robin Cronin of Worcester was indicted in January 2020 along with Dr. Anthony DiStefano III and Dr. … Read More
The Department of Justice announced today criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States for their alleged participation in various healthcare fraud schemes that resulted in … Read More
Today Attorney General Paxton filed an objection to the Texas State Bar’s appointment of a one-sided and partisan “Investigatory Hearing Panel” to investigate him and his staff for defending the rights of the State of Texas by challenging the constitutionality … Read More
The Republicans trying to unseat embattled Attorney General Ken Paxton are unsparing in their criticism of the incumbent from their own party — and beginning to draw some hard contrasts with one another. During separate one-on-one interviews for the 2021 … Read More
Chris Callaway served as a Texas Ranger from 2012 to 2018 and worked on public integrity cases, including investigating both local officials and a legislator. Statewide, Rangers like him handled more than 560 cases involving corruption by local and state … Read More
BOISE, Idaho — A Boise woman who ran a caregiver business in Boise will spend time in jail for forging a client’s signature on documents submitted to Medicaid. Kendra Hessing, 43, was sentenced Tuesday to two years in prison. A … Read More
BOSTON – A California woman was sentenced yesterday for her role in a multi-million-dollar Medicare fraud scheme. Stefanie Hirsch, 51, of Los Angeles, Calif., was sentenced by U.S. Senior District Court Judge George A. O’Toole Jr. to three years of … Read More
A federal jury in the Eastern District of Michigan convicted a Michigan doctor today for his role in masterminding and executing a complex scheme to defraud Medicare and other health insurance programs by administering medically unnecessary spinal injections in exchange … Read More
Hundreds of organizations from mostly southern parts of the United States are pleading with Congress to expand Medicaid in the 12 states that have refused to do so. Among those states is Texas, which has the highest uninsured rate in … Read More
PITTSBURGH, PA – A South Hills pharmacist pleaded guilty in federal court to charges of obtaining controlled substances by fraud, misbranding of drugs, and health care fraud conspiracy, Acting United States Attorney Stephen R. Kaufman announced today. Timothy W. Forester, … Read More
FAYETTEVILLE – A Florida dentist, formerly of Arkansas, pleaded guilty today to one count of conspiracy to commit honest services fraud in a scheme with former Arkansas State Senator Jeremy Hutchinson that occurred between 2014 and 2016. U.S. District Judge … Read More
John Peter Smith Hospital agreed to pay $3.3 million to settle a case alleging it violated the False Claims Act by upcoding claims given to federal healthcare programs such as Medicare, TRICARE, and VA health benefits programs. The suit stems … Read More
ABINGDON, Va. – A Bristol, Tennessee man was sentenced today to three months of home confinement for conspiring with another man to pay and receive kickbacks. In addition to home confinement, he will pay $56,000 in monetary penalties and will … Read More
NEW YORK, Sept. 16, 2021 /PRNewswire/ — The United States Department of Justice (DOJ) has filed its complaint in intervention in a Constantine Cannon whistleblower’s lawsuit against Independent Health Association (IH), coding consultant subsidiary DxID LLC (DxID) and Betsy Gaffney, … Read More
An ophthalmologist in Rye, NY, has pleaded guilty in connection with a seven-year healthcare fraud scheme. Dr. Ameet Goyal falsely billed for millions of dollars of procedures he did not perform, according to a press release from the U.S. Attorney’s … Read More
A major California-based health care system, Sutter Health, and several of its medical practice foundation affiliates have agreed to pay a total of $90 million to settle allegations that they violated the False Claims Act (“FCA”) by knowingly submitting inaccurate … Read More
EL PASO – An El Paso businesswoman and her nephew were arrested today on criminal charges for their alleged roles in committing health care fraud. According to court documents, Zenia Chavez, 45, and Raul Alejandro Fuentes, 23, of El Paso, … Read More
WASHINGTON — Former NFL players Clinton Portis, Tamarick Vanover and Robert McCune pleaded guilty for their roles in a nationwide health care fraud scheme and could face years in prison, the U.S. Department of Justice announced Tuesday. Portis, Vanover and … Read More
Indiana Attorney General Todd Rokita announced Wednesday that Indiana Medicaid has recovered $1.8 million as part of a $75 million national civil settlement resolving allegations that Bristol-Myers Squibb Co. overcharged state Medicaid programs for drugs. Of the $1.8 million, $746,780 goes directly … Read More
The U.S. Department of Justice (DOJ) has alleged that the University of Pittsburgh Medical Center in Pennsylvania (UPMC) and the head of cardiothoracic surgery, James Luketich, “fraudulently bill[ed] Medicare and Medicaid for complex surgeries,” according to court documents. The complaint … Read More
If you’re interested in issues surrounding the statewide operation of Medicaid managed care, you may want to apply to be a member of the State Medicaid Managed Care Advisory Committee. The Texas Health and Human Services Commission executive commissioner will … Read More
More than a year into the pandemic and all the government programs, funding, and relief that came along with it, the federal government is accelerating its pace of prosecution of fraud. Since the passing of the Coronavirus Aid, Relief, and … Read More
SUFFOLK COUNTY, NY — A former dentist from Long Island was convicted of Medicaid fraud and sentenced to prison, New York Attorney General Letitia James announced on Wednesday. Dawer Nadi, 63, submitted false Medicaid claims for dental services after his … Read More
n anticipation of the upcoming solicitation and resulting contract for STAR+PLUS, the Health and Human Services Commission (HHSC) is issuing this Request for Public Comment to seek information and comments regarding the proposed Best Value Criteria the agency will use … Read More
A new law will no longer require some Texas doctors to obtain approval for certain medical procedures, treatments or drugs. Physicians with a proven track record — who are approved 90% of the time for a service — will receive “gold … Read More
September 3, 2021 — The COVID-19 pandemic affected the income of all dentists in 2020, but female clinicians took a much bigger financial hit than their male colleagues, according to a webinar hosted by the ADA’s Health Policy Institute (HPI) on … Read More
The latest ADA Health Policy Institute (HPI) survey, conducted in August, included additional questions relating to staffing and found that recruitment challenges were becoming an issue in U.S. dental offices. For 40.1% of all respondents, filling vacant positions in the … Read More
WASHINGTON – The White House is trying to shorten projections from federal health officials that it could take several years for American seniors to benefit from Democrats’ push for free dental coverage, according to four people with knowledge of the … Read More
An Easley chiropractor’s string of businesses must pay $140 million in judgments after a federal whistleblower lawsuit that alleged the medical companies charged for unnecessary tests in exchange for kickbacks. The default judgments were awarded in U.S. District Court in … Read More
Leonel Palatnik, 42, co-owner of Dallas-based Panda Conservation Group, a medical lab company, pleaded guilty Aug. 31 for his role in a $73 million Medicare kickback conspiracy, according to a Justice Department news release. Mr. Palatnik paid kickbacks to a telehealth company … Read More
The largest healthcare system in Pennsylvania and one of its top physicians are being sued by the federal government for alleged healthcare fraud. UPMC, its chairman of cardiothoracic surgery and the University of Pittsburgh Physicians group are accused of billing … Read More
