WHY WE DID THIS STUDY The Department of Health and Human Services (HHS) OIG is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCU or Unit). This MFCU Fiscal Year (FY) 2015 Annual Report highlights statistical achievements … Read More
Hospitals in the Dallas-Fort Worth region were overpaid by $27 million in federal funds to provide health care for the uninsured, according to a new order from the Obama administration, which is threatening to take the money back. Federal health … Read More
When FBI and Health and Human Services investigators announced earlier this summer they had snared more than 300 people trying to bilk Medicare out of $900 million, one might have concluded the corner had been turned in the fight against … Read More
The Department of Health and Human Services Office of Inspector General audit released earlier this week found Texas had miscalculated payments for the Medicaid Supplemental Physician Payments program and owed the federal government some $57.9 million for the period 2004 … Read More
The audit section of the Department of Health and Human Services Office of Inspector General issued a report earlier this month that Texas now owed the federal government some $57.9 million because the state Health and Human Services Commission did … Read More
The weekend can’t come fast enough for the Texas Health and Human Services Commission. On Wednesday, federal officials asked the state’s largest agency to return $57,884,268, the federal share of $95,359,841 in supplemental payments to doctors made improperly from 2004 to … Read More
The U.S. Department of Health and Human Services (HHS) released a report from its Office of the Inspector General (OIG) regarding the wireless networks of the Centers for Medicare & Medicaid Services’ (CMS) facilities. The report shows that CMS, which collects … Read More
The Centers for Medicare and Medicaid Services has awarded positions on a potential 10-year, $2.5 billion contract vehicle to seven companies for program integrity support services intended to help CMS and its partners identify instances of healthcare fraud, waste and abuse … Read More
More than 300 people across the nation — including 22 in the Houston area and seven in McAllen — have been charged with stealing more than $900 million in what federal investigators say is the “largest Medicare fraud takedown in … Read More
Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges … Read More
Subpar provider enrollment screening processes continue to plague Medicare and Medicaid, leaving both programs vulnerable to fraud and contributing to nearly $90 billion in improper payments in 2015, according to testimony during a House subcommittee hearing. In her testimony Tuesday, Ann … Read More
Picture yourself as a physician, health care administrator, or nurse. The government initiates a False Claims Act (FCA) investigation and you (or your company), as a provider, commence an immediate internal investigation. The findings are brought to the government, you … Read More
There have been many changes for Medicaid dental providers over the last few years. The change from fee-for-service to managed care. The upheaval caused by the former Health and Human Services Commission Office of Inspector General and rampant allegations … Read More
We want to close out 2015 with a round-up of the year’s most important stories relating to TDMR issues. It has been an exceptional year for changes at the Health and Human Services Commission. The implosion that occurred at HHSC … Read More
PLANO, TX—A Denton County, Texas, nurse has been convicted of 9 counts of health care fraud in the Eastern District of Texas, announced U.S. Attorney John M. Bales today. Florence Kroma a/k/a Florence Kamara a/k/a Florence Koroma a/k/a Florence Bangura, … Read More
The Centers for Medicare & Medicaid Services (CMS) knew as far back as 2008 that certain Medicare Advantage plans were pocketing billions in overpayments, but officials still held back on auditing the plans and recouping payments tied to inflated risk … Read More
In the latest government blow against rampant Medicare fraud, two doctors and a registered nurse in New Orleans were given stiff prison sentences and millions of dollars in fines this week in federal court for their roles in a long-term $50 … Read More
HHS says few states have taken it up on an offer to receive federal funding for data-mining, which would allow their Medicaid fraud units to search claims. States say they don’t need it, even though the improper payment rate has … Read More
The federal government has warned Texas that it cannot block Medicaid participants from “qualified providers of their choice” or because of the provider’s “scope of practice.” In doing so, the U.S. Department of Health and Human Services has essentially put … Read More
Congress and the President have two months to hammer out a budget before the country teeters on another fiscal cliff. One big issue is the $85 billion in spending cuts on defense and domestic programs imposed by the sequester. Some … Read More
Medicare spent more than $30 million during the first half of 2012 on ambulance transports for patients that appear to be ghosts on paper, according to a new report released by the Office of Inspector General (OIG) Tuesday. The report revealed … Read More
