The Government Accountability Office recently issued a pair of reports within days of one another critical of how the Medicaid program gathers data and screens its provider participants. Medicaid, by far, is the leading source of payment for long-term care … Read More
WASHINGTON (AP) — House Republicans on Monday released their long-awaited plan for unraveling former President Barack Obama’s health care law, a package that would scale back the government’s role in helping people afford coverage and likely leave more Americans uninsured. … Read More
Over 65,000 ineligible providers have been culled from the Medicaid program due to a component of the Affordable Care Act that requires periodic recertification of eligibility, according to Modern Healthcare. The measure, which was meant to prevent fraud and inefficiency, … Read More
In the first nine months of 2016, just 28.2 million Americans, or 8.8 percent, were uninsured, according to survey data from the CDC. That’s 20.4 million fewer Americans than in 2010, when the ACA was signed into law, and 0.4 … Read More
Medicaid is a joint federal-state health care program for low income and medically needy people, with an estimated $36 billion in improper payments in fiscal year 2016. We’ve identified some ways to reduce these errors, such as by confirming that … Read More
January 31, 2017 — Policy experts discussed what dental care might look like under U.S. President Donald Trump and the new Congress during a January 24 webinar. The panelists were particularly concerned about children’s dental benefits if the Patient Protection … Read More
The following is a statement received from MB2 Dental Solutions, the Dallas-area dental service organization, that recently settled with federal and state authorities for a whopping $8.45 million over allegations of Medicaid fraud. A company representative told us that they … Read More
Poor Americans insured by Medicaid will pay more out-of-pocket toward their healthcare services under proposals favored by Dr. Tom Price, Donald Trump’s pick to be U.S. Secretary of Health and Human Services. During the first of two committee hearings he … Read More
States may receive their Medicaid funding in block grants under President Donald Trump’s plan to replace the Affordable Care Act, one of his advisers reported this weekend. White House adviser Kellyanne Conway, appearing on Sunday Today, said that moving the … Read More
The administrator of five Houston-area home health agencies pleaded guilty today to conspiring to defraud the State of Texas’ Medicaid-funded Home and Community-Based Service and the Primary Home Care Programs of more than $7.8 million. These programs provide qualified individuals … Read More
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program) under the joint direction of the Attorney General and the Secretary of the Department of Health … Read More
Tuesday, TDMR republished a press release issued by the Department of Justice, U.S. Attorney’s Office, Northern District of Texas that Carrollton-based MB2 Dental Solutions and 21 pediatric dental practices affiliated with MB2 had agreed to an $8.45 million settlement to resolve … Read More
DALLAS – Texas-based MB2 Dental Solutions (MB2) and 21 pediatric dental practices affiliated with MB2, along with their owners and marketing chief, have agreed to pay the United States and the State of Texas Medicaid program $8.45 million to resolve … Read More
Enrollment in Medicaid and CHIP has grown by nearly 17 million people since the Affordable Care Act was enacted, according to the Centers for Medicare and Medicaid Services. CMS compared enrollment data from October 2016 to July through September 2013, … Read More
On Dec. 7, 2016, just in time for the holiday season, the Office of Inspector General (OIG) released a policy statement regarding the nominal value of gifts that healthcare providers may give to Medicare and Medicaid beneficiaries. In short, the … Read More
President-elect Donald Trump unveiled two big health care decisions Tuesday.He picked Rep. Tom Price to head the Department of Health and Human Services and tapped Seema Verma, a health care consultant, to head the Centers for Medicare & Medicaid Services. … Read More
The idea by president-elect Donald Trump to change how Medicaid coverage for poor Americans is financed by giving block grants of money to states will face a tough time becoming a reality.Medicaid, which is jointly funded by federal and state … Read More
Think less federal funding, more state control, fewer participants and higher costs for those in the program. Here’s how Medicaid works now: Nearly 73 million Americans are on Medicaid or the related Children’s Health Insurance Program (CHIP). The programs cost … Read More
As the next president begins to plan for America’s future health care needs, including the Medicaid safety net that catches and takes care of the poor, Donald Trump might be called the new kid on the “block.”That sobriquet stems from … Read More
Significant and persistent compliance, payment and fraud vulnerabilities exist within the Medicaid program that covers home care for elderly and disabled people, according to a recent report from HHS’ Office of Inspector General. In the report, the OIG highlighted some … Read More
