The Idaho Department of Health and Welfare (State agency) did not implement adequate information system general controls over its Medicaid claims processing system. We identified 19 reportable weaknesses, which we consolidated into 5 findings and grouped into access controls, configuration … Read More
The New Jersey Department of Human Services (State agency) generally claimed Federal reimbursement for Disproportionate Share Hospital (DSH) payments that did not exceed hospital-specific limits. DSH payments may not exceed hospitals’ uncompensated care costs for providing services to patients who … Read More
March 28, 2014 — Some 23 New York state general dentists and six orthodontists received $13.2 million in Medicaid payments in 2012 for services that appeared unnecessary or may not have been performed at all, according to a new report … Read More
With a high-profile legal settlement with Carousel Pediatrics, a children’s health provider, under its belt, the Texas Health and Human Services Commission’s Office of Inspector General says its ramped-up efforts to rein in Medicaid fraud have started to pay off. … Read More
A recent review of our website content revealed to us that while PDF files containing these photos have always been on the site, perhaps they have not been as prominently displayed as they should be. Medicaid after all is about … Read More
The NY Times, in conjunction with the Texas Tribune, has published an article on the recent $3.75 million settlement between Carousel Pediatrics and the Texas Health and Human Services Commission Office of the Inspector General and its affect on the … Read More
Questionable Billing for Medicaid Pediatric Dental Services in New York March 26, 2014 Lucia Fort, a program analyst for the Office of Evaluation and Inspections, is interviewed by Meridith Seife, the Deputy Regional Inspector General for the Office of Evaluation and … Read More
Carousel Pediatrics, a chain of Austin clinics originally accused of defrauding the government of $18 million in Medicaid payments, has agreed to repay $3.75 million for what regulators called a “pattern of billing errors” over four years. The settlement allowed … Read More
by Alexa Ura, The Texas Tribune March 17, 2014 Carousel Pediatrics, which has been the subject of a multiyear investigation in Texas, has settled its Medicaid fraud case with the Health and Human Services Commission’s Office of Inspector General, agreeing to … Read More
The Health and Human Services Commission issued a press release this afternoon that OIG has now settled with Carousel Pediatrics of Austin on claims of Medicaid fraud, now deemed billing errors, for $3.75 million. $22.1 million settled for $3.75 million … Read More
Several patient recruiters, including a medical clinic owner, were sentenced today for their participation in a health care fraud scheme involving Flores Home Health Care Inc., a defunct home health care company. Acting Assistant Attorney General Mythili Raman of the … Read More
TDMR has received notification that HHSC-OIG has begun a Provider Education series that will cover topics of particular interest to Medicaid providers. It is about time. The first topic is Understanding Waste, Abuse and Fraud and TDMR has rabble roused … Read More
March 11, 2014 — Church Street Health Management (CSHM), which operates 70 Small Smiles dental clinics in 22 states and the District of Columbia, has been excluded from participation in the Medicaid and Medicare programs for a minimum of five … Read More
LUBBOCK, TX (KCBD) – A Lubbock dentist is voicing concerns about patient privacy and complaining about “Big Brother” after the FBI seized his patient records on Thursday morning. The FBI executed multiple search warrant around 8 a.m. Thursday at the … Read More
In a highly unusual move, a judge working for the Texas Health and Human Services Commission last week overturned findings of an outside judge — essentially changing a finding of innocence to one of guilt. The case is particularly unusual … Read More
March 5, 2014 — A Texas judge has upheld payment holds on Medicaid payments for Houston dental clinic Antoine Dental Center (ADC), citing credible evidence of Medicaid fraud. The clinics billed about $8.1 million for orthodontic services in less than … Read More
Attorney General Eric Holder and HHS Secretary Kathleen Sebelius today released the annual Health Care Fraud and Abuse Control (HCFAC) Program report showing that for every dollar spent on health care-related fraud and abuse investigations through this and other programs … Read More
HOUSTON—Augustine Ihenacho Nnadi, aka Austin, 60, of Houston, has been arrested for accepting a bribe in exchange for assistance in an ongoing health care fraud case, announced United States Attorney Kenneth Magidson. The FBI arrested Nnadi this morning shortly after … Read More
Dr. Chang Ho Lee, 68, of Palisades Park, N.J., pleaded guilty today to health care fraud and agreed to forfeit more than $3.4 million in fraud proceeds. Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. … Read More
Hundreds of North Texas Nigerian-Americans are caught up in the biggest home health care frauds ever uncovered by U.S. law enforcement. Federal indictments were issued in 2012 against those who allegedly profited the most from half a billion dollars in … Read More
