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
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
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
The Baylor Regional Medical Center at Plano, accused of protecting a neurosurgeon who allegedly killed and maimed patients, gained an ally this week in Texas Attorney General Greg Abbott. Abbott filed motions to intervene in three separate federal court suits … Read More
Private contractors should be held to the same accountability as the agencies that contract them, says University of Baltimore law professor Kimberly Brown. “From Abu Ghraib to Blackwater, a string of scandals has heightened public awareness that highly sensitive federal … 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
The American Academy of Implant Dentistry (AAID) has filed a federal lawsuit challenging the constitutionality of regulations by the Texas State Board of Dental Examiners that limit dentists from advertising themselves as “specialists.” The AAID, which has won similar suits … 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
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
The Big Conversation If the University of Texas System regents tap Gov. Rick Perry favorite Kyle Janek as their next chancellor, they won’t get pushback from the president of the system’s flagship campus. “I’ve known Kyle for a long … Read More
The Travis County Clerk’s Office has recently put its court records online. In the public interest, we are publishing here the record of Jack Stick’s DWI case. The following are the meanings of the prefixes used in the entries. Event … Read More
Gov. Rick Perry has reappointed Douglas Wilson of Pflugerville as inspector general of the Texas Health and Human Services Commission (HHSC) for a term to expire Feb. 1, 2015. The inspector general works to prevent, detect and investigate fraud, abuse … 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
Enrollment in the Health Insurance Marketplace continued to rise in February to a five-month total of 4.2 million. As in January, the percent of young adults who selected a Marketplace plan was 3 percentage points higher than it was from … Read More
WASHINGTON — The share of Americans without health insurance is dropping to the lowest levels since President Barack Obama took office, but sign-ups under his health care law lag among Hispanics — a big pool of potential beneficiaries. With just … 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
When Steve Aragon’s daughter invited him to speak to her students for career day, he wasn’t sure what he was going to say. He was lined up behind a judge, a SWAT team member and a zoologist. But when it … 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
EDINBURG — Sitting at an old picnic table in front of a dilapidated house, María Díaz, a hotel housekeeper, tells stories of the rejection that comes with living in impoverished Texas colonias. The trash on her street is not picked … 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
Gov. Rick Perry is encouraging University of Texas System regents to consider Health and Human Services Executive Commissioner Kyle Janek for the open job of chancellor, sources said Tuesday. Francisco Cigarroa, the current UT System chancellor, last week announced his … Read More
Citing shortfalls in Medicaid financing and billions in annual uncompensated care costs, the president and chief executive of the Texas Hospital Association said Friday that it was time for medical facilities to join together on a long-term strategy to compensate … Read More
AUSTIN — Attorney General Greg Abbott, who has said he supports the Americans with Disabilities Act, has tenaciously battled to block the courthouse door to disabled Texans who sue the state. In a series of legal cases in his three … Read More
In 2011, state regulators announced that they were taking a giant stride toward fighting blatant insurance fraud. They said they had identified nearly four dozen dentists and orthodontists who had ripped off taxpayers by billing Medicaid tens of millions of … 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
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
More than 40 health and community groups launched a campaign Wednesday to raise awareness of the coverage gap created when Texas officials declined to expand Medicaid as part of the Affordable Care Act. Advocating that poor Texans should have greater … 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
