In 2015, the Government Accountability Office (GAO) estimated that taxpayers lost $136 billion to improper payments, a low-end estimate that mostly came from Medicare and Medicaid. The two popular and costly federal health care programs are growing rapidly, yet they … Read More
Today, Health and Human Services Commission Inspector General Stuart Bowen Jr. issued his fourth quarterly report since he took office back in early 2015 replacing former Inspector General Doug Wilson. Please find a copy of the report below. It can … Read More
A Baker woman accused of defrauding Louisiana to the tune of $1 million-plus in a Medicaid fraud scheme has been sentenced to five years in prison. Even though 38-year-old Chanda Hall pleaded guilty in April to a racketeering charge, The … Read More
TDMR has learned that a number of dental providers have reported being placed on payment hold by MCNA for “willful misrepresentation or abuse of claims.” Payment holds placed for mistakes and missing paperwork In these reports, dentists claim that MCNA’s … Read More
HARTFORD — A state court has ordered a Winsted dentist to pay $717,046 in restitution and fines for bilking the state’s Medicaid program, including using unlicensed assistants to provide pediatric dental cleanings and fluoride treatments. http://rep-am.com/news/local/974243.txt Republican American
If you remember the heyday of HHSC/TMHP/Xerox program spending on orthodontia back in 2011 that begat allegations of Medicaid fraud, it was at a sky-high $249 million. In 2015, it was $13.6 million. So it is little wonder that the number … Read More
DALLAS C The Estate of Dr. Kenneth Michael Rice and UMC Physicians (UMCP) have agreed to pay a total of $3,280,000.00 to the United States and the State of Texas to settle allegations that Dr. Rice and UMCP violated the … Read More
AUSTIN — The lawyer for a whistleblower who sued a top Ken Paxton donor said he was unaware the donor gave $100,000 to the attorney general during an investigation into his client’s claims, and he wants proof that it did … Read More
Over the past two weeks, it has been a major story that Attorney General Ken Paxton took a $100,000 donation for his personal legal fees from a friend whose company was accused of Medicaid fraud. The company just settled the … Read More
A woman has been sentenced to three years in prison for Medicaid fraud. Delphine Lucas, 50, pleaded guilty to one felony count of vendor fraud on July 7, according to a statement from Illinois State Police. She has since been … Read More
If the irony of Ken Paxton being Texas’ attorney general were a wall, it would be a huge, magnificent wall growing taller by the day. As the state’s top legal authority, an attorney general is expected to be above ethical … Read More
There may be, strictly speaking, a question on the legality, but there is no question on the ethics. Attorney General Ken Paxton was wrong to accept a gift from a party under investigation by his office.Last year, Preferred Imaging founder … Read More
LITTLE ROCK (KATV) — Arkansas Attorney General Leslie Rutledge announced the sentence of a Johnson County woman who pleaded guilty to Medicaid fraud. Sherry Wommack, 46, was sentenced to three years of probation and ordered to pay a $600 fine, … Read More
Dang. That Ken Paxton sure seems snakebit. The Texas attorney general’s latest pratfall was the sort of mistake that your average statewide politician is — or ought to be — too paranoid to make. Paxton was indicted last year for allegedly steering people to … Read More
AUSTIN — Attorney General Ken Paxton took a $100,000 gift from a Texas CEO who was being investigated for Medicare and Medicaid fraud, but he had no knowledge of the probe and his agency had little to do with it, multiple agencies … Read More
Facing possible prison time over accusations that he defrauded investors in 2011, Texas Attorney General Ken Paxton insists that he is the victim of a politically motivated witch hunt because he dares to run his powerful agency based on conservative … Read More
AUSTIN, Texas (AP) — Texas Attorney General Ken Paxton accepted $100,000 from the head of a company his office was investigating for Medicaid fraud despite internal rules at his agency that prohibit such gifts. Paxton is using the money toward … Read More
AUSTIN — A North Texas company whose president gave Ken Paxton $100,000 last year to fight his felony fraud indictments will pay $3.5 million after allegations it skimped on services to Medicaid and Medicare patients while over-billing the government. A former employee who brought the original lawsuit against Preferred … Read More
Touting a breakthrough in combating rampant fraud in the Medicare and Medicaid health care systems, the Obama Administration on Wednesday told Congress that it had prevented $42 billion of improper payments to doctors and other medical providers in fiscal 2013 … Read More
DALLAS — Preferred Imaging, LLC, (Preferred Imaging), a provider of diagnostic imaging services, has agreed to pay $3,510,000 to resolve allegations that it improperly billed Medicare and Medicaid for services performed without proper medical supervision in violation of the False … Read More
