What GAO Found GAO identified four key issues facing the Medicaid program, based on prior work. Access to care : Medicaid enrollees report access to care that is generally comparable to that of privately insured individuals and better than that … Read More
President Barack Obama gave Medicare and Medicaid, the federal and state health care entitlements for the elderly and poor, respectively, a clean bill of financial health in his weekly addresson Saturday as he marked the programs’ 50th birthday. “Today, we’re often … Read More
Enrollment in private insurance plans has soared as the government has tried control costs and improve care for Medicare and Medicaid beneficiaries. Source: As Medicare and Medicaid Turn 50, Use of Private Health Plans Surges – The New York Times
HOUSTON—Dr. Dennis B. Barson Jr., 42, has been ordered to federal prison following his convictions related to a conspiracy to defraud Medicare of $2.1 million in less than two months, announced U.S. Attorney Kenneth Magidson. A federal jury convicted Barson … Read More
A Michigan resident was sentenced to 80 months in prison late yesterday for his leading role in a $12.6 million Medicare fraud and tax fraud scheme. Eleven other individuals have been convicted in this case. Assistant Attorney General Leslie R. Caldwell … Read More
Newly released documents show the federal government attempted to collect $16.7 million from the state after alleging four New Mexico companies that provide in-home health care services didn’t comply with the rules for submitting Medicaid reimbursement claims. In June 2012, … Read More
July 14, 2015 — U.S. Sen. Charles Grassley (R-IA) has sent letters to key government agencies, asking how many criminal and civil cases have been brought against dentists suspected of fraudulent treatment and billing practices involving Medicaid patients. “Some dentists … Read More
Six Houstonians are in custody on wide-ranging charges involving a $12 million conspiracy to commit healthcare fraud and to pay kickbacks, announced U.S. Attorney Kenneth Magidson. The arrests were made in conjunction with a search warrant executed at a downtown … Read More
Washington, DC–(ENEWSPF)–July 6, 2015. AstraZeneca LP has agreed to pay the United States and participating states a total of $46.5 million, plus interest, to resolve allegations that it knowingly underpaid rebates owed under the Medicaid Drug Rebate Program, the Justice … Read More
The U.S. Department of Health and Human Services inspector general is asking a Maryland state health agency to refund $34.2 million in federal dollars it received for a waiver program that the watchdog said was wrongly applied, it said in … Read More
The Office of the Inspector General at HHS announced Tuesday the creation of a new litigation team that will concentrate on identifying and fining Medicare and Medicaid fraud. The team’s creation is intended to put further pressure on physicians, drugmakers … Read More
WASHINGTON, DC – House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Oversight and Investigations Subcommittee Chairman Tim Murphy (R-PA) today sent a letter to Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt in their continued oversight … Read More
On Tuesday, representatives from the United States Department of Health and Human Services Office of Inspector General (OIG) announced the creation of an OIG litigation team that will focus specifically on civil monetary penalties and exclusion cases. The announcement was … Read More
On June 9, 2015, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Fraud Alert focused on compensation arrangements paid to physicians. See, “Physician Compensation Arrangements May Result in Significant Liability” [link:https://oig.hhs.gov/compliance/alerts/guidance/Fraud_Alert_Physician_Compensation_06092015.pdf]. The Fraud … Read More
Joe White didn’t use elaborate methods to bilk a federal stimulus program: He simply lied on application forms. But getting back the nearly $18 million in tax money that the feds plowed into the rural Texas hospital chain he managed … Read More
DALLAS—Attorney General Loretta E Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulting in charges against 243 individuals, including 46 … Read More
NEW YORK – Attorney General Eric T. Schneiderman today announced a settlement with Aspen Dental Management, Inc., an East Syracuse-based company that provides business support and administrative services to seven independently owned dental practices that maintain 40 offices in New … Read More
The U.S. Justice Department charged 243 people, including 46 doctors, nurses and other medical professionals, with defrauding the Medicare system of $712 million through false billing. Attorney General Loretta Lynch announced the charges Thursday in Washington, calling the case the … Read More
Two House committees have requested a review of the Centers for Medicare & Medicaid Services’ Fraud Prevention System, according to a letter sent to the Government Accountability Office. Bipartisan leaders on the House Energy and Commerce and House Ways and … Read More
