A recent court ruling in favor of a Texas orthodontics provider adds to the state’s longstanding inability to prove claims that dental providers overbilled Medicaid tens of millions of dollars, according to the Austin American-Statesman. In the latest case, an … Read More
In an important win for hospice and other health care providers facing claims under the False Claims Act (FCA), a federal court in Alabama gave a summary judgment victory last week to hospice provider Aseracare Inc. Key Takeaway A difference … Read More
State Medicaid regulators pursuing orthodontists who they claim bilked Texas out of tens of millions of dollars suffered another decisive setback Thursday, when an appeals court ruled investigators hadn’t proven any fraud had occurred in one of the state’s largest … Read More
Today the Sixth Court of Appeals issued their decision in the Medicaid payment hold case of Antoine Dental Center of Houston. The court again exonerated the practice from allegations of Medicaid fraud, again terminated the payment hold and, for the … Read More
On Jan. 6, Nevaeh Hall was running, playing and laughing at a Chuck E. Cheese indoor playground and game room.The next day, after a morning dental appointment, the 4 year old was in an ambulance en route to Texas Children’s … Read More
The Texas Supreme Court this week issued a ruling allowing a whistleblower suit filed by Michael McMillen, a former Health and Human Services Commission Office of Inspector General attorney, to continue. McMillen contends he was fired in early 2012 for reporting … Read More
The Texas Supreme Court has given another shot to a former government lawyer who alleged he got fired after blowing the whistle that the state was illegally seeking reimbursement from some Medicaid recipients. F. Michael McMillen saw his employment lawsuit … Read More
UPDATE: MCNA has responded to our recent request for a contact for provider complaints and provided information about their complaint process. See information below. Managed Care Organizations (MCOs) received significant mention in the report issued by the Health and Human … Read More
AUSTIN — The Travis County District Attorney’s Office has transferred its investigation of a controversial no-bid contract to another law enforcement agency better able to handle the complicated case. Travis County Public Integrity Unit chief Gregg Cox disclosed the move … Read More
UPDATE: The Travis County Public Integrity Unit has forwarded the criminal investigation into the 21 CT matter to another undisclosed investigative unit. Per the Unit’s head, the investigation is starting to move faster and was moved for reason of expertise … Read More
They met on an airplane in the spring of 2011 – the CEO of an Austin technology company and a Texas state official who found themselves seated next to each other and began talking about movies, and then work. Irene … Read More
There have been many changes for Medicaid dental providers over the last few years. The change from fee-for-service to managed care. The upheaval caused by the former Health and Human Services Commission Office of Inspector General and rampant allegations … Read More
Almost six months ago, undercover videos surfaced purporting to show officials with Planned Parenthood in Texas discussing illegal acts. Texas Republicans pounced, opening up multiple battlefronts against the embattled women’s health organization. With allegations flying that Planned Parenthood was illegally … Read More
A Harris County grand jury on Monday indicted the videographers behind undercover recordings of a Planned Parenthood clinic in Houston and cleared the women’s health provider of any wrongdoing. The indictments — part of the county prosecutor’s investigation into allegations that … Read More
A state employee has been put on probation after a three-month internal investigation found that she had tried to secure a job for her daughter with a potential vendor. Jean Garcia, a technology service manager for the state’s Health and … Read More
No, that wasn’t $200 million. It wasn’t $50 million. It wasn’t even $500,000 or $250,000. The amount of dental fraud found and recovered by Texas dental management organizations in 2015 was only $243,982.84 per the “HHSC OIG Annual Report on … Read More
This afternoon, the Health and Human Services Commission Inspector General Stuart Bowen sent out his second quarterly report – quite unlike his predecessor who sent out no such reports. It is a remarkable 28-pages and will take some time to … Read More
We want to close out 2015 with a round-up of the year’s most important stories relating to TDMR issues. It has been an exceptional year for changes at the Health and Human Services Commission. The implosion that occurred at HHSC … Read More
AUSTIN — A court hearing set for Monday about the effort by Texas to halt Medicaid reimbursements to Planned Parenthood has been canceled because state officials have not yet actually kicked the organization out of the program.Health inspector general Stuart … Read More
Almost two months after Gov. Greg Abbott praised state health officials for moving decisively to drop Planned Parenthood as a Medicaid health-care provider, the organization is still seeing patients and being reimbursed under the program.State health officials have not yet … Read More
