The Department of Health and Human Services Office of Inspector General recently released its 2021 Medicaid Fraud Control Units (MFCU) Fiscal Year 2021 Annual Report. Investigates criminal fraud Medicaid Fraud Control Units have the job of investigating criminal fraud by … Read More
The Houston Chronicle broke a bombshell story today (paywall, unfortunately). This ortho story still has legs. OAG assisted company they were suing to defraud insurer The Chronicle reported that the Office of the Attorney General had secretly made last-minute modifications … Read More
We found an article recently published on the OIG website that we thought should be republished here. Providers encouraged to self-report errors More providers are participating in the OIG self-audit process so they can determine if they need to self-disclose … Read More
The 2021 annual report published by Texas HHS-OIG on fraud and abuse recoveries by MCOs and DMOs again shows a minimal amount of Medicaid fraud being found and recovered considering the state’s whooping multi-billion dollar healthcare budget. For 2020/2021, the … Read More
TDMR published a letter from a dentist a month ago who expressed their outrage about DMO self-made rules that restrict and inhibit treatment of young Medicaid-eligible children to their detriment. Now that the holiday season is well out of the … Read More
It is remarkable that in a state that cherishes free enterprise, it is okay for dental maintenance organizations to offer money and other inducements to encourage parents with Medicaid-eligible children to use their company yet it is a crime for … Read More
This is a trial balloon. We’ve written numerous articles about the need for changes to the Texas Medicaid Fraud Prevention Act. The Act needs to be a deterrent for real fraudsters, not a state-supported protection racket to be used against … Read More
Our last story on reputationally challenged qui tam relator Joshua Lafountain and the highly questionable settlements forced from a large number of Medicaid dental entities, supported by the Office of the Attorney General, brought about an outraged comment from an … Read More
Back in 2020, we started reporting on the various whistleblower claims brought by Joshua Lafountain, a former dental office manager in Dallas with no formal dental training, against 71 various Medicaid dentists and dental entities. Although he had never worked … Read More
Medicaid fraud or fraud of any type is serious business, and something TDMR decries. Those low enough to use their position as healthcare professionals to bilk federal and state governments for personal gain that cheats the taxpayer and young underprivileged … Read More
On Tuesday, Texas HHS OIG sent out its June email newsletter. Out of the three articles promoted, one is again about dental Medicaid issues. This time the article is about common billing errors committed by Medicaid dentists, an article that … Read More
This past week the Attorney General of Texas sent out a press release that deemed agency personnel who had complained about potential conflicts of interest by the AG himself were “rogue political appointees” rather than whistleblowers because they had only … Read More
A recent open records request to the Texas Office of the Attorney General reveals that the state has paid out so far $457,416.67 to qui tam relator Joshua Lafountain. No knowledge or evidence of wrongdoing TDMR reported, starting last May, … Read More
Almost a decade ago, on May 13, 2011, Byron Harris, famed WFAA investigative reporter, started a large freight train roaring down the track with his first story of a series, “Texas taxpayers pay big for straight teeth.” False narrative destroyed … Read More
This article is reprinted from the OIG Monthly Newsletter received today. The majority of Texas Medicaid dental providers take pride in their work and deliver excellent care to their patients. Those who try to cheat the system and fail to … Read More
Bill filing has started for the upcoming legislative session at the Texas Capitol. One of the early filings is HB 648, a bill introduced by House Rep. Richard Peña Raymond of Laredo to modify the mandate of the HHSC Office … Read More
TDMR recently reported about an open record request filed with the Office of the Attorney General to find out how many dentists were indicted for Medicaid fraud by the OAG’s Medicaid Fraud Control Unit (MFCU), the section of the OAG … Read More
Online research has found that lawyers for Joshua Lafountain held a high-powered fundraiser in August of 2016 for the current trial judge in the case, Judge Maricela Moore of Dallas District Court 162. The event held at the offices of … Read More
More details have emerged about Joshua Lafountain, the relator in a Texas Medicaid Fraud Prevention Act qui tam lawsuit filed against 71 dental organizations and dentists in 2016. The case is now before a judge in Dallas County District Court. … Read More
TDMR recently received information from an open records request to the Texas Medicaid Fraud Control Unit of the Office of the Attorney General. The request asked for a list of investigations conducted by MFCU on dentists between 2011 and 2016 … Read More
A few weeks ago, we published our analysis of the latest Texas Health and Human Services Office of Inspector General quarterly report and were struck by the fact that despite the large number of Medicaid health professions represented, dentists received a … Read More
Attorney General Ken Paxton’s office yesterday sent out a press release announcing a final judgment in the civil Medicaid fraud case against Dr. Richard Malouf. Here is the text of the release: AUSTIN – Attorney General Ken Paxton today announced … Read More
At the end of April, a three-judge panel of the Fifth District Court of Appeals in Dallas ordered a malpractice lawsuit against the firm of Sommerman McCaffity Quesada & Geisler and Al Ellis, of counsel at the firm, to continue. The case … Read More
The Attorney General of Texas Ken Paxton sent out a press release Thursday that a Travis County judge had issued a summary judgment ordering Dr. Richard Malouf of Dallas to pay Texas back some $12 million for Medicaid fraud. The court … Read More
A Swansea dentist accused of defrauding Illinois Medicaid of thousands of dollars over a period of several years has pleaded guilty to the scheme. Yun Sup Kim, 48, of St. Louis, appeared at the federal courthouse in Benton on Thursday … Read More
A Marshfield, Mo. man whose wife was sentenced earlier for her role in a Medicaid fraud scheme involving their dental clinics was sentenced in federal court for failing to pay over payroll taxes and collecting unemployment benefits he wasn’t entitled … Read More
Earlier this month, an Alaska dentist was found guilty of Medicaid fraud and endangering his patients. But before he will be sentenced for his crimes, Dr. Seth Lookhart is going to California. To learn how to be a farmer. On … Read More
Paul Mathieu, MD, of New Jersey, was recently sentenced to four years in prison for his role in a scheme to defraud Medicare and Medicaid of $30 Million. He was convicted in May on charges of health care fraud, wire … Read More
LONGVIEW, Texas — A Texas man who operated a private ambulance service must serve 30 months in federal prison and pay more than $750,000 in restitution after being convicted for fraudulently billing Medicare and Medicaid. Joseph Valdie Kimble, who operated … Read More
A dentist recorded working on a patient while on a hoverboard was found guilty of Medicaid fraud and endangering patients Friday. Anchorage Superior Court Judge Michael Wolverton found Dr. Seth Lookhart’s guilty on 46 counts. Lookhart was found to have … Read More