TULSA, Okla. (AP) — A former Oklahoma oral surgeon whose filthy clinics led to thousands of patients being tested for HIV and hepatitis was sentenced Thursday to six months’ house arrest for fraudulently billing Medicaid for anesthesia services that were … Read More
LITTLE ROCK, Ark. (July 12, 2016) – Arkansas Attorney General Leslie Rutledge today announced the conviction of a Crittenden County woman for Medicaid fraud. Lacasha Perry pleaded guilty in Pulaski County District Court. Perry will pay a fine of $2,916. She … Read More
Dr. Juan D. Villarreal of Harlingen Family Dentistry and founder of Texas Dentists for Medicaid Reform has completed the writing of a book about his personal experience with Texas Medicaid and its attempt to falsely accuse Texas dentists of healthcare … Read More
JEFFERSON CITY, Mo. (KMOV.com) – A personal care attendant will serve five years probation and be ordered to pay back $25,000 to Missouri’s Medicaid Program. Yvonne Conly was originally sentenced to serve three concurrent prison sentences of five years, following her … Read More
HOUSTON – A Houston federal jury has returned guilty verdicts against four defendants on all counts as charged in a $6 million fraudulent Medicare billing scheme, announced U.S. Attorney Kenneth Magidson. Giam Nguyen, D.O., 46, of Houston, Benjamin Martinez, M.D., … Read More
HHSC’s Inspector General is enlisting the help of managed care organizations and health care providers to fight Medicaid fraud, waste and abuse in a cooperative effort. The office’s Integrity Initiative creates a framework for managed care organizations, health care providers … Read More
AUSTIN — Texas state health officials once again are delaying a massive data project that has struggled to get off of the ground for more than a decade. The state Health and Human Services Commission informed lawmakers Tuesday it was pausing … Read More
In Waco, a jury returned guilty verdicts against 55–year-old DTS Medical Supply Company owner Daniel Thomason Smith and 45-year-old DTS office manager Kathleen Marina Kelly-Tuorila in connection with an estimated $3.5 million Health Care Fraud scheme announced United States Attorney … Read More
Three North Texas cab company executives and their entities have agreed to pay the U.S. more than $1 million to resolve Medicaid fraud allegations. Jackie Bewley, Jeff Finkel and Elizabeth George — all executives at Irving Holdings, the parent company of … 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
A Chickasaw County nurse is headed to prison for one year after pleading guilty to Medicaid fraud, Mississippi Attorney General Jim Hood announced Tuesday. Cheryl Renee Hamblet, 42, of Houston, appeared before Choctaw County Circuit Court Judge Joseph H. Loper … Read More
The federal government will soon unveil a new contractor program aimed at fraud in both the Medicare and Medicaid programs, according to an official with the Centers for Medicare & Medicaid Services. The new Unified Program Integrity Contractor program will … Read More
You might remember the case of Austin dentist, Dr. Rachel Trueblood. $16 million overpayment demand settled for $39,000 Back in 2014, Dr. Trueblood had been accused of Medicaid fraud, placed on “credible allegations of fraud” payment hold which closed her … Read More
The New Jersey Office of the State Comptroller, Medicaid Fraud Division, did not always suspend Medicaid payments to providers with credible allegations of fraud in accordance with the Affordable Care Act. Of the 49 providers with credible allegations of fraud … Read More
The policy revision to the Medicaid orthodontic benefit process contemplated by representatives of the Texas Medicaid and Healthcare Partnership and the Health and Human Services Commission in 2009 was sweeping. Per the final draft of the confidential policy revision attached … Read More
From October 1, 2009, through September 30, 2012, the Washington State Health Care Authority (State agency) claimed $117,000 in unallowable Federal Medicaid reimbursement for dental services. The unallowable payments consisted of (1) duplicate payments, (2) payments for services that were … Read More
The Health and Human Services Commission in February 2009 asked the individuals working on the new Medicaid orthodontic benefit policy to review whether or not a board certified orthodontist should review each and every prior authorization request for orthodontic treatment. … Read More
The TMHP document reported about in our last story that was recently appended to a court filing by Xerox shows that staff from the Health and Human Services Commission and its Office of Inspector General were well aware of the … Read More
A new document has come to light out of the lawsuit the state filed in 2014 against Xerox, its former Medicaid claims administrator, that shows Medicaid dentists were concerned as early as 2007 about Xerox’s prior authorization process and demanded … Read More
