The owner and operator of five Houston-area home health agencies pleaded guilty to conspiring to defraud Medicare and the State of Texas’s Medicaid-funded Home and Community-Based Service and Primary Home Care programs of more than $17 million. He also pleaded … Read More
Former patients of a Harrison Twp. dental office under investigation by the Ohio Attorney General’s Office for Medicaid fraud spoke out today.Agents with the state’s Medicaid Fraud Investigative Unit raided Dixie Dental and Denture, 3609 N. Dixie Drive, owned by … Read More
Government efforts to fight health-care fraud would get a $70 million boost under the Trump administration’s proposed budget blueprint for fiscal year 2018. The March 16 proposal would provide $751 million in discretionary funding for the Health Care Fraud and … Read More
MOREHEAD CITY, N.C. (WNCT)–The state accuses A Pefect Fit for You of defrauding it of more than $12 million through Medicaid claims without proper paperwork. The store’s owner, Margaret Gibson, is also accused by her former business partner, Shelley Bandy, … Read More
United States Attorney G. F. “Pete” Peterman, III, announces that Dr. Stanley B. Marable, DDS, age 55, a dentist from Valdosta, Georgia, was sentenced March 16, 2017 to serve twenty-seven (27) months in Federal prison for Healthcare Fraud followed by … Read More
HOUSTON, TX — The owner of a medical clinic with locations in Houston and Port Arthur was sentenced this week to 33 months in federal prison after being convicted of Medicare and Medicaid fraud.Verona Spicer, 47, the owner of Elite … Read More
Medicaid Fraud Control Units delivered nearly $1.9 billion in recoveries in fiscal year 2016, according to a new data set and interactive map released Monday by federal officials. The data and the map, put out by the Office of Inspector … Read More
MCALLEN – A McAllen woman is waiting to learn her sentence after she was convicted in connection with a Medicaid fraud scheme. Federal prosecutors said 41-year-old Maria Garza was found guilty on 18 counts to defraud Texas Medicaid. Authorities said … Read More
Over 65,000 ineligible providers have been culled from the Medicaid program due to a component of the Affordable Care Act that requires periodic recertification of eligibility, according to Modern Healthcare. The measure, which was meant to prevent fraud and inefficiency, … Read More
Several legal media outlets reported yesterday that former Texas Medicaid claims administrator Xerox has brought an appeal before the Texas Supreme Court because the company says the state is “wrongfully blocking the company from designating the dentists who treated patients in the alleged … Read More
Jeff Leston, the founder of Castlestone LLC, has provided TDMR with his take on how to improve government healthcare plans such as Texas Medicaid to reduce waste, fraud and abuse. Castlestone is a company created to use the infrastructure of … Read More
U.S. District Judge Sam Sparks ruled Tuesday afternoon that Texas clinics affiliated with Planned Parenthood can continue to care for patients under the state’s Medicaid program, a phew-worthy victory for reproductive rights advocates and a loss for the state’s GOP leaders. In … Read More
ATLANTA (AP) — An Atlanta-area dentist has been sentenced to a year and six months in federal prison for filing nearly $1 million in false claims with Georgia’s Medicaid program. U.S. Attorney John Horn, in a news release Wednesday, said … Read More
Facing 19 years in prison after losing his pediatric dentistry practice on charges of Medicaid fraud and accusations of child abuse, Howard Schneider was deemed incompetent for trial Wednesday, according to Times-Union news partner First Coast News. The decision, passed down … Read More
McALLEN — Prosecutor Michael Edward Day stood before a federal jury Tuesday to deliver his opening statement in a case connected to the largest healthcare fraud takedown in U.S. history, and repeated an ominous saying three times in Spanish. Paz, … Read More
McALLEN — A Mission doctor accused of submitting false Medicaid claims for patients who were deceased pleaded guilty to the charges Tuesday. Dr. Pedro Garcia, 68, went before federal District Judge Ricardo Hinojosa and pleaded guilty to conspiracy to commit … Read More
BOSTON (Legal Newsline) — Massachusetts Attorney General Maura Healey announced Jan. 25 that Newton dentist Dr. Julia Faigel and her 21 corporations will pay a total of $475,000 following allegations of improperly billing the state’s Medicaid system. “This pattern of … Read More
Lee College’s Center for Workforce and Community Development will host two free health care fraud prevention seminars on Feb. 28. “We’re excited to offer both a morning and evening presentation to the public. It’s an important topic, and we want … Read More
TDMR received a notice yesterday from the Health and Human Services Inspector General office that Inspector General Stuart Bowen will be hosting, along with Sen. Chuy Hinojosa, a “Rio Grande Valley Medicaid Integrity Symposium.” The event is to take place … Read More
Medicaid is a joint federal-state health care program for low income and medically needy people, with an estimated $36 billion in improper payments in fiscal year 2016. We’ve identified some ways to reduce these errors, such as by confirming that … Read More