BEAUMONT, Texas – A Center, Texas couple now living in Elgin, Texas, has pleaded guilty to federal violations in a health care fraud scheme in the Eastern District of Texas, announced U.S. Attorney John M. Bales today. Cathy Harvill, 57, … Read More
Medical device manufacturer EndoGastric Solutions Inc. has agreed to pay the government up to $5.25 million to resolve allegations that it violated the False Claims Act by misleading health care providers about how to bill federal health care programs for … Read More
CORPUS CHRISTI, TX—Dr. Roque Joel Ramirez, 49, of Robstown, has entered a plea of guilty to mail fraud in connection with his scheme to defraud Medicare and Medicaid through fraudulent billings, announced United States Attorney Kenneth Magidson and Texas Attorney … Read More
On Sunday, the Austin American Statesman published a feature article on the current state of affairs regarding how Texas regulators are dealing with the claims of large scale Medicaid orthodontic fraud that have been swirling around Texas since 2011. The … Read More
Vulnerabilities in electronic health records systems are creating opportunities for fraud among healthcare providers and contractors working to achieve Meaningful Use attestation, says the Office of Inspector General. With CMS spending at least $18.8 billion through December on Meaningful Use electronic health … Read More
This past week a number of Medicaid dentists filed suit against ACS, Affiliated Computer Systems, the state’s Medicaid claims administrator better known as TMHP or the Texas Medicaid and Health Partnership. The dentists allege that ACS was negligent in their … Read More
COLUMBIA, SC—United States Attorney Bill Nettles stated that R.L. Robinson-Taylor, age 46, of Cordova, South Carolina, was sentenced yesterday in federal court in Columbia for conspiracy to commit health care fraud, a violation of 18 U.S.C. § 1349. United States … Read More
ABILENE, TX—Dr. Tuan Truong, aka “Terry Truong,” of Abilene, a dentist who practiced pediatric dentistry at Kool Smiles in Abilene, was sentenced this afternoon by U.S. District Judge Jorge A. Solis to 18 months in federal prison. Truong pleaded guilty … Read More
Antoine Dental Center of Houston, Harlingen Family Dentistry of Harlingen, M&M Orthodontics of San Antonio and Dr. Paul Dunn of Levelland filed suit this past Monday against ACS, Affiliated Computer Services, the state’s private contractor which handles claims administration for … Read More
TYLER, TEXAS (KETK) — The former Chief Financial Officer for Dr. Tariq Mahmood’s Texas hospitals has been charged with health care fraud violations in the Eastern District of Texas, announced U.S. Attorney John M. Bales today. Joe White, 66, of … Read More
February 6, 2014 — Thousands of applications for orthodontic approvals under Medicaid were delayed after Texas employed a single dentist to review them. The understaffing led to dentists, not the private company reviewing the applications, being accused of fraud for … Read More
DALLAS (CN) – A healthcare administrator delayed thousands of orthodontic approvals under Medicaid by employing just one dentist to review Texas applications, such disastrous understaffing that dentists – but not the private company – were accused of fraud for working … Read More
Today was a day filled with successes for Texas Attorney General Greg Abbott as a judge ruled the state may seize the Fundamentalist Church of Jesus Christ of Latter Day Saints compound where polygamist leader Warren Jeffs committed horrific crimes … Read More
Federal regulators moved today to block new home-health agencies from starting up in the Dallas and Houston areas. The reason, in a word: fraud.Specifically, the regulators said they wouldn’t let any new agencies bill Medicare, the federal health insurance program … Read More
A long time dental Medicaid provider recently sent to TDMR an old article that was written in the March/April 2005 edition of the Texas Medicaid Bulletin. It is interesting because both the Texas Medicaid and Health Partnership (TMHP) and the … Read More
January 27th, 2014, was the latest scheduled pre-trial hearing date for Jack Stick’s DWI case. Stick is the Deputy Inspector General for Enforcement for Texas HHSC-OIG who was arrested for DWI way back in September 2012. A docket search done … Read More
The Justice Department’s Medicare Fraud Strike Force has set record numbers for health care prosecutions in Fiscal Year 2013, demonstrating the targeted and coordinated approach remains strong as the strike force enters its eighth year of fighting fraud against the … Read More
A federal grand jury has handed down additional charges against Dr. Tariq Mahmood, whose rural hospital chain collapsed last year amid reports of reckless care and alleged fraud. The Dallas businessman now faces seven counts of aggravated identity theft, according … Read More
The operator and director of nursing of a home health agency based in Richmond, Texas, was arrested yesterday for her alleged role in a Medicare fraud scheme and a conspiracy to structure bank withdrawals. The owner and operator of the … Read More
Yesterday the Dallas Morning News reported that a North Dallas psychotherapist plead guilty to a five-year health care fraud scheme and agreed to surrender his license to practice psychology. The US Attorneys Office press release states that Michael Ellis Wolf, … Read More
