This week, Attorney General Ken Paxton issued a press release touting his agency’s recovery of some $203 million in 2023 from Medicaid fraud, waste, and abuse. The figures come from the 2023 Joint Interagency Coordination Report, which “summarizes the collective … Read More
Last month, TDMR was told that Inspector General Sylvia Hernandez Kauffman was going to be leaving OIG sometime in September. Today, we received confirmation from an OIG spokesperson that Ms. Hernandez Kauffman will be leaving the position on October 2. … Read More
The Office of Inspector General has another proposed rule on the Texas HHS “Comment on Proposed and Draft Rules” webpage entitled – “Recoupment of Overpayments Identified by Retrospective Payment Review.” This one is another addition to the Texas Administrative Code … Read More
The U.S. Department of Health and Human Services Office of the Inspector General just published an audit report this week that Texas paid out incorrectly $922,557 in CHIP payments to Medicaid managed care organizations. Now a million dollars in the … Read More
Texas HHS-OIG published on their website June 24 an audit they completed on DentaQuest back on January 9. The audit found that DentaQuest had $1.53 million in “unallowable, unsupported, and overstated expenses on its Administrative Expenses FSR [Financial Statistical Report]” … Read More
During our onsite inspections, we identified deficiencies in areas related to life safety or emergency preparedness at 18 of the 20 nursing homes that we audited. Specifically, we found 235 deficiencies with life safety requirements related to building exits and … Read More
The Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) recently published its Fall 2019 Semiannual Report to Congress. The Report covers the period of April 1, 2019 through September 30, 2019, and identifies “significant problems, abuses, … Read More
Washington, DC—America’s taxpayers could see nearly $5.9 billion in misspent Medicare, Medicaid, and other health and human service program dollars returned to the government as the result of fiscal year 2019 work by the Department of Health and Human Services, … Read More
Why OIG Did This Review Outlier claim payments are based on hospital cost reports from the latest cost-reporting period for which the cost report is either settled as final or tentatively settled. The Centers for Medicare & Medicaid Services (CMS) … Read More
BEAUMONT, Texas — A Beaumont counselor pleaded guilty Friday in federal court to health care fraud after overbilling Medicaid nearly $270,000. Douglas Duane Franklin, 59, pleaded guilty before U.S. Magistrate Judge Zack Hawthorn on Friday according to a news release … Read More
The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving orthotic braces and other medical equipment. Scammers are offering Medicare beneficiaries orthotic braces that are supposedly free to them … Read More
This fall edition of the Semiannual Report to Congress covers OIG activities from April 2018 through September 2018. Historically, about 80 percent of OIG’s resources are directed to work related to Medicare and Medicaid. This is mirrored in the organization … Read More
New York may have improperly claimed reimbursement for 7,650 dental services totaling $1.3 million ($670,000 Federal share). Of these, 712 claims, totaling $66,000 ($34,000 Federal share), were for Medicaid fee-for-service dental services and 6,938 claims, totaling $1.3 million ($635,000 Federal share), … Read More
October 24, 2018 – Two recent advisory opinions from the Office of the Inspector General (OIG) at HHS are demonstrating why current healthcare fraud and abuse laws are not aligned with value-based payment and care delivery. The federal watchdog recently … Read More
An indictment was unsealed today charging the owner and sole practitioner of a medical clinic with conspiracy to illegally distribute prescription drugs, U.S. Attorney Matthew Schneider announced today. Schneider was joined in the announcement by Special Agent in Charge Timothy … Read More
OIG recognizes Protecting HHS Data, Systems, and Beneficiaries from Cybersecurity Threats as a top management and performance challenge facing HHS. In partnering with various HHS agencies to address this challenge, OIG has formed a multidisciplinary Cybersecurity Team comprised of auditors, … Read More
A Houston psychiatrist was sentenced today to 150 months in prison for his role in a $155 million Medicare fraud scheme involving false and fraudulent claims for psychiatric services. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal … Read More
Attorney General Ken Paxton commended the Medicaid Fraud Control Unit of his office for its role in the arrests of 12 Houston-area individuals as part of the largest health care fraud enforcement action in American history. Attorney General Paxton’s Medicaid … Read More
January 17, 2018 – Law enforcement agencies and federal healthcare administrators including HHS, the Office of the Inspector General (OIG), the FBI, and US Attorney’s Offices across the country investigated provider healthcare schemes that defrauded Medicare and Medicaid more than … Read More
