WHY WE DID THIS STUDY The Office of Inspector General (OIG) oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based … Read More
SANTA FE – A health care company that tried to root out fraud in New Mexico’s Medicaid program has now been accused of committing Medicaid fraud itself. Three lawsuits filed against OptumHealth Inc. this year accuse the company of malfeasance stemming … Read More
Four federal lawmakers from New Mexico – Sen. Martin Heinrich, Sen. Tom Udall, Rep. Ben Ray Luján and Rep. Michelle Lujan Grisham – filed a bill last week to guarantee due process rights to Medicaid providers across the country who are … Read More
When agencies that receive Medicaid reimbursements are accused of fraud, it can impact that provider as well as its patients for months at a time—regardless of whether any parties are ever found guilty.Four U.S. lawmakers recently introduced a bill meant … Read More
WILMINGTON, N.C. (WNCT) – Terry Lamont Speller, 38, was sentenced to 240 months in federal prison and three years of supervised release following his guilty plea to Medicaid fraud. The Winterville-native was also ordered to pay back the money he … Read More
A vast web of bribes, kickbacks, counterfeit hardware and a legislative loophole allowed one California spine surgeon to cash in on spinal fusion surgeries for which the state paid millions of dollars, according to an article by Los Angeles Magazine. … Read More
PIERRE, S.D. (AP) — A man accused of defrauding the South Dakota Medicaid program has been sentenced to two years of probation and ordered to pay back $990. Thirty-eight-year-old Tanka Bhujel pleaded guilty in state court to one count of … Read More
Commentary: U.S. Sens. Tom Udall and Martin Heinrich, and U.S. Reps. Ben Ray Luján and Michelle Lujan Grisham introduced the Medicaid Program Integrity Enhancement Act of 2016. The bill protects Medicaid patients by establishing clear guidelines that ensure that state agencies investigating … Read More
A former official with Arizona’s health care program for the poor pleaded guilty Tuesday to fraud and theft charges in a case in which he was accused of stealing millions in public money. Michael John Veit, the former chief procurement … Read More
Ohio Attorney General Mike DeWine said Thursday that Ohio’s Medicaid Fraud Control Unit ranks first in the nation for the number of convictions secured in fiscal year 2015, according to a statistical summary of Medicaid fraud control units in all … Read More
USA Today reported last week that 27 corporations listed in the Standard & Poor’s 500 paid no income tax for 2015 despite having pre-tax profits. The corporate giants include General Motors, Hewlett Packard, United Continental, News Corp, Weyerhauser amongst others. … Read More
Xerox is on a list of 27 large and profitable companies that paid no income tax last year. A report in the USA Today lists Xerox as one of several profitable companies that reported negative income tax expenses in 2015. … Read More
HOUSTON – The leader and four others charged in a $13 million Medicare and Medicaid health care fraud case have entered guilty pleas for their respective roles, announced U.S. Attorney Kenneth Magidson. Mkrtich “Mike” Yepremian, 58, of Houston, pleaded guilty … Read More
Law360, Washington (March 2, 2016, 7:46 PM ET) — The U.S. House of Representatives on Wednesday unanimously passed a bill, with the backing of the White House, intended to ensure Medicaid providers terminated for fraud or quality issues in one … Read More
The emails between two people at the center of a no-bid state contract scandal are a window on how cozy associations can meld into influence — misused to the public’s detriment. An Express-News article by Brian M. Rosenthal of the … Read More
In the five years he served as U.S. Attorney for the Eastern District of Tennessee, Bill Killian oversaw dozens of healthcare fraud cases. By the time he resigned from his post Dec. 5, Killian’s district had collected more than $200 million … Read More
They say you shouldn’t mess with Texas. Those submitting fraudulent claims to the state’s Medicaid program should heed that advice. According to new Medicaid Fraud Control Unit (MFCU) statistics and an interactive map released by the Office of Inspector General, the … Read More
Federal prosecutors have accused Cherie R. Dillon of health care fraud and aggravated identity theft tied to her Payette business, Dental Healthcare with Heart. They say Dillon, 60, performed dental procedures that could only be carried out by a dentist. … Read More
ALBUQUERQUE – Democrats with the state’s congressional delegation are calling for a federal investigation into the withholding of Medicaid payments from 15 nonprofits that provided behavioral health services to needy New Mexicans. In a letter sent Friday to U.S. Health and … Read More
