The Idaho Department of Health and Welfare (State agency) did not ensure that Molina Medicaid Solutions (Molina) implemented adequate information system general controls over the State agency’s Medicaid Management Information System (MMIS). We identified 21 reportable weaknesses, which we consolidated … Read More
The California Department of Health Care Services (State agency) did not always comply with certain Federal requirements when claiming Federal reimbursement at the 90-percent rate for family planning services provided under the Family Planning, Access, Care, and Treatment (FPACT) program … Read More
Mobile, Alabama-based Infirmary Health System Inc. (IHS), two IHS-affiliated clinics and Diagnostic Physicians Group P.C. (DPG) have agreed to pay the United States $24.5 million to resolve a lawsuit alleging that they violated the False Claims Act by paying or … Read More
Today, Health and Human Services Secretary Sylvia M. Burwell announced a new innovative collaboration with states to improve care for Medicaid beneficiaries by accelerating efforts in reforming their health care systems to improve health and care while reducing costs. The … Read More
HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015. New health center sites will increase access to comprehensive, … Read More
Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the availability of up to $300 million under the Affordable Care Act to help the nation’s community health centers expand service hours, hire more medical providers, and add oral health, … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the State agency. However, the seven remaining hospitals in our sample did not always reconcile patient account credit balances and … Read More
This morning it was reported that the Inspector General of the Department of Health and Human Services issued a report that roughly 20% of all Medicare payments for evaluation and management claims in the United States are overpayments to physicians, … Read More
Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a report from the inspector general of the Department of Health and Human Services. But in its reply to the findings, the Centers … Read More
The Obama administration’s efforts to crack down on bogus Medicare payments have ended up sweeping in too many “good actors” who get ensnared in a costly and tedious appeals process, House lawmakers said Tuesday. While tackling Medicare fraud is worthwhile, … Read More
San Antonio (CNN) — Clerks scheduling medical appointments for veterans were “cooking the books” at their bosses’ behest to hide the fact some had to wait weeks, if not months, for appointments, a VA scheduler in San Antonio said Thursday. … Read More
HOUSTON – Yolanda Nowlin, 42, has been ordered to federal prison for 11 years following her multiple convictions in relation to a large health care fraud conspiracy, announced United States Attorney Kenneth Magidson. A federal jury in Houston convicted Nowlin … Read More
WHY WE DID THIS STUDY OIG oversees the activities of all 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. The reviews … Read More
CSHM, which owns 54 Small Smiles dental clinics in the U.S., has agreed to sell the chain after the company was recently excluded from participating in the Medicaid and Medicare programs by the U.S. Department of Health and Human Services … Read More
Nothing about Texas Medicaid spending on dental or orthodontia. Medicaid Integrity Program Report for Fiscal Year 2013.
In April, we commemorate National Minority Health Month, a time to raise awareness about health disparities that persist among racial and ethnic minorities. This year’s theme – “Prevention is Power: Taking Action for Health Equity” – embodies the ambitious goal … Read More
In an unheralded August 2012 audit report that is available online, the federal Health and Human Services Office of Inspector General found that the Texas Health and Human Services Commission had not returned $2.6 million in Medicaid funding back to … Read More
DALLAS — Two Grand Prairie, Texas, men, convicted at trial in October 2013 on conspiracy and health care fraud charges related to their operation of A Medical House Calls, a physician house-call company in North Texas, were sentenced this morning … Read More
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
Gov. Rick Perry today released the following statement on attacks by the Obama administration over the failures of Obamacare: “Yet again, the Obama Administration would rather point fingers at other people than accept any of the responsibility for Obamacare’s failure. … Read More
A new security risk assessment (SRA) tool to help guide health care providers in small to medium sized offices conduct risk assessments of their organizations is now available from HHS. The SRA tool is the result of a collaborative effort … 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
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
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
On February 27th, administrative law judge Rick Gilpin of Texas Health and Human Services Commission issued a final order in the “credible allegation of fraud” payment hold case of Antoine Dental of Houston, fully reversing the Proposal for Decision written … 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
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
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
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
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
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
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
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
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
Debra Jean Velasquez, of Robstown, and Sylvia Salinas Ramirez, of Driscoll, have been ordered to prison in a scheme to defraud the Texas Medicaid program through fraudulent home health billings, announced United States Attorney Kenneth Magidson along with Texas Attorney … Read More
Washington, DC – A Houston doctor has been arrested on charges related to her alleged participation in a $158 million Medicare fraud scheme involving false claims for mental health treatment.Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal … Read More
