DALLAS—Attorney General Loretta E Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulting in charges against 243 individuals, including 46 … Read More
This morning, TDMR was notified that Governor Greg Abbott has now signed into law SB 207, the legislation which makes major changes and improvements to the way the Texas Health and Human Services Commission Office of Inspector General will work. … Read More
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
In 2012, Connecticut filed a civil lawsuit against nearly 30 players in an elaborate scheme to defraud Medicaid. The state has since recovered millions of dollars in settlement funds and a number of dental offices have been shuttered. Dentists have … Read More
McALLEN — Federal agents Tuesday arrested the owner and an employee at a defunct Mission-based durable medical equipment supplier, accusing them of overbilling the government for unnecessary adult diapers. A federal grand jury this month indicted Veronica Vela and Cynthia … Read More
WESLACO -Several Medicare busts are happening across the Valley. Four investigations are coming to a close. Court documents were filed a week ago and unsealed today. All four separate indictments have different charges all dealing with medical fraud Source: Several … Read More
A new fraud alert released by the Office of the Inspector General highlights the agency’s renewed interest in physician compensation arrangements that could violate anti-kickback regulations if payments do not reflect fair market value. Source: OIG fraud alert targets physician compensation agreements
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
The United States Attorney`s Office for the Northern District of Georgia announced that it has reached a settlement with Dennis Jaffe and Dennis B. Jaffe D.M.D., P.C., to pay $324,327.05 to settle health fraud claims — specifically that Jaffe violated … Read More
Connecticut will recover nearly $300,000 from another batch of dentists and their practices accused of committing Medicaid fraud, state investigators say. Source: Trio settles CT Medicaid fraud suit
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
ATLANTA, Ga. (WJCL) — An Atlanta-based dentist has pleaded guilty to criminal charges and settled with the Attorney General’s office for more than $324,000.Attorney General Sam Olens announced Friday the conclusion of a multi-part investigation into Dr. Dennis B. Jaffe’s … Read More
Update, 1:10 p.m. Recent scandals and newspaper headlines were not the reason that Kyle Janek stepped down from the agency, Janek told reporters a few minutes ago.Gov. Greg Abbott did not pressure Janek to resign, he added, and Janek initiated … Read More
The federal government paid almost $10 million in medicaid benefits to 200 dead people, according to a new report from the Government Accountability Office. And that’s just the tip of the iceberg. In just four states in fiscal year 2011, … 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
DALLAS — Texas paid $191,410,707 for unallowable orthodontic services from 2008 through 2010, according to a federal investigation to be released on Thursday. And officials say the federal government wants a large portion of it back. The findings are in … Read More
Our opinion: If the state itself minimizes fraud in Medicaid, what hope is there of controlling its costs?The challenge for New York’s $62 billion Medicaid program has long been to root out waste, fraud and abuse. But what to do … Read More
WASHINGTON—Starting Aug. 1, providers considered at “high risk” for defrauding state Medicaid programs will undergo a criminal background check that includes fingerprinting. By March 2016, all of a states’ Medicaid and CHIP providers must be ranked as having a limited, … Read More
Federal and state agencies should take more steps to prevent Medicaid fraud, such as fraudsters using the identities of deceased patients or providers to receive Source: Medicaid Anti-Fraud Efforts Criticized
The recent Kellogg Brown & Root Servs., Inc. v. United States ex rel. Carter Supreme Court decision is a very glass half-full/half-empty ruling for healthcare providers. Source: Supreme Court decision expands False Claims Act liability for providers
The Centers for Medicare and Medicaid Services on Monday released enormous sets of data on hospital and physician reimbursement in 2013, its latest effort to enlist the public in identifying suspect billing and trends in health care utilization. Source: CMS … Read More
