A Florida federal judge has endorsed a whistleblower’s use of extrapolation in False Claims Act litigation against nursing homes to prove potentially vast liability based on a small billing sample, the latest setback for defense counsel seeking to curtail the … Read More
JACKSONVILLE, Fla. — First Coast News has confirmed that state investigators have launched a Medicaid Fraud inquiry into the practice of controversial Jacksonville dentist Dr. Howard Schneider. The State Attorney General’s Office confirmed to First Coast News that a criminal … Read More
By M.B. Pell and Kristina CookeNEW YORK/SAN FRANCISCO, April 29 (Reuters) – A doctor who took kickbacks from a Pennsylvania hospice involved in a multimillion-dollar fraud. An Ohio psychiatrist who billed for treating no-show patients. A Georgia optometrist who claimed he … Read More
NCI Inc. has won a $14 million contract to provide program integrity services to the Centers for Medicaid and Medicare Services.NCI’s AdvanceMed business was awarded the Zone Program Integrity Contractor contract for Zone 3, which seeks to identify and reduce … Read More
The state’s massive health and human services system would be partially consolidated under a bill heard by the House Human Services Committee on Monday evening. Under House Bill 2304 by Four Price, R-Amarillo, three of the state’s five health and human … Read More
HOUSTON—William Owuama, 56, and Marla Owuama, 47, have been sentenced following their convictions related to a healthcare fraud scheme in which Mr. Owuama’s Company billed Medicare and Medicaid for more than $9 million, announced U.S. Attorney Kenneth Magidson. Both pleaded … Read More
Last week, state Comptroller Tom DiNapoli released an audit identifying at least $513 million in “improper” Medicaid payments — plus another $361 million in “questionable” transactions — over four years. Good work, Tom — but the true amount is likely … Read More
AUSTIN – A sophisticated software program crunched through a sea of Texas hospital records in July 2013, instantaneously comparing payment records against Medicaid rules to identify $4.4 million in questionable spending and start a process that eventually returned the money … Read More
Nearly one-third of Medicaid fraud criminal convictions the federal government obtained last year involved home health aides, the Inspector General for Health & Human Services reports. Thirty percent of the 2014 cases involved home health aides, while certified nursing aides … Read More
AUSTIN – A renewed effort to evaluate state contracting oversight could end up illustrating an uncomfortable reality, former lawmakers and government watchdogs say: even the strictest of safeguards will not work if not taken seriously by agency officials. Despite an … Read More
Health care providers who say they’ve been unfairly targeted by Texas Medicaid fraud investigators tallied a win Tuesday when the Senate passed a bill to crack down on that office and give doctors room to push back against bogus fraud … Read More
The Senate passed a bill Tuesday that seeks to revamp the state agency that investigates fraud, waste and abuse in Medicaid and other state health services. The Office of Inspector General at the Health and Human Services Commission is supposed … 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
AUSTIN — A new bill to curb alleged abuses of an organization that is itself supposed to police abuses got Texas Senate approval Tuesday. Senators voted 30-0 to pass Senate Bill 207 by state Sen. Juan “Chuy” Hinojosa, D-McAllen, which … Read More
State Rep. John Kuempel, chairman of the House General Investigating and Ethics Committee, launched an official inquiry Monday into contracting practices at 11 state agencies.Kuempel requested information on contracts at the Health and Human Services Commission, where questions surrounding a $20 million, … Read More
Gregg Cox, the Travis County prosecutor who oversees the embattled Public Integrity Unit, on Monday rejected a request from the Department of Public Safety to re-open an investigation into controversial border security contracts, telling Director Steve McCraw the unit does … Read More
Three years ago, a company called Geo Care Inc. failed to win a contract from the Texas Health and Human Services Commission to privatize the Kerrville State Hospital, one of the state’s 10 psychiatric facilities. So the company’s lobbyist, Frank … Read More
In August 2013, a lobbyist for a national company that privatizes state prisons emailed a bold proposal to Kyle Janek, the top official over a Texas health agency that at the time was facing scrutiny for a spate of gruesome … Read More