A former Tenet Healthcare Corp. VP is the first executive of the Dallas-based hospital chain to be charged for an alleged role in defrauding Medicaid through a $400 million kickback scheme. John Holland, 60, pleaded not guilty Wednesday in a … Read More
The following is a statement received from MB2 Dental Solutions, the Dallas-area dental service organization, that recently settled with federal and state authorities for a whopping $8.45 million over allegations of Medicaid fraud. A company representative told us that they … Read More
A mother and son were convicted of crimes related to a $7 million home healthcare fraud conspiracy in which they provided forged documents and fraudulent forms to bill for services that were not provided. Delores L. Knight, 70, of Cleveland … Read More
States may receive their Medicaid funding in block grants under President Donald Trump’s plan to replace the Affordable Care Act, one of his advisers reported this weekend. White House adviser Kellyanne Conway, appearing on Sunday Today, said that moving the … Read More
The administrator of five Houston-area home health agencies pleaded guilty today to conspiring to defraud the State of Texas’ Medicaid-funded Home and Community-Based Service and the Primary Home Care Programs of more than $7.8 million. These programs provide qualified individuals … Read More
MCALLEN – The owner of a Rio Grande Valley medical equipment company accused of trying to defraud state Medicaid was arrested on Thursday. Anna Ramirez-Ambriz faces six counts of healthcare fraud and three counts of aggravated identity theft. A federal … Read More
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program) under the joint direction of the Attorney General and the Secretary of the Department of Health … Read More
Update 3:30 p.m.: U.S. District Judge Sam Sparks issued a temporary order Thursday blocking Texas officials from ousting Planned Parenthood as a Medicaid provider — a termination set to take place Saturday.Sparks did not rule on the merits of the … Read More
The Texas Attorney General’s office has accused some of the state’s largest pharmacies of cheating the Medicaid program by reporting exaggerated prices on medications and raking in larger reimbursements than they deserve. And while several pharmacies have settled with the … Read More
Tuesday, TDMR republished a press release issued by the Department of Justice, U.S. Attorney’s Office, Northern District of Texas that Carrollton-based MB2 Dental Solutions and 21 pediatric dental practices affiliated with MB2 had agreed to an $8.45 million settlement to resolve … Read More
DALLAS – Texas-based MB2 Dental Solutions (MB2) and 21 pediatric dental practices affiliated with MB2, along with their owners and marketing chief, have agreed to pay the United States and the State of Texas Medicaid program $8.45 million to resolve … Read More
2016 ended very badly for Texas Medicaid. It was a very poor Christmas for many. There were a number of important divisive events that occurred which we decided not to comment on during the holiday season. We didn’t want to spread … Read More
CVS Pharmacy, accused by the state of Texas of defrauding Medicaid of $30.5 million, is suing the state Health and Human Services Commission, claiming state officials approved the billing practices at the heart of the fraud case, court records show. … Read More
Progressives have already homed in on Republican efforts to privatize Medicare as one of the major domestic political battles of 2017. If Donald J. Trump decides to gut the basic guarantee of Medicare and revamp its structure so that it … Read More
After more than a year of delays, Texas is officially kicking Planned Parenthood out of the state’s Medicaid program. In a move that could affect thousands of low-income women, state health officials on Tuesday delivered a final legal notice to … Read More
HOUSTON – Two brothers have been convicted on charges of conspiracy to commit health care fraud, health care fraud and money laundering, announced U.S. Attorney Kenneth Magidson. Kevin Olufemi Davies, 29, and his brother Melvin Olusola Davies, 28, owned and … Read More
A Charlotte woman was sentenced in federal court this week to 16 years in prison for orchestrating an $11 million Medicaid fraud scheme, authorities said Thursday.Cynthia Teresa Harlan, 49, was sentenced Wednesday following a July conviction on one count each … Read More
There have been rumors flying by the last few weeks that Inspector General Stuart Bowen wants to make it easier to place “credible allegation of fraud” (CAF) payment holds against Medicaid providers. We had no idea that this was difficult … Read More
Operators of two Fort Defiance medical transportation companies have been sentenced to prison for health-care fraud after collecting more than $3 million from a government health program for thousands of trips that never occurred, federal prosecutors said.Sylvia Begay, 50, who operated Hozho Nahasdlii … Read More
Zwanger-Pesiri Radiology will pay more than $10 million in a settlement over Medicare and Medicaid fraud the firm committed.Attorney General Eric T. Schneiderman and United States Attorney Robert L. Capers announced Wednesday that Zwanger & Pesiri Radiology Group, LLP, Zwanger … Read More