Who are “Medicaid people” ? During a recent meeting of the Tompkins county legislature, Lansing representative Mike Sigler stated his opposition to a statewide single-payer health insurance plan by commenting, “I work hard for my health insurance,” and adding, “Medicaid … Read More
A prominent U.S. senator is asking the Centers for Medicare & Medicaid Services to investigate Medicare Advantage plans that may have inflated their risk scores to receive higher reimbursements. In her letter to CMS Acting Administrator Andy Slavitt, Sen. Claire … Read More
A medical loss ratio (MLR) may sound like a tricky concept, but in essence it’s just a number that tells health plans how much of their premium revenue they have to spend on taking care of patients. A recent CMS … Read More
Florida pediatric dentist Dr. Howard Schneider is being sued by nearly 50 patients for allegedly extracting kids’ teeth for no reason, and in some cases hitting or choking them.Brandi Motley took to her 6-year-old daughter, Bri’el, to Schneider to have one … Read More
ANDERSON — A former employee at the Anderson Dental Clinic was given a one-year suspended prison sentence Tuesday for her role in issuing a prescription using the name of a dentist who had left the practice. Deborah Davis, 56, was … Read More
Attorney General Eric Schneiderman announced Wednesday arraignment, guilty plea and sentencing of Patricia Power, 63, of 4883 Rushmore Road, Farmington. Power pleaded guilty for petit larceny based upon criminal charges filed by Schneiderman’s office. The mother of a disabled adult … Read More
Federal prosecutors are moving fraud enforcement into the C-suite, according to Assistant Attorney General Leslie R. Caldwell. Just as the Department of Justice has pursued charges at against executives for financial fraud, healthcare executives will be held accountable for fraud … Read More
MOBILE, AL (WALA) – Alabama Attorney General Luther Strange arrested Mobile dentist, William Gerard Eastburn, on one count of filing false claims with the Alabama Medicaid Agency and one count of first-degree theft of property. The Attorney General’s Medicaid Fraud … Read More
In March, Attorney General Pam Bondi announced she had nailed someone for Medicaid fraud. The culprit was a 49-year-old home-health worker from dirt-poor Gadsden County, accused of bilking the state out of $13,000. For her crime, Melissa Letica Simmons was … Read More
The auditors worked in a non-descript, three-story brick building near a warehouse district in Menands, a couple miles north of the state Capitol.Their surroundings were ordinary, including hand-me-down state government furnishings. But their job was a crucial one: auditing the … Read More
Sunday night on this Memorial Day weekend, the Texas House of Representatives passed Senate Bill 207, the legislation that will reform the Health and Human Services Commission Office of Inspector General. The recorded vote was 142-0. The bill now goes back … Read More
The consequence for involvement in the $116 million fraudulent Medicare billing scheme at Riverside General Hospital promises to be steep – the equivalent of a death sentence – for the oldest of a dozen defendants who were convicted at trial … Read More
As the Legislature gears up for Round 2 of its battle to pass a budget and figure out what to do about Medicaid expansion and health coverage for the poor, the Republicans in Tallahassee who want to sabotage Obamacare have … Read More
HARLINGEN, Texas, May 18, 2015 /PRNewswire/ — Nestled within its 900-plus pages of legalese, the Patient Protection and Affordable Care Act, or ACA, requires healthcare providers participating in federal programs to have an effective compliance program in place. For providers without … Read More
LOS ANGELES (AP) — A California dentist who treats children under Medicaid billed for more than 1,000 services a day for almost 100 days in 2012. Another provided 33 procedures — including multiple stainless steel crowns and baby root canals … Read More
The front-page of the Austin American Statesman Sunday morning carried the full story of the unprecedented ruling by the State Office of Administrative Hearings (SOAH) to award a Medicaid dentist back some $380,000 in legal fees from the Health and Human … Read More
Judges: State botched fraud case, must pay $400K in feesAUSTIN, Texas (AP) – A panel of judges has determined that Texas regulators so badly botched a Medicaid fraud investigation of a dentist that they’re responsible for paying the nearly $400,000 … Read More
