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
Two House committees have requested a review of the Centers for Medicare & Medicaid Services’ Fraud Prevention System, according to a letter sent to the Government Accountability Office. Bipartisan leaders on the House Energy and Commerce and House Ways and … Read More
Most Medicaid payments Texas made to providers for full vials of Herceptin from 2010 through 2012 were incorrect and resulted in overpayments of approximately $566,000 (Federal share). Copies can also be obtained by contacting the Office of Public Affairs at … Read More
An inspector general’s fraud alert on Tuesday warned referring physicians of fines and prison time that can result from accepting kickbacks disguised as medical directorships, the latest sign of rising interest in punishing individual doctors instead of just corporations for … Read More
Texas owes the U.S. government $133 million for unallowable orthodontic Medicaid treatments from 2008 to 2010, according to a new report by the Office of Inspector General (OIG). Many of the claims were improperly approved because they did not have … Read More
HOUSTON — Texas should repay at least $133 million in Medicaid funding misspent on unnecessary dental and orthodontic procedures, according to a federal audit. Source: Feds say Texas should repay $133 million in Medicaid funds misspent on dental care | … Read More
HHS’ Office of Inspector General recovered $1.8 billion from healthcare providers and programs in the first six months of fiscal 2015, according to the OIG’s Semiannual Report to Congress. Here are five takeaways from the OIG’s report. 1. In the … Read More
Back last August, the Department of Health and Human Services Office of Inspector General released an audit report that the Texas Health and Human Services Commission was responsible for the conduct of its Medicaid claims administrator for the hundreds of … Read More
From the Office of Inspector General of Department of Health and Human Services http://oig.hhs.gov [Matt Moore] I’m Matt Moore, an audit manager in Dallas, speaking with Eugena Newton, a senior auditor who is also in our Dallas office. Eugena, your … Read More
The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs) (OEI-06-15-00010, April 2015). Although the MFCUs reported another strong … Read More
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 (MFCUs or Units or Unit). This MFCU Fiscal Year (FY) 2014 Annual Report highlights … Read More
Nearly one-third of Medicaid fraud criminal convictions the federal government obtained last year involved home health aides, the Inspector General for Health & Human Services reports. Thirty percent of the 2014 cases involved home health aides, while certified nursing aides … Read More
The U.S. Department of Health and Human Services Office of Inspector General issued a report today detailing the cumulative efforts of state Medicaid Fraud Control Units in dealing with Medicaid fraud, waste and abuse in 2014. Pharmaceutical settlements are largest … Read More
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 (MFCUs or Units or Unit). This MFCU Fiscal Year (FY) 2014 Annual Report highlights … Read More
The Colorado Department of Health Care Policy and Financing (State agency) lacked sufficient internal controls to ensure that Medicaid claims submitted by providers and paid by the State agency during fiscal year (FY) 2011 correctly included National Provider Identifiers (NPIs) … Read More
TYLER, Texas – A 63-year-old Dallas County, Texas, physician, has been sentenced to federal prison for health care fraud and identity theft violations in the Eastern District of Texas, announced U.S. Attorney John M. Bales. Tariq Mahmood, 63, of Cedar … Read More
WHAT WE FOUND For fiscal years 2011 through 2013, the Unit reported 10 criminal convictions, 63 civil judgments and settlements, and recoveries of over $63 million. We identified one issue of significant noncompliance with applicable laws, regulations, or policy transmittals … Read More
The Iowa Department of Human Services (State agency) did not always use the correct Federal medical assistance percentages (FMAPs) when processing claim adjustments reported to the Centers for Medicare & Medicaid Services. Of the 1.1 million claims we reviewed, the … Read More
Over the past year, false claims prosecution under the “worthless services” theory has picked up traction. Now that the Department of Justice (DOJ) plans to simultaneously prosecute civil and criminal whistleblower claims, this legal approach may take on an even larger … Read More
An advisory opinion released last week by the U.S. Department of Health and Human Services Office of Inspector General (OIG) advises labs not to enter exclusive agreements with physician practices that would cover patient fees for certain insurance plans. This … Read More
