The Obama administration has warned state officials that pushing Planned Parenthood out of the state’s Medicaid program could put Texas at odds with federal law. Officials with the federal Centers for Medicare & Medicaid Services contacted the state Medicaid director on Tuesday … Read More
Viju Mathew wanted to make sure that his wife could take care of their mentally disabled adult son and 4-year-old daughter, his lawyers say, so he agreed to plead guilty to federal health care fraud charges.But seven months later, his … Read More
A Santa Fe judge on Friday called a decision by Gov. Susana Martinez’s administration to withhold Medicaid funds from a behavioral health care agency “arbitrary, capricious or otherwise not in accordance with the law.” The decision by state First District … Read More
LITTLE ROCK, Ark. (Arkansas AG) – Arkansas Attorney General Leslie Rutledge announced the arrest of a Pulaski County man by the Attorney General’s Medicaid Fraud Control Unit. Myron Thrash, 35, of Little Rock was arrested on one count of Medicaid … Read More
As reported in the press this week, there has been a tremendous effort on the part of the new Health and Human Services Commission Inspector General Stuart Bowen to settle old, outstanding investigations against Medicaid providers—including dentists. Per the Chronicle, … Read More
In the 1980s and 90s, driftnet fishing was a common technique used to catch salmon, tuna and other types of fish. It was an incredibly effective and efficient commercial fishing method. The nets, which were as long as 50 kilometers, … Read More
AUSTIN – Texas officials are giving up on getting medical providers to repay hundreds of millions of dollars in Medicaid funding that the state for years has said was fraudulently billed for questionable dental and orthodontic procedures. After a series of … Read More
The top watchdog of Medicaid and other federal entitlement programs in Texas has identified more than $100 million in possible fraud and waste this fiscal year, according to the first report to the governor after years of public failures and … Read More
As reported last week by the Austin American Statesman, Stuart Bowen, the new Inspector General for the Texas Health and Human Services Commission, is sending his first report to the Governor today. TDMR has obtained a copy of the full … Read More
If there is a poster child for dysfunction in Texas government, look no further than the agency Stuart Bowen inherited in January. The Office of Inspector General over the state’s sprawling health agency, charged with investigating Medicaid fraud and waste, … Read More
An Albany judge dismissed an indictment against a nurse charged in a Medicaid fraud, saying there was no evidence she knew that the owners of the facility she managed had falsely certified its regulatory compliance. Gelena Deverman, 35, was charged … Read More
The recent decision by a Travis County District Court judge that again vindicated Antoine Dental Center of Houston on allegations of Medicaid fraud and vacated a three-year “credible allegation of fraud” payment hold has been appealed by the Civil Medicaid … Read More
Yesterday, Travis County District Court Judge Amy Clark Meachum issued her decision in the case of Antoine Dental Centers of Houston, vindicating the practice in its payment hold case. The practice had been accused of “credible allegations of fraud” in … Read More
A district court judge on Wednesday handed state Medicaid regulators another decisive courtroom loss, adding one more notch to the Health and Human Service Commission’s Office of Inspector General’s unenviable losing streak pursuing dentists and orthodontists it claims have bilked … Read More
The story about Dr. Rachel Trueblood settling in October 2014 with the Health and Human Services Commission Office of Inspector General for $39,000 after the agency was demanding $16 million in Medicaid overpayments is well-known. However, the story of another … Read More
In January, Stuart Bowen took charge of a state office rocked by accusations of corruption, incompetence and inefficiency. Responsible for ferreting out fraud amid the programs and procedures of the sprawling Health and Human Services Commission, the office of Inspector General … Read More
Last Wednesday, July 16, lawyers for Antoine Dental Centers of Houston again went to court. Going Travis County District Court This time they appeared before Travis County District Court to appeal the Medicaid payment hold final decision by former Health … Read More
This morning, TDMR was notified that Governor Greg Abbott has now signed into law SB 207, the legislation which makes major changes and improvements to the way the Texas Health and Human Services Commission Office of Inspector General will work. … Read More
The front-page of the Austin American Statesman Sunday morning carried the full story of the unprecedented ruling by the State Office of Administrative Hearings (SOAH) to award a Medicaid dentist back some $380,000 in legal fees from the Health and Human … Read More
