A federal judge’s ruling that the Affordable Care Act is unconstitutional is likely to be overturned on appeal and may boomerang politically on Republicans. Judge Reed O’Connor ruled for some 20 state plaintiffs that the ACA’s individual mandate is no … Read More
An Idaho think tank has filed a lawsuit asking the state’s Supreme Court to block a scheduled expansion of Medicaid. The suit, brought by the Idaho Freedom Foundation, says the expansion— which was passed through a ballot initiative during the … Read More
An operator of a durable medical equipment (DME) company was ordered to federal prison following his admission of defrauding Medicaid, announced U.S. Attorney Ryan K. Patrick. George Louis Moreno, 59, of McAllen, pleaded guilty Jan. 24, 2018. Today, U.S. District … Read More
The owner of an Upper Valley durable medical equipment company has been indicted for medicaid fraud. A 14-count federal indictment was unsealed Thursday against Omar Cuate Canales, who operates Bluebonnet DME in Roma. Canales is charged with submitting false health … Read More
PHOENIX — A dentist who was arrested for falsifying his anesthesia credentials is being sued by a former patient for medical malpractice and consumer fraud. Kris Peterson filed a lawsuit against Dr. Pankaj Goyal on December 7. “It’s pretty shocking,” … Read More
Watchdog estimates recent audit of fraudulent Medicaid payments totaling nearly $2 billion ‘is really closer to $60 billion’ A recent audit of the Department of Health and Human Services (HHS) reveals that it directed $2.6 billion worth of taxpayer money … Read More
McALLEN — The operator of a local durable medical equipment company was sentenced to three years in prison Wednesday, court documents show. George Louis Moreno, operator of Mars DME Inc., stood before U.S. District Judge Micaela Alvarez Wednesday morning during … Read More
Eight Dallas, Texas-area pharmacy owners and marketers were charged in an indictment unsealed today for their roles in a scheme involving approximately $92 million in compound drug claims to TRICARE and the U.S. Department of Labor (DOL), which were allegedly … Read More
HHS has published the 12th edition of a reference guide for Texas Medicaid and CHIP, commonly known as the Pink Book. The new version that has under gone a complete redesign is posted here.
A Fairfield County woman has admitted to her role in an elaborate scheme to defraud Medicaid for services they never provided. Toshirea Jackson of Bridgeport has pleaded guilty in Bridgeport district court to one count of healthcare fraud for participating in … Read More
A Texas federal judge’s ruling Friday invalidating the Affordable Care Act could create political headaches for Medicaid expansion supporters in states that are moving to implement or maintain expansion. https://www.modernhealthcare.com/article/20181218/NEWS/181219901
In 2012, Tanya Walker took the $200 her father loaned her to see a doctor. She was in the aftermath of a divorce and needed a prescription for antidepressants, she said. But her doctor in Texarkana found signs of hypertension … Read More
Nearly 20% of Texans under the age of 65 don’t have health insurance and most of them are working, according to a new analysis that could further pressure that state’s policymakers and politicians to expand Medicaid coverage for the poor. Texas has … Read More
12-07-2018 | Audit (A-05-17-00013) | Complete Report | Report in Brief In a previous review, OIG determined that CMS had recovered the majority of Medicaid overpayments that we had identified in audit reports issued during Federal fiscal years (FYs) 2000 … Read More
Geoffrey S. Berman, the United States Attorney for the Southern District of New York, announced that LUIS OMAR VARGAS, an unlicensed dentist, was convicted last Friday, after a two-week jury trial, for defrauding health insurance companies by billing for false … Read More
Sarah Sarder, Breaking News Reporter. A Midlothian woman admitted Thursday to defrauding Medicaid while she was behind bars awaiting sentencing for a previous fraud scheme, authorities said. Alexis C. Norman, 47, pleaded guilty to one count of conspiracy to commit … Read More
Houston Chronicle: What is more Texan than pit barbecue, bluebonnets, Friday Night Lights, Whataburger and Willie? If you’re a Texan who likes to wrap yourself in the Lone Star flag, wrap your head around this: more ubiquitous than any Texas-shaped … Read More
Over the past several decades, American families have experienced skyrocketing health-care costs. While the national debate over the Affordable Care Act has dominated our public discourse, a new report reveals that state government policies are responsible for much of our … Read More
For our audit period (January 1, 2015, through December 31, 2017), Medicare should not have paid suppliers for any of the $34 million for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that were provided during inpatient stays. In addition, … Read More
St. Louis, MO – Demagio Smith, 28, of St. Louis, Missouri, pled guilty to conspiracy to make false statements to Medicaid. In his plea agreement, Smith admitted that he repeatedly submitted false time sheets to Medicaid that suggested that he … Read More