Good morning, Mr. Chairman and distinguished Members of the Subcommittee. Thank you for the opportunity to testify about fraud, waste and abuse in our Medicare program. My experience working in law enforcement and private practice has taught me that, notwithstanding … Read More
The State agency did not always comply with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud between July 1, 2011, and June 30, 2013. Of the 401 cases … Read More
Improper Medicare payments and fraud populated the Office of Inspector General’s (OIG) list of the top 25 unimplemented recommendations, according to a report from the watchdog agency that offered insight into where the Centers for Medicare & Medicaid Services (CMS) still … Read More
More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control (HCFAC) Program, Attorney General Eric Holder and HHS Secretary Sylvia M. Burwell announced today. The government’s health … Read More
When investigators suspected that Houston’s Riverside General Hospital had filed Medicare claims for patients who weren’t treated, they moved to block all payments to the facility. Then politics intervened. Rep. Sheila Jackson Lee, a Texas Democrat, contacted the federal official … Read More
The United States Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released its Fiscal Year 2015 Work Plan (“2015 Plan”) on October 31, 2014. OIG releases a work plan annually to identify the new and ongoing investigative, enforcement … Read More
Daybreak Venture, LLC, the general partner of 74 skilled nursing and long-term-care facilities throughout Texas, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 24, 2014. … Read More
WHAT WE FOUND We identified 94 general dentists and 1 oral surgeon in Indiana with questionable billing. These providers are extreme outliers when compared to their peers. Medicaid paid these providers $30.5 million for pediatric dental services in 2012. These … Read More
Federal officials are planning a wide range of audits into billing and government spending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly expanding under … Read More
Another HHS-OIG audit about to be released of the Texas Medicaid program will cost Texas another $30 million, according to a story in this morning’s Austin American Statesman. The federal audit covers 2011 for non-emergency medical transportation services. The article reports … Read More
The federal government wants Texas to pay back more than $30 million for incorrectly claimed Medicaid reimbursements. An audit to be released Wednesday by the Office of Inspector General within the U.S. Department of Health and Human Services describes how … Read More
Summary Some of the New York State Department of Health’s (Health Department) claims for Federal Medicaid reimbursement for supported employment services did not comply with certain Federal and State requirements. On the basis of our sample results, we estimated that … Read More
The Colorado Department of Health Care Policy & Financing (State agency) claimed $4.1 million ($2.5 million Federal share) in unallowable Medicaid nursing facility supplemental payments for State fiscal years (FY) 2010 and 2011. For these two FYs, the State agency … Read More
Signed into law in 1965, Medicaid ensures health coverage for nearly 60 million Americans today. Since the Medicaid program was established, the costs and responsibilities for administering it have been shared between the States and the Federal Government. However, a … Read More
BALTIMORE — The ordinary looking office building in a suburb of Baltimore gives no hint of the high-tech detective work going on inside. A $100 million system churns through complicated medical claims, searching for suspicious patterns and posting the findings … Read More
Data mining is the process of identifying fraud through the screening and analysis of data. On May 17, 2013, the Department of Health and Human Services (HHS) issued the final rule "State Medicaid Fraud Control Units; Data Mining" (78 Fed. … Read More
Summary WHY WE DID THIS STUDY OIG oversees the activities of all State Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. … Read More
Department of Justice Office of Public Affairs FOR IMMEDIATE RELEASEWednesday, August 20, 2014 Michigan Home Health Agency Owner Pleads Guilty to Participating in $22 Million Medicare Fraud Scheme A greater Detroit-area owner of three home health agencies pleaded guilty today … Read More
Summary WHY WE DID THIS STUDY Medicaid is the primary source of dental coverage for children in low-income families and provides access to dental care for approximately 37 million children. In recent years, a number of dental providers and chains … Read More
AUSTIN — Texas state government ultimately is to blame for hundreds of millions of dollars of Medicaid spending wasted on braces and orthodontic work that were not medically necessary, according to federal auditors. The audit report, released last week, concludes … Read More