HOUSTON — Texas should repay at least $133 million in Medicaid funding misspent on unnecessary dental and orthodontic procedures, according to a federal audit. Source: Feds say Texas should repay $133 million in Medicaid funds misspent on dental care | … Read More
The federal government paid almost $10 million in medicaid benefits to 200 dead people, according to a new report from the Government Accountability Office. And that’s just the tip of the iceberg. In just four states in fiscal year 2011, … Read More
Back last August, the Department of Health and Human Services Office of Inspector General released an audit report that the Texas Health and Human Services Commission was responsible for the conduct of its Medicaid claims administrator for the hundreds of … Read More
WASHINGTON—Starting Aug. 1, providers considered at “high risk” for defrauding state Medicaid programs will undergo a criminal background check that includes fingerprinting. By March 2016, all of a states’ Medicaid and CHIP providers must be ranked as having a limited, … Read More
The Centers for Medicare and Medicaid Services on Monday released enormous sets of data on hospital and physician reimbursement in 2013, its latest effort to enlist the public in identifying suspect billing and trends in health care utilization. Source: CMS … Read More
A prominent U.S. senator is asking the Centers for Medicare & Medicaid Services to investigate Medicare Advantage plans that may have inflated their risk scores to receive higher reimbursements. In her letter to CMS Acting Administrator Andy Slavitt, Sen. Claire … Read More
The Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) has released its Fiscal Year (FY) 2014 Annual Report (Report) on the performance of the Medicaid Fraud Control Units (MFCUs) (OEI-06-15-00010, April 2015). Although the MFCUs reported another strong … 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 (MFCUs or Units or Unit). This MFCU Fiscal Year (FY) 2014 Annual Report highlights … Read More
Law360, New York (May 26, 2015, 7:36 PM ET) — The Centers for Medicare and Medicaid Services put forth a proposal Tuesday that would update the way managed care organizations are regulated for the first time in a decade in … Read More
Federal prosecutors are moving fraud enforcement into the C-suite, according to Assistant Attorney General Leslie R. Caldwell. Just as the Department of Justice has pursued charges at against executives for financial fraud, healthcare executives will be held accountable for fraud … Read More
As the Legislature gears up for Round 2 of its battle to pass a budget and figure out what to do about Medicaid expansion and health coverage for the poor, the Republicans in Tallahassee who want to sabotage Obamacare have … Read More
U.S. Also Elects to Intervene Against Novartis Pharmaceuticals Corporation in Claims that Novartis Gave Kickbacks to Accredo in Exchange for Increased Refills of Exjade Drug, and Understated Exjade’s Serious and Potentially Life-Threatening Side Effects to Patients Accredo Admits to Conduct … Read More
The Colorado Department of Health Care Policy and Financing (State agency) lacked sufficient internal controls to ensure that Medicaid claims submitted by providers and paid by the State agency during fiscal year (FY) 2011 correctly included National Provider Identifiers (NPIs) … Read More
WHAT WE FOUND For fiscal years 2011 through 2013, the Unit reported 10 criminal convictions, 63 civil judgments and settlements, and recoveries of over $63 million. We identified one issue of significant noncompliance with applicable laws, regulations, or policy transmittals … Read More
On March 25, 2015, a bipartisan group of U.S. Senators reintroduced the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (“PRIME Act” or “Act”)[1] following the lead of the U.S. House of Representatives, which tapped the bill for reconsideration … Read More
Now, with the HHS OIG amendment to HHS regulation (42 CFR §1007.19), State Medicaid Fraud Control Units are empowered to use Federal matching funds to acquire data mining tools and technology themselves to improve their efforts in identifying and analyzing … Read More
April 2, 2015 — Dentists and other private healthcare providers cannot sue to force states to raise their Medicare reimbursement rates, according to a U.S. Supreme Court ruling issued on March 31. This ruling means that dentists and other healthcare … 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
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
2016 Budget plans will have both improvements and challenges for Medicare and Medicaid providers. On Monday, February 2, 2015, President Barack Obama released the 2016 Federal budget. It reveals plans for saving federal money on Medicaid and Medicare which will … Read More
For over a year, we have released monthly Medicaid and Children’s Health Insurance Program (CHIP) data that reflects enrollment activities across all states and growth in health coverage. The most recent Medicaid and CHIP data shows enrollment reaching over 10.1 … Read More