AUSTIN — A discussion about restructing the Texas health agency morphed into a heated argument about President Obama’s health care law in the state Senate on Wednesday, as Democrats frustrated at not getting a committee hearing on a Medicaid expansion plan … Read More
A Texas senator on Wednesday requested that the embattled Public Integrity Unit of the Travis County District Attorney’s office re-open its investigation into $20 million in no-bid border security contracts awarded by the Department of Public Safety to the private … Read More
The Texas Senate on Wednesday tentatively approved a measure to partially consolidate the state’s massive health and human services system. Under Senate Bill 200 by Jane Nelson, R-Flower Mound, three of the state’s five health and human services agencies — the … 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
HARTFORD >> A New York state man faces years in federal prison and hefty fines after pleading guilty Wednesday to charges that he helped a convicted felon get Medicaid money through dental practices in West Haven, Stamford and Trumbull. Mehran … Read More
If there is a silver lining to the no-bid contracting scandal at the state’s health commission, it is the response to prevent future similar debacles. In light of Gov. Greg Abbott’s independent “strike force” review of the Texas Health and … Read More
State and federal welfare programs are plagued with fraud and abuse, endangering the safety nets created to help the neediest among us. Their sheer size makes them vulnerable, and it is up to the states to ensure these programs and … Read More
TYLER, Texas – A 63-year-old Dallas County, Texas, physician, has been sentenced to federal prison for health care fraud and identity theft violations in the Eastern District of Texas, announced U.S. Attorney John M. Bales. Tariq Mahmood, 63, of Cedar … 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
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
April 10, 2015 — Children enrolled in the Children’s Health Insurance Program (CHIP) had higher rates of dental access and more checkups than privately insured children, but fewer in the program actually visited dentists, according to a new federal report … Read More
Criminal investigators looking into Texas’ no-bid contract with Austin tech firm 21CT are now delving into allegations that the former state official in charge of billions of dollars in technology contracts abused her position when she urged companies vying for … Read More
Law360, Dallas (April 09, 2015, 6:58 PM ET) — A Texas appellate court on Thursday largely affirmed dismissal of a suit brought by Pharmserv Inc. challenging the state Health and Human Services Commission’s Medicaid payment hold rules, but remanded the … 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
The Iowa Department of Human Services (State agency) did not always use the correct Federal medical assistance percentages (FMAPs) when processing claim adjustments reported to the Centers for Medicare & Medicaid Services. Of the 1.1 million claims we reviewed, the … Read More
AUSTIN, TEXAS (Attorney General) – Texas Attorney General Ken Paxton has resolved an enforcement action against New Jersey-based pharmaceutical product manufacturer Glenmark Generics Inc. USA. The agreement resolves the State’s investigation under the Texas Medicaid Fraud Prevention Act (“TMFPA”) against … Read More
We have seen many Medicare fraud scams – phony providers who commit identity theft and bill for services never performed, surgeons performing unnecessary procedures, providers overbilling and “patient recruiters” paying homeless people to seek treatment they don’t need. Another scheme … Read More
by Edgar Walters, The Texas Tribune It’s been a tough year so far for Kyle Janek, the head of the state’s embattled Health and Human Services Commission — and it’s only April. Two separate government-issued reports have criticized Janek’s leadership. … 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
Attorney General Kathleen G. Kane has charged three Pennsylvanians with Medicaid fraud. According to court papers, Catrina Abbot, 33, of Philadelphia is accused of submitting false time sheets that netted her more than $3,000 through fraudulent Medicaid claims. Abbott is facing multiple … 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
Contract High is an occasional series looking at how Texas outsourced crucial state services for two decades — and got smoked. Amid a gusher of news in recent months over a handful of troubled state contracts, lawmakers have vowed to … Read More
