Recent stories in the news seem to suggest that health care fraud is running rampant. We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in Greensboro for alleged Medicaid fraud, and, … Read More
Ohio’s Medicaid office searched for ways to continue paying hundreds of healthcare services providers after uncovering "credible allegations of fraud," violating the Affordable Care Act. The state agency came up with "good cause" to continue funneling money to providers strongly … Read More
Good morning, Mr. Chairman and distinguished Members of the Subcommittee. Thank you for the opportunity to testify about fraud, waste and abuse in our Medicare program. My experience working in law enforcement and private practice has taught me that, notwithstanding … Read More
The State agency did not always comply with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud between July 1, 2011, and June 30, 2013. Of the 401 cases … Read More
Improper Medicare payments and fraud populated the Office of Inspector General’s (OIG) list of the top 25 unimplemented recommendations, according to a report from the watchdog agency that offered insight into where the Centers for Medicare & Medicaid Services (CMS) still … Read More
The news that Smile Magic Dental clinics recently settled with the Texas Health and Human Services Commission Office of Inspector General over allegations of Medicaid fraud confirms what TDMR has been saying for a long time – that the purpose … Read More
More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control (HCFAC) Program, Attorney General Eric Holder and HHS Secretary Sylvia M. Burwell announced today. The government’s health … Read More
by Terri Langford On a rainy day in February three years ago, about 30 men and women recently hired by the state filed into a dull government classroom to begin a week of training for their new positions. Texas funnels a … Read More
A Pullman dentist found guilty of medicaid fraud has submitted a request for a new trial and says he has conclusive evidence proving he provided the fillings the state argued were never completed. Alfred Fairbanks, 69, a dentist at Today’s … Read More
ALBUQUERQUE, N.M. State officials would have to follow certain procedures before cutting off government funding for health care providers suspected of Medicaid fraud or overbilling under a measure passed Tuesday by the New Mexico Senate. The legislation sponsored by Senate … Read More
(Bloomberg) — New York state is seeking to extend a contract with Computer Sciences Corp. to run its Medicaid computer system because a deal for Xerox Corp. to take over the program is stalled. The length of the extension is … Read More
The new chief watchdog for the embattled Texas Health and Human Services Commission told lawmakers Monday he plans to right the department rocked by a contracting scandal by focusing not just on Medicaid and food stamp fraud, but all types … Read More
DOVER, Del. (AP) – Legislative budget writers grilled Delaware Medicaid officials Wednesday on delays in a program aimed at reducing waste, fraud and abuse, and about the lack of access by thousands of Medicaid enrollees to the state’s only children’s … Read More
Washington, DC—(ENEWSPF)—February 24, 2015. A Miami man pleaded guilty today to health care fraud charges in connection with a $5 million scheme to defraud Medicare. Angel M. Mirabal, 62, of Miami, Florida, pleaded guilty to one count of conspiracy to … Read More
Acting Attorney General John J. Hoffman and the Office of the Insurance Fraud Prosecutor (OIFP) announced that a 79-year-old woman was indicted today for allegedly stealing approximately $214,000 from an account she managed on behalf of her elderly cousin, using … Read More
February 20, 2015 — CSHM, the owner of the Small Smiles dental chain that was excluded from the Medicaid program last year, has filed for Chapter 7 bankruptcy, according to documents filed in the U.S. District Court for the District … Read More
Sen. Joan Huffman added her voice to those Texas politicians calling for the resignation of Health and Human Services Commission Executive Commissioner Kyle Janek yesterday per the Houston Chronicle. Huffman wasn’t satisfied with Janek’s answers nor his demeanor while answering … Read More
HOUSTON—Aliksandr Beketav, 53, Mikhail Shiforenko, 43, Alexsandr Voronov, 46, and Daniela Gozes-Wagner, 32, have been arrested following the return of a federal indictment alleging a health care fraud conspiracy and conspiracy to commit money laundering, announced U.S. Attorney Kenneth Magidson. … Read More
An investigator from the Florida Office of Attorney General Medicaid Fraud Control Unit confirmed yesterday that an arrest had been made for Medicaid fraud. $6.7 billion in Medicaid waste, fraud and abuse nationwide Had their office uncovered a major Medicaid … Read More
Gone are the sales quota-like performance standards imposed by Jack Stick, the embattled former general counsel of Texas’ Health and Human Services Commission. And the agency is still debating what to do with the $2,800 black leather executive chair he … Read More
