McALLEN — A Pharr woman pleaded guilty Friday for her role in connection with a federal healthcare insurance fraud scheme, prosecutors said. Martha Lidia Flores admitted to engaging in a kickback scheme of exchanging referrals of Medicare beneficiaries for money … Read More
Channel 8’s Byron Harris announced Friday that he’ll retire in October. Ed Bark posted a solid story Monday about the investigative reporter and his 40 years at the TV station. I’d like to go in a slightly different direction. Harris … Read More
Another 100 Florida hospitals — 17 of which are in the Tampa Bay area — will be audited by the state to determine whether they’re receiving more in Medicaid payments than legally allowed, Gov. Rick Scott said Monday. They join … Read More
Empire State Home Care Services has agreed to pay $6 million as part of a settlement with the New York state attorney general to resolve allegations of improper Medicaid billing. Source: Brooklyn Medicaid Fraud Case Settled
Health care fraud is one of the government’s costliest problems. It’s a hall of mirrors where billions of dollars are lost to swindlers looking to cash in on the millions of transactions generated by insurance-paying agencies every day. Last year, … Read More
Yesterday, Travis County District Court Judge Amy Clark Meachum issued her decision in the case of Antoine Dental Centers of Houston, vindicating the practice in its payment hold case. The practice had been accused of “credible allegations of fraud” in … Read More
A district court judge on Wednesday handed state Medicaid regulators another decisive courtroom loss, adding one more notch to the Health and Human Service Commission’s Office of Inspector General’s unenviable losing streak pursuing dentists and orthodontists it claims have bilked … Read More
Fresh off a House Subcommittee hearing in which legislators grilled the Centers for Medicare & Medicaid Services regarding Part D fraud controls, the Government Accountability Office (GAO) released a report this week noting that four state Medicaid programs spent $33 million in 2011 … Read More
SOUTHINGTON — A local dentist who resides in Southbury was arrested today for defrauding Medicaid, according to the Department of Justice. Thomas L. Derienzo, 58, of Bucks Hill Road, is accused of billing Medicaid for more expensive procedures than he … 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
The story about Dr. Rachel Trueblood settling in October 2014 with the Health and Human Services Commission Office of Inspector General for $39,000 after the agency was demanding $16 million in Medicaid overpayments is well-known. However, the story of another … Read More
DALLAS – Alexis C. Norman, 47, of Midlothian, Texas, appeared in federal court this morning before U.S. Magistrate Judge David L. Horan and pleaded guilty to one count of health care fraud, announced John Parker, U.S. Attorney for the Northern … Read More
In January, Stuart Bowen took charge of a state office rocked by accusations of corruption, incompetence and inefficiency. Responsible for ferreting out fraud amid the programs and procedures of the sprawling Health and Human Services Commission, the office of Inspector General … Read More
For the record, the DWI trial that was scheduled on July 30 for former Health and Human Services Commission chief counsel and former deputy inspector general for enforcement Jack Stick has again been delayed until September 17. Stick’s original arrest … 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
TDMR has learned that the new Health and Human Services Commission Inspector General Stuart Bowen, Jr. has been taking on and overhauling the agency’s use of statistical sampling and extrapolation. This is the most controversial tool that the agency had … 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
The transition from a reactive approach to relying on claims data to better predict and prevent fraudulent payments has led to significant progress in fighting Medicare and Medicaid fraud, former Centers for Medicare & Medicaid Services (CMS) Administrator Don Berwick told the … Read More
The vicissitudes of Dr. Paul Dunn have been chronicled by TDMR over the last several years. Dunn first appeared on the scene when he came to Austin during the 2013 legislative session. “Credible allegation of fraud” payment hold, but told … Read More
A Michigan resident was sentenced to 80 months in prison late yesterday for his leading role in a $12.6 million Medicare fraud and tax fraud scheme. Eleven other individuals have been convicted in this case. Assistant Attorney General Leslie R. Caldwell … Read More
Newly released documents show the federal government attempted to collect $16.7 million from the state after alleging four New Mexico companies that provide in-home health care services didn’t comply with the rules for submitting Medicaid reimbursement claims. In June 2012, … Read More
A Dallas-area woman has pleaded guilty in a $1.6 million Medicaid scam over false claims using the names of legitimate counselors. Brenda Ward of Cedar Hill faces up to 10 years in federal prison and a $250,000 fine. Ward on … Read More
The former CEO of Summit Point in Battle Creek is facing criminal charges for spending more than half a million dollars in public funds on a fortuneteller. Summit Pointe is a Community Mental Health Authority, contracted through the State, that … Read More
Last Wednesday, July 16, lawyers for Antoine Dental Centers of Houston again went to court. Going Travis County District Court This time they appeared before Travis County District Court to appeal the Medicaid payment hold final decision by former Health … Read More
NEW YORK (AP) >> The owner of a Brooklyn medical supply business was sentenced to up to 21 years in prison in a Medicaid fraud scheme. Source: Medicaid scammer draws 7-21 years in prison
Alabama’s Medicaid fraud investigation unit collected hundreds of thousands of dollars from the trust fund accounts of dead nursing home and foster care residents until federal inspectors in 2012 told them to stop, a federal report shows. Source: Inspectors: Medicaid … 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
HOUSTON—Six Houstonians have been arrested on wide-ranging charges involving a $12 million conspiracy to commit health care fraud and to pay kickbacks, announced U.S. Attorney Kenneth Magidson. The arrests were made in conjunction with a search warrant executed at a … Read More
NEW YORK (Reuters) – Walgreen Co has reached a $22.4 million settlement with the New York attorney general resolving claims that a unit improperly billed the government for reimbursement for a pediatric drug. The settlement, disclosed in court papers filed … Read More
The eight steps you need to take to put together a program for yourself! Many people have asked what the process for establishing an effective compliance program is. At one point, having a compliance program was optional. As a result … 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
Thirty people have been charged with Welfare Fraud for illegally obtaining over $324,000 in public assistance benefits administered through the Orange County Department of Social Services—mostly Medicaid.The enforcement action was the result of the collaborative efforts of the Orange County … 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
Four firms provided “proof of concept” demonstrations of their Medicaid fraud detection software to the Texas Health and Human Services Commission and its Office of Inspector General back in 2011. These proof of concept projects allowed the firms to access … Read More
This past Friday at the Leon Valley Conference Center in San Antonio, Star Compliance Services and TDMR held our third healthcare compliance seminar, following our recent successful seminar in Houston and the earlier one held in February at Weslaco. Gregory … Read More
Walgreen Co will pay $2.55 million to settle charges by New York’s attorney general that a pharmacy unit improperly billed Medicaid for costly drugs to treat hemophilia patients, without proof that it actually delivered the drugs to those patients. Attorney … 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
The press has uncovered a lot of conduct unbecoming at the Texas Health and Human Services Commission and its Office of Inspector General in the last eight months. First there was the Sunset Advisory Commission with its damning report on … Read More
