Media

California made capitation payments after beneficiaries’ deaths. Of the 184 capitation payments in our random sample, 6 payments were correct. For the remaining 178 payments, California made unallowable payments totaling $433,948 ($302,755 Federal share). Despite California’s efforts to identify and … Read More

Detroit — A federal grand jury has indicted a Wayne County man who was once a member of the state board that regulates pharmacies and drugs for allegedly bilking health insurance plans out of millions, officials said. Nabil Fakih, owner … Read More

A doctor from Morristown was found guilty on charges related to a $30 million Medicare and Medicaid scheme, authorities said on Thursday. Paul Mathieu, 53, posed as the owner of three medical clinics in Brooklyn for six years while billing … Read More

A company known as “Acadia Healthcare” has agreed to pay penalties and fines totaling $17 million. Acadia and it’s subcontractors admitted overcharging for drug testing of clients at drug treatment centers across West Virginia. Source: Largest healthcare fraud settlement in … Read More

In Mississippi and Arkansas, Kool Smiles Dental has changed its brand name to Sunnybrook Dentistry. The report by the Daily Journal of Tupelo, Mississippi, implied that the rebranding may have been a consequence of the death of a child at … Read More

Memphis, TN – Decatur Hospital Authority, d/b/a Wise Health System in Decatur, Texas will pay $431,182.96 to the United States to resolve allegations of billing false claims to Medicare for genetic testing panels for surgical patients that were not medically … Read More

HOUSTON (CBSDFW.COM/AP) — A businessman who operated an ambulance company in the Houston area must serve more than five years in federal prison for running what prosecutors call a $2.8 million billing scam. Keeble Lovall, 46, of Houston was sentenced … Read More

An owner of a Florida medical clinic was sentenced to serve 91 months in prison today for her role in a $2.5 million health care fraud scheme. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. … Read More

McALLEN, Texas ‐ The owner of a durable medical equipment (DME) company has been ordered to federal prison for defrauding Medicaid of more than $3 million, announced U.S. Attorney Ryan K. Patrick. Anna Ramirez-Ambriz, 57, of McAllen, pleaded guilty March … Read More

Gary D. Newsome, former CEO of Health Management Associates LLC (HMA), a hospital chain that was headquartered in Naples, Florida, has agreed to pay the United States $3.46 million to settle allegations that he caused HMA to knowingly submit false … Read More

A proposed bill would allow Medicaid recipients to take the Uber and Lyft ride-sharing companies to the doctor or Emergency Room for non-emergency appointments–and charge the government– and the taxpayer for it. HB 1576, sponsored by Rep. Dade Phelan, R-Beaumont, … Read More

AUSTIN – Investigative work by the decorated Medicaid Fraud Control Unit of Texas Attorney General Ken Paxton’s office helped federal prosecutors obtain convictions and prison sentences in two home health care fraud cases against five individuals who cheated Medicaid and … Read More

Attorney General Leslie Rutledge has announced the arrest of Chirie Bazzelle, owner of New Beginnings Behavioral Health Services, on Medicaid fraud charges related in part to contracts with others arrested previously in the sprawling public corruption probe involving Preferred Family … Read More

Federal prosecutors say it was a symbiotic relationship. Dental clinic owner Pamela Van Drie needed a dentist who would go along with her plan to defraud Medicaid without asking too many questions. And dentist James Dye needed a dental office … Read More

KANSAS CITY, KS (KCTV) – Last week, a Kansas City woman last week pleaded guilty to Medicaid fraud and related charges according to Kansas Attorney General Derek Schmidt. Jennifer Lynn Jones, 28, pleaded guilty in Wyandotte County District Court to … Read More

COVINGTON, LA (WAFB) – The Louisiana Department of Health (LDH) may have a legal battle on its hands if it wants thousands of dollars improperly billed to Medicaid back. State auditors interviewed employees at Convington-based Walk With Me Community Improvement … Read More

HARRISBURG — Pennsylvania Auditor General Eugene DePasquale is launching random audits of private contractors hired by the state to provide care for people covered by the state’s Medicaid program. There are about 2.75 million people covered by Medicaid in Pennsylvania, … Read More

Katherine Edmundson didn’t know her 7-year-old son was off Medicaid until she took him to the dentist for his annual cleaning in February. An employee at the front desk told her that his coverage was invalid and that her son … Read More

In the early 2000s Terry Mitchell’s dentist retired. For a while, Mitchell, an electrician in his 50s, stopped seeking dental care altogether. But when one of his wisdom teeth began to ache, he started looking for someone new. An acquaintance … Read More