Over the past decade, the Texas Health and Human Services Commission has bungled several major contracts that totaled nearly $2 billion, and despite public blowups and calls for reform, problems persist in part because of a lack of accountability in … Read More
Allegations of double billing and unlicensed administration of a drug were behind the search warrant executed by the Florida Attorney General’s Medicaid Fraud Unit at Churchill Dentistry in Ocala. An affidavit filed in support of the warrant relies on information … Read More
McALLEN — The owner of a McAllen ambulance company pleaded guilty Tuesday to forging documents and submitting more than $600,000 in false claims to federal and state health care programs. Frank Gonzalez, 32, appeared before U.S. District Judge Ricardo Hinojosa, … Read More
HOUSTON—William Owuama, 55, and Marla Owuama, 47, of Houston, have entered guilty pleas to charges related to a healthcare fraud scheme in which they billed Medicare for more than $9 million, announced U.S. Attorney Kenneth Magidson. William Owuama was the … Read More
First the breakup, then the requisite division of property. Among the official belongings of Jack Stick, former general counsel for the Texas Health and Human Services Commission, is one black leather executive chair — high-backed with a five-star wood capped … Read More
Vermont’s top health care official says there are people receiving Medicaid benefits who are not eligible, but officials are not sure how widespread the problem is. An internal memo provided to VTDigger and the firsthand account of a local tax … Read More
Lawyers for a number of Medicaid dentists have filed their response to a revised suit filed by the state in the wake of the Sunset Advisory Commission hearings last December. Nonsuited administrative cases a victory for due process rights Prior to Christmas, … Read More
(Reuters) – A unit of Community Health Systems Inc, one of the largest U.S. hospital groups, and three of its hospitals have agreed to pay $75 million to settle claims that they made illegal donations to county governments in New … Read More
TYLER, Texas — A 44-year-old woman, formerly of Port Harcourt, Nigeria, has been sentenced to federal prison for a health care fraud scheme in the Eastern District of Texas, announced U.S. Attorney John M. Bales today. Vivian Yusuf pleaded guilty … Read More
For those of you who follow my blog, you know that the single state agency in New Mexico, Human Services Department (HSD), accused 15 behavioral health care providers, which made up 87% of the mental health care in NM, of … Read More
OCALA – Investigators were executing a search warrant at a pediatric dental office in Ocala Wednesday morning.As part of a Medicaid fraud investigation, officials with the Florida Attorney General’s Office and other investigators were at Churchill Dentistry, at 255 SE … Read More
WICHITA, Kan. (AP) — A former executive who sued a firm managing part of the privatized Medicaid program in Kansas asked a judge Monday to toss out counterclaims accusing her of trying to extort $3 million, calling those claims a … Read More
MANCHESTER — Prosecutors have dropped all felony charges against the brother of city orthodontist Dr. Nicholas Marshall, who was cleared of felony Medicaid fraud charges by a jury in October.While Dr. Marshall was cleared of 45 felonies, charges lingered against … Read More
There is a primary reason why states around the nation have trouble fighting Medicaid fraud. States inept fighting fraud Both the KCBS videos from California we posted and the recent Sunset Commission report on Texas HHSC-OIG highlight that state agencies can … Read More
In a harsh rebuke of the 2013 behavioral health shake-up that thrust mental health care for indigent New Mexicans into disarray, a Santa Fe judge on Friday ruled that the state Human Services Department had denied due process to one … Read More
A Rockwall man who the feds say is at the center of one of the largest schemes to bilk Medicaid in history has once again had his trial delayed. Jacques A. Roy’s long-delayed criminal trial was set to begin on … Read More
Jan. 21–The trial for a Pullman dentist accused of four counts of Medicaid fraud began late Tuesday afternoon in Latah County. After a lengthy morning spent selecting jurors, attorneys gave their opening statements a little past 2 p.m. in the … Read More
HELENA – A Republican state senator from Billings Wednesday presented a key piece of GOP plans to reform Medicaid and public-assistance programs in Montana: A bill to hire an outside contractor to verify the eligibility of welfare applicants. “If we … Read More
David Gibson, CEO from Reflective Medical, one of the companies that demonstrated their Medicaid fraud detection software to HHSC back in 2010 and 2011, sent TDMR links to a couple of YouTube videos that show the kind of fraud that … Read More
FORT WORTH, Texas (U.S. Attorney’s Office, Northern District of Texas) — The owner/operator of a chiropractic clinic in Fort Worth, Texas, was sentenced this morning on a federal felony conviction stemming from her submission of false reimbursement claims to Medicare … Read More