An embattled Texas provider that’s slated to shutter two hospitals on Friday closed an outpatient clinic in Temple Wednesday. Little River Healthcare’s primary- and specialty-care clinic King’s Daughters Clinic was closed to patients Wednesday. The clinic’s voicemail greeting did not … Read More
A Houston, Texas doctor was sentenced to 60 months in prison followed by three years of supervised release today for his role in a fraudulent medical clinic that ran costly, unnecessary diagnostic tests. Assistant Attorney General Brian A. Benczkowski of … Read More
NEW YORK, Dec. 3, 2018 /PRNewswire/ — This afternoon, former pro and college football star Michael Griffin will help students at Cook Elementary School learn about the importance good oral hygiene at a fun and interactive event. K-2 students at … Read More
This fall edition of the Semiannual Report to Congress covers OIG activities from April 2018 through September 2018. Historically, about 80 percent of OIG’s resources are directed to work related to Medicare and Medicaid. This is mirrored in the organization … Read More
PITTSBURGH (AP) — Two sisters who ran multiple home health care companies in Pittsburgh were indicted by a federal grand jury for their alleged role in a multi-million dollar health care fraud scheme. Court documents unsealed Tuesday show Arlinda Moriarty … Read More
New York may have improperly claimed reimbursement for 7,650 dental services totaling $1.3 million ($670,000 Federal share). Of these, 712 claims, totaling $66,000 ($34,000 Federal share), were for Medicaid fee-for-service dental services and 6,938 claims, totaling $1.3 million ($635,000 Federal share), … Read More
For the first time in a decade, the number of children without health insurance in the United States has risen — and Texas again has the largest share. A Georgetown University Center for Children and Families report released Thursday found … Read More
A Houston, Texas doctor was sentenced to 60 months in prison followed by three years of supervised release today for his role in a fraudulent medical clinic that ran costly, unnecessary diagnostic tests. Assistant Attorney General Brian A. Benczkowski of … Read More
BELL COUNTY, Texas — The Texas Health Care Association said Bell County’s long term care facilities don’t have enough Medicaid funding to provide quality care for every patient, and there will be more even more seniors that need care in … Read More
AUSTIN — Texas spent less money this year to help fewer babies and toddlers struggling with autism, speech delays, Down syndrome or other disabilities than it did six years ago despite estimates that more children are in need, according to … Read More
A New Jersey physician was arrested earlier this month for his role in a telemedicine scheme in which he prescribed expensive compounded medications to patients who did not need them, according to New Jersey U.S. Attorney’s Office. Bernard Ogon, M.D., … Read More
WASHINGTON — The Trump administration has labored zealously to cut federal regulations, but its latest move has still astonished some experts on health care: It has asked for recommendations to relax rules that prohibit kickbacks and other payments intended to … Read More
November 21, 2018, Washington DC—A federal grand jury indicted two clinic workers yesterday for their roles in a scheme involving approximately $5.9 million in allegedly fraudulent Department of Labor claims for unprovided drug screening and improperly coded physical therapy and … Read More
FORT WORTH Attorneys for a North Texas hospital corporation indicted this week on accusations that it involuntarily and illegally held patients filed a motion Friday requesting that the indictment be quashed. SAS Healthcare Inc., commonly known as Sundance Behavioral Heathcare … Read More
HOUSTON – A Harris County woman alleges a dentist punctured her sinus during a procedure and she needed further surgeries and treatments. Allison Ripley filed a complaint on Oct. 24 in the Harris County District Court against Mauricio Ceballos, DDS, … Read More
Texas children lag behind their peers across the country in educational opportunities, access to health care and financial secruity, according to a report released Thursday. Ahead of the 2019 legislative session, the “State of Texas Children” report, compiled by the … Read More
Defendants Made Millions by Artificially Inflating the Company’s Stock and Inducing Elderly Victims to Invest An indictment was unsealed today in federal court in Central Islip charging Christian Romandetti, Sr., the Chief Executive Officer of First Choice Healthcare Solutions, Inc … Read More
FORT WORTH A corporation that runs behavioral health hospitals in North Texas has been indicted on nine criminal counts of violating the Texas Mental Health Code, accused of holding four patients involuntarily and illegally at its Arlington facility. SAS Healthcare … Read More
The owner of two Detroit-area clinics was sentenced to 160 months in prison today for her role in a scheme involving approximately $8.9 million in fraudulent Medicare claims for home health care and other physician services that were procured through … Read More
The day after the federal 5th Circuit Court of Appeals ruled against Texas for spending tens of millions of dollars less than it was supposed to on kids with disabilities in 2012, advocates have dug up documents appearing to show … Read More
