The Louisiana Department of Health & Hospitals State agency did not always pay Medicaid electronic health record EHR incentive payments in accordance with Federal and State requirements. The State agency made incorrect EHR incentive payments to 20 hospitals totaling $4.4 … Read More
Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, announced today that on September 3, 2014, Christopher Spivey, 30, pled guilty to submitting false and fraudulent bills in relation to personal assistant services in the Home Services … Read More
The following excerpt is from the Houston Chronicle about Xerox and the State coming to an agreement on the disputed files. AUSTIN – Lawyers for the Xerox Corp. agreed Thursday to temporarily turn over private health information about millions of … Read More
Data mining is the process of identifying fraud through the screening and analysis of data. On May 17, 2013, the Department of Health and Human Services (HHS) issued the final rule "State Medicaid Fraud Control Units; Data Mining" (78 Fed. … Read More
State regulators in Texas last week agreed to settle allegations of Medicaid fraud against Trueblood Dental Associates, P.A. Brace yourself for the numbers: The state agreed to recover just $39,211 out of a $16,209,289 projected overpayment for dental claims in a … Read More
August 29, 2014 — In the latest development in the ongoing Texas Medicaid scandal, the state Health and Human Services Commission (HHSC) has filed a second lawsuit against Xerox, claiming the company is refusing to turn over patient records. Without … Read More
NEW YORK – Attorney General Eric T. Schneiderman today announced the arrests of four individuals for allegedly practicing dentistry without a license at two Brooklyn dental clinics, which are separately owned by a father and his son who are licensed … Read More
Law360, New York (August 11, 2014, 2:39 PM ET) — The state of Texas has reached a $19.5 million settlement with Taro Pharmaceuticals USA Inc. to resolve allegations that the drug company fraudulently reported inflated drug prices to the Medicaid … Read More
Fraud in Medicaid constitutes a scam amounting to more than a billion dollars and a newly installed computer system is assisting to ferret out the criminals. As per Kaiser, about $28 billion is paid by Texas to provide care for … Read More
On August 14th, the Senate Committee on Health and Human Services heard testimony regarding Medicaid fraud, waste and abuse. The full presentation given by Chris Traylor, Chief Deputy Commissioner, Douglas Wilson, Inspector General, Kay Ghahremani, Texas Medicaid/CHIP Director, and Joseph … Read More
ABINGDON, VIRGINIA – A Wise, Va. dentist has admitted to obtaining hydrocodone by fraud and to illegally distributing over 2,500 hydrocodone pills. Newton Carroll Mullins, 65, of Wise, Va., who operates a dental practice in Wise, Virginia, waived his right … Read More
The allegations state health regulators leveled against Rachel Trueblood two years ago were dramatic: The Austin dentist had billed the government for millions of dollars in unnecessary procedures and office time, they said. Regulators froze $100,000 of outstanding Medicaid payments … Read More
HOUSTON—Andrea Michelle Tellison, 47, has been ordered to federal prison for eight years following her convictions of 14 counts of health care fraud and seven counts of aggravated identity theft, announced United States Attorney Kenneth Magidson. A jury convicted Tellison … Read More
To understand waste, fraud and abuse of taxpayer dollars in the Medicaid system, let’s begin with a couple of basics on what the role of Medicaid is in health care and how it works. Medicaid Basics Medicaid is a program … Read More
August 26, 2014 — Texas health officials have accepted a $39,211 settlement from an Austin dental practice that had been charged with improperly billing more than $16 million in orthodontic Medicaid claims. Glenn Wood, MD, who owns Carousel Pediatrics, disputed … Read More
Texas Medicaid officials, already in a legal battle with Xerox Corp. over the company’s alleged failure to prevent widespread dental fraud, filed another lawsuit Tuesday accusing Xerox of improperly taking large quantities of medical records and not protecting patients’ confidentiality. … Read More
Summary WHY WE DID THIS STUDY OIG oversees the activities of 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. … Read More
Texas Health and Human Services Commission Inspector General Doug Wilson told Sen. Judith Zaffirini and other members of the Senate Committee on Health and Human Services at their August 14th hearing on Medicaid fraud, waste and abuse that his agency … Read More
Sen. Jane Nelson quizzed Health and Human Services Commission Inspector General Doug Wilson about the lack of Medicaid fraud convictions in Texas despite the tremendous resources the Legislature gave to the OIG last session. The questioning occurred during the August 14th … Read More
Summary WHY WE DID THIS STUDY Medicaid is the primary source of dental coverage for children in low-income families and provides access to dental care for approximately 37 million children. In recent years, a number of dental providers and chains … Read More