The Supreme Court of Iowa ruled in favor of appellee Robert F. Colwell, DDS, over the Iowa Department of Human Services in the Supreme Court of Iowa, No. 18-0464, on February 8, 2019, in a case that addressed the way … Read More

Cleburne resident Sparrow Joe on Monday said she and her husband, Raymond Luther, were surprised to receive packages of medical equipment they never requested and later outraged by the response they received from others. In a turn that appears possibly … Read More

One of the largest healthcare fraud schemes investigated by the FBI and HHS and prosecuted by the Department of Justice resulted in $1.2 billion in losses and charges against 24 executives of telemedicine and durable medical equipment (DME) companies. Officials … Read More

Two people arrested on health care fraud charges are expected to appear in court. Everardo Villarreal and Delilah Rae Robles were partners in a medical supply company in Elsa. They’re accused of submitting fraudulent payment claims of more than $850,000 … Read More

Conduent said a “noisy resignation” letter from a disgruntled board member was part of a takeover attempt by Carl Icahn that was aimed at replacing current chairman William Parrett. Board member Michael Nevin resigned immediately from the IT service provider’s … Read More

The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving orthotic braces and other medical equipment. Scammers are offering Medicare beneficiaries orthotic braces that are supposedly free to them … Read More

A federal jury found a South Florida health care facility owner guilty today for his role in the largest health care fraud scheme ever charged by the Justice Department, involving over $1.3 billion in fraudulent claims to Medicare and Medicaid … Read More

HOUSTON – An appeals court will allow a liability lawsuit to move forward against a dentist who is accused of failing to properly diagnose and treat a patient. According to the April 2 filing at the Texas 14th Court of … Read More

Federal prosecutors on Tuesday said they dismantled one of the largest health care fraud schemes ever investigated by the FBI, charging 24 people in a $1.2 billion alleged scam involving telemedicine and durable medical equipment companies. As part of the … Read More

Imagine suddenly losing your health care coverage over some undelivered paperwork. Recent reports suggest this is happening to thousands of Texas’ poorest children, jeopardizing their ability to get basic medical care and yanking away a ladder proven to help families … Read More

Last October, Texas education officials told lawmakers they would likely owe the federal government $33 million for illegally decreasing funding for kids with disabilities. They reassured them it was a fraction — just 3% — of their federal special education … Read More

HARTFORD — Connecticut Attorney General William Tong on Thursday announced a $252,913 settlement with New Haven dentist Robert Sorrentino to resolve allegations that he violated the False Claims Act by submitting false claims for oral surgery and maxillofacial services to … Read More

AUSTIN — About 50,000 Texas children are losing Medicaid coverage each year because their families fail to quickly send proof to the state they are still poor enough to qualify, state data show. Yet one in three children kicked off … Read More

Philip Esformes, an obsessive businessman who built an empire of healthcare facilities in Miami-Dade, was found guilty Friday of over 20 charges, including bribery and paying kickbacks, in a scheme to generate streams of patients for both his businesses. The … Read More

PROVIDENCE, R.I. (WPRI) – More than 1,000 dead Rhode Islanders received over $11 million in Medicaid benefits last year, according to a financial audit reviewed by the Target 12 investigators. It’s one of the findings in the state’s 443-page annual … Read More

Bristol-Myers Squibb Co. didn’t demonstrate that a federal court erred in allowing a whistleblower to proceed with claims that the company engaged in Medicaid fraud under the False Claims Act. Ronald J. Streck adequately pled the falsity and knowledge elements … Read More

PUEBLO COUNTY, Colo. – A Pueblo County couple is facing theft charges after they defrauded the Colorado Medicaid program out of hundreds of thousands of dollars, according to the Colorado Attorney General’s Office. The office said Frank Palcic and Melanie … Read More

Sylvia Hernandez Kauffman, the first woman in state history to be named Inspector General for Texas Health and Human Services, was born and raised in Brownsville. Her reappointment to the office, by Gov. Greg Abbott, was confirmed by the Senate … Read More

Attorney General Bob Ferguson recently announced that CareOne Dental Corporation and its owners will pay $1 million over allegations they repeatedly billed Medicaid for non-covered services and for services the company didn’t provide, the second-largest resolution of an in-state Medicaid … Read More

Medicare made more than $23 billion in improper payments in 2017 due to insufficient documentation, according to a new Government Accountability Office report. The GAO also found in its review that Medicaid paid out more than $4 billion for services … Read More

Efforts in several states to require Medicaid recipients to work, study, volunteer or search for a job have stalled amid court challenges and questions from lawmakers, but the Trump Administration vowed to continue approving similar work requirements. A federal judge … Read More