Judges: State botched fraud case, must pay $400K in feesAUSTIN, Texas (AP) – A panel of judges has determined that Texas regulators so badly botched a Medicaid fraud investigation of a dentist that they’re responsible for paying the nearly $400,000 … Read More
TDMR has started a regular video news segment that will be carrying Texas Medicaid news plus relevant stories from around the country. Over the next few weeks, we will be starting to include interviews with key players in Texas. Our … Read More
UPDATE: After publishing this article, TDMR was alerted that it is a DENTIST, not a medical doctor that is involved in this case. It involves the Rhoden Group from Corpus Christi with Dr. Cheryl Rhoden, DDS as the principal. This … Read More
Two articles from the Houston Chronicle this last week should send shivers down the spine of every Texan about what kind of government his or her tax dollars are buying. The whole contracting fiasco in the Texas Health and Human Services … 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
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
The news that Smile Magic Dental clinics recently settled with the Texas Health and Human Services Commission Office of Inspector General over allegations of Medicaid fraud confirms what TDMR has been saying for a long time – that the purpose … Read More
March 17, 2015 — Four clinics of Texas’ Smile Magic chain have agreed to pay $4.5 million to settle Medicaid fraud charges. The whistleblower lawsuit claimed the clinics used paid recruiters to target parents in grocery store parking lots and … Read More
Rep. Bobby Guerra filed H.B. No. 3023 this week. The purpose of the bill is to make it mandatory for Medicaid providers to get an overpayment hearing before the State Office of Administrative Hearings if they dispute an recoupment demand from the Health and Human … Read More
Former Health and Human Services Commission chief counsel Jack Stick’s name was again prominent in the Houston Chronicle yesterday. Former employees coming forward Former employees of HHSC and the HHSC-Office of Inspector General where Stick worked earlier as deputy inspector general … Read More
Lawyers for a number of Medicaid dentists have filed their response to a revised suit filed by the state in the wake of the Sunset Advisory Commission hearings last December. Nonsuited administrative cases a victory for due process rights Prior to Christmas, … Read More
TDMR has learned today that OIG administrative actions against a number of dental providers that have been accused of “credible allegations of fraud” have been nonsuited by OIG. UPDATE: Here is the document State v. Dentists The affected providers include Antoine Dental … Read More
It is now official – Jack Stick, HHSC Chief Counsel and former OIG deputy inspector general for enforcement, has resigned from HHSC over published allegations of interference in the HHSC contracting process on two contracts – one for data mining software … Read More
In today’s public hearings, members of the Texas Sunset Advisory Commission passed staff recommendations and supplemental additions made by a special work group, relating to the Health and Human Services Commission Office of the Inspector General. The final report is now online and … Read More
December 2, 2014 — A Texas appeals court has invalidated several rules related to payment holds imposed during Medicaid fraud investigations, saying they violate due process rights. The Third Court of Appeals invalidated rules that authorized the Texas Office of … Read More
Houston Chronicle business columnist Chris Tomlinson blasted the Texas Health and Human Services Commission Office of Inspector General for its treatment of Medicaid providers in his column Wednesday. His criticism however goes further than OIG and alleges that OIG’s overzealousness … Read More
Judge rightfully reins in anti-fraud unit after abusive action By Chris TomlinsonNovember 26, 2014 Doctors, dentists and other health care providers who care for the state’s most disadvantaged got some much needed relief Tuesday from an over-zealous, politically motivated anti-fraud … Read More
Law360, Dallas (November 25, 2014, 5:55 PM ET) — A Texas appeals court on Tuesday invalidated three Texas Health and Human Services Commission rules related to payment holds imposed during Medicaid fraud investigations, holding they violate due process rights. The … Read More
Today, the Texas 3rd Court of Appeals overturned a lower court decision and negated Health and Human Services Commission rules that allow for the Office of Inspector General to place Medicaid payment holds in certain circumstances, basically for only program violations … Read More
In a letter to the Texas Sunset Advisory Commission, TDMR President Gregory Ewing has recommended, based on the testimony in the public hearings held last week, that all pending OIG cases be stayed for external review. All pending cases should … Read More
AUSTIN — When Gov. Rick Perry tried to force a district attorney from office for drunken driving, he cited outrage at her behavior and a loss of confidence in her ability to do the job.But on his own staff, Perry … Read More