Drugmaker Mylan will pay $465 million to settle allegations that it overbilled Medicaid for its life-saving EpiPen, ending one of the controversies over the soaring price of the emergency allergy injection.The settlement with the Department of Justice follows news that … Read More
Two of Tenet Healthcare Corp.’s former subsidiaries admitted to conspiring to defraud Medicaid by using referral contracts for translation services to funnel pregnant patients through their doors.Atlanta Medical Center and North Fulton Hospital in Georgia each pled guilty to one … Read More
Although mandatory pediatric dental insurance was included in U.S. healthcare reform, coverage is a stark departure from the benefits envisioned by the Patient Protection and Affordable Care Act and those required under Medicaid, according to a new report. Coverage isn’t … Read More
WHY WE DID THIS STUDY The Department of Health and Human Services (HHS) OIG is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCU or Unit). This MFCU Fiscal Year (FY) 2015 Annual Report highlights statistical achievements … Read More
A key domestic policy directive presidential aspirant Donald Trump made to Congress as a way to reform the healthcare system is to “block-grant Medicaid to the states.”The health insurance program for poor Americans, which is funded by a matching formula of state … Read More
Hospitals in the Dallas-Fort Worth region were overpaid by $27 million in federal funds to provide health care for the uninsured, according to a new order from the Obama administration, which is threatening to take the money back. Federal health … Read More
The U.S. Department of Health and Human Services (HHS) released a report from its Office of the Inspector General (OIG) regarding the wireless networks of the Centers for Medicare & Medicaid Services’ (CMS) facilities. The report shows that CMS, which collects … Read More
DALLAS C The Estate of Dr. Kenneth Michael Rice and UMC Physicians (UMCP) have agreed to pay a total of $3,280,000.00 to the United States and the State of Texas to settle allegations that Dr. Rice and UMCP violated the … Read More
AUSTIN — The lawyer for a whistleblower who sued a top Ken Paxton donor said he was unaware the donor gave $100,000 to the attorney general during an investigation into his client’s claims, and he wants proof that it did … Read More
Over the past two weeks, it has been a major story that Attorney General Ken Paxton took a $100,000 donation for his personal legal fees from a friend whose company was accused of Medicaid fraud. The company just settled the … Read More
The owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician’s assistant were charged with conspiracy, obstruction, money laundering and health care fraud in connection with a $1 billion scheme involving numerous … Read More
Touting a breakthrough in combating rampant fraud in the Medicare and Medicaid health care systems, the Obama Administration on Wednesday told Congress that it had prevented $42 billion of improper payments to doctors and other medical providers in fiscal 2013 … Read More
DALLAS — Preferred Imaging, LLC, (Preferred Imaging), a provider of diagnostic imaging services, has agreed to pay $3,510,000 to resolve allegations that it improperly billed Medicare and Medicaid for services performed without proper medical supervision in violation of the False … Read More
The Centers for Medicare and Medicaid Services has awarded positions on a potential 10-year, $2.5 billion contract vehicle to seven companies for program integrity support services intended to help CMS and its partners identify instances of healthcare fraud, waste and abuse … Read More
HOUSTON – A Houston federal jury has returned guilty verdicts against four defendants on all counts as charged in a $6 million fraudulent Medicare billing scheme, announced U.S. Attorney Kenneth Magidson. Giam Nguyen, D.O., 46, of Houston, Benjamin Martinez, M.D., … Read More
In Waco, a jury returned guilty verdicts against 55–year-old DTS Medical Supply Company owner Daniel Thomason Smith and 45-year-old DTS office manager Kathleen Marina Kelly-Tuorila in connection with an estimated $3.5 million Health Care Fraud scheme announced United States Attorney … Read More
More than 300 people across the nation — including 22 in the Houston area and seven in McAllen — have been charged with stealing more than $900 million in what federal investigators say is the “largest Medicare fraud takedown in … Read More
Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges … Read More
Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced nearly $156 million in funding to support 420 health centers in 47 states, the District of Columbia and Puerto Rico to increase access to integrated oral health care services … Read More
The federal government will soon unveil a new contractor program aimed at fraud in both the Medicare and Medicaid programs, according to an official with the Centers for Medicare & Medicaid Services. The new Unified Program Integrity Contractor program will … Read More