Federal taxpayers may have forfeited at least $1 billion because a slate of drugs were misclassified under Medicaid’s rebate program, the Health and Human Services’ chief watchdog said Wednesday. HHS’ inspector general said the vast majority of the tens of … Read More
If he’s confirmed as the next secretary of the Department of Health and Human Services, Alex Azar will have his hands full. The Office of Inspector General has identified 10 management and performance challenges that the HHS faces across all … Read More
A relatively new Medicaid health homes program has caught the eye of a health-care watchdog, with a report expected by fiscal year 2019.The Health and Human Services Office of Inspector General will review an optional Medicaid benefit that creates health … Read More
Medicaid agencies are having a difficult time imposing payment suspensions on providers against which there is credible allegation of fraud, according to a new government watchdog report. The report (PDF), from the Department of Health and Human Services’ Office of … Read More
Virginia has not adequately secured its Medicaid data and information systems, according to an HHS Office of Inspector General report.The Virginia Department of Medical Assistance Services, which manages the state’s Medicaid program, uses an outside contractor to operate its claims … Read More
Each year the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) releases its annual Medicaid Fraud Compliance Performance Report. There is much to learn from this compendium of information provided by 50 Medicaid Fraud … Read More
The Texas Health and Human Services Commission did not always claim Federal Medicaid reimbursement for managed care payments in compliance with Federal requirements. Of the 3,170 beneficiary matches in our review, 3,045 were assigned more than 1 Medicaid identification number. … Read More
Medicaid Fraud Control Units delivered nearly $1.9 billion in recoveries in fiscal year 2016, according to a new data set and interactive map released Monday by federal officials. The data and the map, put out by the Office of Inspector … Read More
For the last several years, TDMR has provided contact information on its website for reporting Medicaid fraud, waste and abuse to both state and federal healthcare authorities. From the links provided on practically every page of our website, anyone could go … Read More
The following is a statement received from MB2 Dental Solutions, the Dallas-area dental service organization, that recently settled with federal and state authorities for a whopping $8.45 million over allegations of Medicaid fraud. A company representative told us that they … Read More
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program) under the joint direction of the Attorney General and the Secretary of the Department of Health … Read More
New Jersey improperly claimed at least $94.8 million in Medicaid reimbursement claims, according to a recent estimate from HHS’ Office of Inspector General. Out of 100 claims from a random sample OIG investigated, 92 did not comply with federal or … Read More
The North Carolina Department of Health and Human Services (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services that did not comply with Federal or State requirements. Of the 200 sample items, 82 complied with Federal … Read More
The Audit division of the Health and Human Services Office of Inspector General released a report at the end of October (although TDMR just received the email notification about it today) about an audit they conducted on the practice of … Read More
The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a New York City dentist that did not comply with certain Federal and State requirements. Of the 100 randomly selected claims that we reviewed, … Read More
A recently published proposed rule expands the functions and responsibilities of state Medicaid Fraud Control Units (MFCUs). The rule was issued by the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) on Sept. 20 … Read More
Significant and persistent compliance, payment and fraud vulnerabilities exist within the Medicaid program that covers home care for elderly and disabled people, according to a recent report from HHS’ Office of Inspector General. In the report, the OIG highlighted some … Read More
AGENCIES: Office of Inspector General (OIG) and Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed rule would amend the regulation governing State Medicaid Fraud Control Units (MFCUs or Units). The proposed rule would incorporate … Read More
HHS’ Office of the Inspector General has released its Medicaid Fraud Control report for fiscal year 2015. Below are six findings from OIG’s report: 1. In FY 2015, combined federal and state expenditures for the Medicaid fraud control units totaled … 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 (MFCU or Unit). This MFCU Fiscal Year (FY) 2015 Annual Report highlights statistical achievements … Read More
Hospitals in the Dallas-Fort Worth region were overpaid by $27 million in federal funds to provide health care for the uninsured, according to a new order from the Obama administration, which is threatening to take the money back. Federal health … Read More