The following is the testimony presented last week to the Texas Senate Committee on Health and Human Services by Jason Ray of Riggs Aleshire & Ray in Austin. Ray is an attorney for a number of Medicaid dentists who have … Read More
The former owner of a Los Angeles medical clinic management company pleaded guilty today in connection with his role in a scheme to defraud Medicare. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney … Read More
Three dentists testified before the Senate Health and Human Services Committee on Thursday about their experiences with the Texas Health and Human Services Commission Office of the Inspector General and how their due process rights are still being violated despite … Read More
AUSTIN — Texas state government ultimately is to blame for hundreds of millions of dollars of Medicaid spending wasted on braces and orthodontic work that were not medically necessary, according to federal auditors. The audit report, released last week, concludes … Read More
A federal audit has found a Texas state agency to blame in an ongoing fight with Xerox Corp. over who is responsible for hundreds of millions of Medicaid dollars potentially misspent on unnecessary dental and orthodontic procedures. The Austin American … Read More
Three Medicaid dentists who are involved in HHSC-OIG cases will be testifying tomorrow before the Texas Senate Committee on Health and Human Services. Dr. Chad Evans of Smile Magic from Dallas, Dr. Vivian Teegardin of Harlingen Family Dentistry and Dr. … Read More
The HHS OIG’s contractor self-disclosure program provides a means for contractors to self-disclose potential violations of the False Claims Act and various Federal criminal laws involving fraud, conflict of interest, bribery or gratuity. The Federal Acquisition Regulation (FAR) requires certain … Read More
Texas is “ultimately responsible” for millions of misspent Medicaid dollars, according to a new federal audit, because a state agency failed to properly oversee the contractor that reviewed the medical necessity of Medicaid claims. For nearly five years, the Texas … Read More
August 11, 2014 — In the latest development in the ongoing Texas Medicaid scandal, a federal report has laid the responsibility for hundreds of millions of dollars spent on dental and orthodontic procedures that may have been medically unnecessary squarely … Read More
A federal auditor has laid responsibility for hundreds of millions of dollars spent on dental and orthodontic procedures that may have been medically unnecessary squarely on the state agency that oversaw the program. The Texas Health and Human Services Commission … Read More
Last Wednesday, the Department of Health and Human Services, Office of Inspector General released the results of its long anticipated audit of Texas Medicaid orthodontic spending. The feds conducted the audit because Texas Medicaid payments for orthodontic services rose from … Read More
At a recent deposition in Austin, lawyers for a dental Medicaid provider discovered that the State has invested thousands of dollars to employ a well-known Dallas jury consultant to help prepare the State’s witnesses to testify in depositions and in administrative … Read More
At the end of July, Xerox, Texas Medicaid’s disgraced former claims administrator, filed for a protective order with the Travis County District Court. The stated reason for the order is because the Office of the Attorney General has apparently demanded … Read More
The Senate Committee on Health and Human Services has sent out public notice that it will be holding a public hearing at the Capitol in Austin on Thursday, August 14th. One of the charges the Committee will look into at … Read More
Last week Xerox filed a response to both the lawsuit filed by the State of Texas and its dentist intervenors about Xerox’s allegedly deficient Medicaid orthodontic prior authorization process that led to $1.1 billion in program spending without proper review. … Read More
Letters to both Rep. Richard Peña Raymond and Rep. Lois Kolkhorst, chairmen of the House Human Services and Public Health Committees respectively, have been sent from TDMR President Greg Ewing requesting a public hearing on SB1803 and HHSC’s compliance to … Read More
TYLER — A federal jury took less than two hours on Thursday to find a Dallas businessman who plunged his rural hospital chain into ruin guilty of health-care fraud and conspiracy. Dr. Tariq Mahmood, 63, was convicted on 15 fraud … Read More
The Governor’s office may sue Xerox Corporation for the bungled rollout of a new system to process Medicaid claims. The Enterprise Medicaid Management System was supposed to replace the state’s antiquated 30 year old computer program. It went live on … Read More
Back in May, shortly after Texas filed suit against Xerox and removed the company as the lead contractor in the Texas Medicaid and Healthcare Partnership for its failure to properly handle Medicaid orthodontic prior authorizations leading to $1.1 billion in … Read More
ALBANY—New York State’s decision to award a $550 million Medicaid management contract to Xerox is being challenged by two companies who say the company’s recent history of Medicaid management in other states should disqualify it from running New York’s system. … Read More