On Sept. 11, 2015, the House Energy and Commerce Committee’s Health Subcommittee held a hearing, entitled “Strengthening Medicaid Program Integrity and Closing Loopholes,” to discuss six bills related to improving Medicaid program integrity and closing eligibility loopholes in the program. … Read More
The Texas Health and Human Services Commission made $377 million in Medicaid electronic health record incentive payments to hospitals in 2011 and 2012, but at least $12.5 million of that was made in violation of state and federal regulations, according … Read More
From March 2011 through September 2013, Washington failed to suspend Medicaid payments to 48 providers being investigated for credible allegations of fraud, according to a report from the Office of Inspector General. Source: OIG report: Washington needs better policies for suspending providers … Read More
Law360, New York (September 3, 2015, 10:12 AM ET) — Recent Office of the Inspector General physician guidance, personnel and budget increases, and a Third Circuit decision, all point to the same thing -— physicians who participate in Medicare and … Read More
The CMS has awarded SafeGuard Services a contract worth up to $300 million to help prevent and identify Medicare fraud. SGS is a subsidiary of Hewlett-Packard Enterprise Services and performs data analysis, investigations and medical reviews to detect, prevent, deter … Read More
WHY WE DID THIS STUDY Prior to passage of the Patient Protection and Affordable Care Act (ACA), if a State terminated the participation of a provider from its Medicaid program, the provider could potentially participate in another State’s Medicaid program, … Read More
Some healthcare providers dropped by state Medicaid programs because of fraud or quality problems were still participating in other states’ programs, contrary to requirements in ObamaCare, according to an inspector general report. The Affordable Care Act requires that a state … Read More
July 14, 2015 — U.S. Sen. Charles Grassley (R-IA) has sent letters to key government agencies, asking how many criminal and civil cases have been brought against dentists suspected of fraudulent treatment and billing practices involving Medicaid patients. “Some dentists … Read More
Here is the June/July edition of the Texas Medicaid News! Hello and welcome to the Texas Medicaid news update, I’m Andy Zajac. Things have been hot and heavy over the last few weeks in Austin. 1) Our top story is … Read More
The U.S. Department of Health and Human Services inspector general is asking a Maryland state health agency to refund $34.2 million in federal dollars it received for a waiver program that the watchdog said was wrongly applied, it said in … Read More
The U.S. Department of Health and Human Services Office of Inspector General has created a new team of attorneys focused solely on litigation involving Medicare and Medicaid fraud. The new team was announced at the American Health Lawyers Association’s annual … Read More
A number of states still do not report required quarterly data about services provided to Medicaid beneficiaries enrolled in managed care—information that’s crucial to running Medicaid and protecting it from fraudsters, according to a study HHS’ Office of Inspector General … Read More
The Office of the Inspector General at HHS announced Tuesday the creation of a new litigation team that will concentrate on identifying and fining Medicare and Medicaid fraud. The team’s creation is intended to put further pressure on physicians, drugmakers … Read More
WASHINGTON, DC – House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Oversight and Investigations Subcommittee Chairman Tim Murphy (R-PA) today sent a letter to Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt in their continued oversight … Read More
On Tuesday, representatives from the United States Department of Health and Human Services Office of Inspector General (OIG) announced the creation of an OIG litigation team that will focus specifically on civil monetary penalties and exclusion cases. The announcement was … Read More
The federal government is calling McAllen a hotspot for potential Medicare fraud and abuse. The Department of Health and Human Service Office of Inspector General released a report today detailing the growing problem. Source: HHS OIG: McAllen a Medical Fraud … Read More
DALLAS The case of a troubled Texas hospital system shows how a federal, $24 billion stimulus program that distributes funds to help computerize health-care records has been vulnerable to fraud. It also highlights the challenges in recouping the money that … Read More
On June 9, 2015, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Fraud Alert focused on compensation arrangements paid to physicians. See, “Physician Compensation Arrangements May Result in Significant Liability” [link:https://oig.hhs.gov/compliance/alerts/guidance/Fraud_Alert_Physician_Compensation_06092015.pdf]. The Fraud … Read More
The U.S. Justice Department charged 243 people, including 46 doctors, nurses and other medical professionals, with defrauding the Medicare system of $712 million through false billing. Attorney General Loretta Lynch announced the charges Thursday in Washington, calling the case the … Read More