A suit to compel the Texas Health and Human Services Commission to release the full list of names of Medicaid providers that have been placed under a “credible allegation of fraud” payment hold since 2010 has been filed in Travis … Read More
Planned Parenthood’s Texas affiliates on Monday filed a federal lawsuit to keep state health officials from booting them from the state’s Medicaid program. Following Texas’ announcement in October that it would stop funding any care for poor women at Planned Parenthood clinics — a response … Read More
A state worker who came under scrutiny during a high-profile contracting scandal last year has been paid more than $100,000 over the past 11 months without having to work a single day. Frianita Wilson — who earns $115,000 a year … Read More
November 17, 2015 — The Supreme Court of Texas has dismissed a petition that would have prevented practitioners from receiving Medicare funds when that provider is being investigated for fraud. In the November 13 dismissal, the state Supreme Court upheld … Read More
This past Friday, the Texas Supreme Court dismissed a petition from the Texas Office of Attorney General to review a 3rd Court of Appeal decision preventing the Health and Human Services Commission Office of Inspector General from placing payment holds … Read More
As TDMR reported back at the end of September, the new Health and Human Services Commission Inspector General Stuart Bowen had started settling outstanding investigations and cases against Medicaid dentists and providers. Senator Charles Perry was quoted in the media … Read More
The federal government has warned Texas that it cannot block Medicaid participants from “qualified providers of their choice” or because of the provider’s “scope of practice.” In doing so, the U.S. Department of Health and Human Services has essentially put … Read More
SAN ANTONIO — The Texas health commission soon will begin a new project to fight waste, fraud and abuse in the state Medicaid program, a year after another anti-fraud effort fell apart in scandal. The “integrity initiative,” to be launched later … Read More
Texas officials are giving up on recovering most of the hundreds of millions of dollars spent on questionable Medicaid dental and orthodontic procedures. After years of an ongoing scandal over fraudulent billing and courtroom losses, the commission that oversees Medicaid … Read More
Stuart Bowen, the inspector general of the Texas Health and Human Services Commission, told The Dallas Morning News that a whistleblower alleging Medicaid fraud at Texas Planned Parenthood clinics spurred the agency’s investigation. The Daily Signal previously reported that inspectors from the … Read More
The editorial board of the Austin American Statesman has called the decision by Texas “lawmakers and state officials” to investigate Planned Parenthood for Medicaid fraud part of a “witch hunt” that won’t stop until the health care provider “is completely dismantled … Read More
The Governor of the State of Texas said he hopes Planned Parenthood files legal action against their move to cut off Medicaid funding to the abortion biz so he can put their officials under oath. Newly-elected Governor Greg Abbot told … Read More
The Obama administration has warned state officials that pushing Planned Parenthood out of the state’s Medicaid program could put Texas at odds with federal law. Officials with the federal Centers for Medicare & Medicaid Services contacted the state Medicaid director on Tuesday … Read More
If Planned Parenthood has been billing Texas Medicaid for services it hasn’t been rendering, as Gov. Greg Abbott and state health officials suggested this week, it makes sense to cut off the money and go after the organization for whatever it stole. But … Read More
Jack Stick says he’s “the whipping boy,” the guy who became the face of the 21CT contract scandal as Texas officials pointed fingers and scrambled to save their own jobs. “I think in December of last year, people began to … Read More
EDINBURG — The new head of the state health agency’s investigative division visited with stakeholders in Hidalgo County Wednesday to learn about local healthcare issues and promote his vision. Stuart Bowen Jr., inspector general for the Texas Health and Human … Read More
Former Texas health official Jack Stick tried to persuade dozens of other states to buy Austin technology company 21CT’s Medicaid fraud detection system even as he privately complained that the results it produced for Texas were worth “a bucket of … Read More
Jack Stick, a former state official at the center of a contracting scandal at the Texas Health and Human Services Commission, on Friday received a sentence of six days in jail and 90 days without a driver’s license for a … Read More
McALLEN—A 28-year-old ambulance company owner accused of submitting more than $1 million in fraudulent claims to Medicare and Medicaid was convicted Tuesday after pleading guilty before a federal court judge. Victor Lee Gonzalez, the owner of Vic’s Texas Transport Inc., … Read More
Former Texas health commission lawyer Jack Stick, found guilty Monday of driving while intoxicated, will be sentenced within the next two weeks, but no final date has been set, Travis County court officials said Tuesday. The former state representative and … Read More