Follow the link below to a map of the country. Click on a state and the MFCU data for that state will open. Source: 2015 Interactive Map of Expenditures | MFCU | Office of Inspector General | U.S. Department of … Read More
WHY WE DID THIS STUDY OIG oversees 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. The reviews assess Unit … Read More
JACKSON, Miss. (AP) — A 31-year-old Louisville woman is going to prison for Medicaid fraud. Attorney General Jim Hood, in a news release Tuesday, said Labeatris Estes pleaded guilty to two counts of Medicaid fraud before Rankin County Circuit Court … Read More
Under the Affordable Care Act, health-care providers must report and return Medicare or Medicaid overpayments within 60 days after an overpayment is identified, or the date a corresponding cost report is due, whichever is later. But it can be challenging … Read More
James R. Dye, 66, of Independence, Missouri waived his right to a grand jury and pleaded guilty before U.S. Magistrate Judge David P. Rush to a federal information that charges him with health care fraud. In his plea, Dye admitted … Read More
The state said Schneider billed Medicaid more hundreds of thousands of dollars for procedures he didn’t actually perform. The Office of the Attorney General Medicaid Fraud Control Unit interviewed them as a part of their investigation into the pediatric dentist … Read More
A man pleaded guilty Wednesday to Medicaid fraud after being charged with orchestrating a kickback scheme from his jail cell.David Epps, 44, who had been in the Monroe County Jail on an unrelated charge, was sentenced to six months, according to the … Read More
One of the least well-understood scandals of the Obama era is the effort to cripple the auditing system for Medicare payments, allowing sectors of the healthcare industry that helped get Obamacare passed into law to reap billions of dollars in … Read More
UPDATE: The Travis County Public Integrity Unit has forwarded the criminal investigation into the 21 CT matter to another undisclosed investigative unit. Per the Unit’s head, the investigation is starting to move faster and was moved for reason of expertise … 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
Almost six months ago, undercover videos surfaced purporting to show officials with Planned Parenthood in Texas discussing illegal acts. Texas Republicans pounced, opening up multiple battlefronts against the embattled women’s health organization. With allegations flying that Planned Parenthood was illegally … Read More
A Boston dentist with offices in Malden, Everett and South Boston, has agreed to pay $650,000 to the state’s Medicaid program (MassHealth) to resolve allegations of improperly billing for dental work, Attorney General Maura Healey announced Thursday, Jan. 29. The … Read More
A Harris County grand jury on Monday indicted the videographers behind undercover recordings of a Planned Parenthood clinic in Houston and cleared the women’s health provider of any wrongdoing. The indictments — part of the county prosecutor’s investigation into allegations that … Read More
NEW YORK – Attorney General Eric T. Schneiderman today announced a $47 million settlement with CenterLight Healthcare and CenterLight Health System, resolving allegations that CenterLight Healthcare’s Select Medicaid Managed Long Term Care Plan (“MLTCP”) fraudulently billed Medicaid for services they … Read More
A Dallas-area woman must serve nearly five years in federal prison in a Medicaid scam over false claims using the names of legitimate counselors. Brenda Ward of Cedar Hill was sentenced Friday in Dallas. The 48-year-old Ward in July pleaded … Read More
JACKSONVILLE, Fla. – Dr. Howard S. Schneider, the pediatric dentist who faced allegations of mistreatment of pediatric patients, will have a new judge in his Medicaid fraud case. Judge Angela Cox has taken over the case after Judge Mark Hulsey … Read More
No, that wasn’t $200 million. It wasn’t $50 million. It wasn’t even $500,000 or $250,000. The amount of dental fraud found and recovered by Texas dental management organizations in 2015 was only $243,982.84 per the “HHSC OIG Annual Report on … Read More
This afternoon, the Health and Human Services Commission Inspector General Stuart Bowen sent out his second quarterly report – quite unlike his predecessor who sent out no such reports. It is a remarkable 28-pages and will take some time to … Read More
ROCHESTER—Attorney General Eric T. Schneiderman announced the sentencing of Schmeka Morgan, a licensed practical nurse who stole $8,838 from the Medicaid program. Morgan, who provided private nursing services to a special needs young adult, was charged with billing for numerous hours … Read More
A reasonable person would not question the righteousness of the mission, which is rooting out fraud and fighting crime. Yet it’s not unreasonable to ask whether so many Texas Attorney General’s Office investigators need assault-style rifles, handguns and tactical gear … 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
