A document received from an open records request filed in early September shows that the Civil Medicaid Fraud division of the Office of Attorney General (OAG) has expended some 20,953 staff legal hours against 16 dentists and dental practices accused … Read More
Congress and the President have two months to hammer out a budget before the country teeters on another fiscal cliff. One big issue is the $85 billion in spending cuts on defense and domestic programs imposed by the sequester. Some … Read More
HOUSTON—The owner and operator of Elite P Care Medical Services has been convicted of conspiracy to commit health care fraud and health care fraud in a $1 million fraud scheme, announced United States Attorney Kenneth Magidson. Verona Spicer, 46, pleaded … Read More
EDINBURG — The new head of the state health agency’s investigative division visited with stakeholders in Hidalgo County Wednesday to learn about local healthcare issues and promote his vision. Stuart Bowen Jr., inspector general for the Texas Health and Human … Read More
With more large-scale, multi-million dollar fraud schemes surfacing across the country, enforcement officials are utilizing Medicare Fraud Strike Force teams to dismantle entire fraud operations. Source: Anatomy of a fraud bust: Collaboration creates efficiency
Hawaii’s Medicaid Fraud Control Unit is costing 10 times as much to operate as it is in exposing waste, fraud and abuse in the federal health care program for the poor and disadvantaged, according to a new report from the … Read More
A Lincoln pharmacist tearfully pleaded guilty Tuesday to health care fraud, admitting he bilked Nebraska’s Medicaid program of $14.4 million in what is believed to be the largest such fraud Source: Lincoln pharmacist pleads guilty to possibly state’s biggest Medicaid … Read More
The most successful Medicare Fraud Strike Force sent health care scammers scurrying all over the country — but hasn’t come close to running out of cases on its own turf. The Southern District of Florida accounted for 18 percent of health care … 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
Attorney General Pam Bondi’s Medicaid fraud control unit and the Altamonte Springs Police Department said they arrested Orange County dentist Dr. Merys Downer-Garnette on Thursday. Downer-Garnetted is accused of billing double-billing for services not rendered, totaling more than $5,500 in … Read More
McALLEN—A 28-year-old ambulance company owner accused of submitting more than $1 million in fraudulent claims to Medicare and Medicaid was convicted Tuesday after pleading guilty before a federal court judge. Victor Lee Gonzalez, the owner of Vic’s Texas Transport Inc., … 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
Former Texas health commission lawyer Jack Stick, found guilty Monday of driving while intoxicated, will be sentenced within the next two weeks, but no final date has been set, Travis County court officials said Tuesday. The former state representative and … 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
UPDATE: Stick has been sentenced to six days in jail. The man who famously carried a toy stuffed wolf into informal resolution meetings with Medicaid providers and quipped that he could “find a program violation on Jesus Christ” if Jesus … Read More
A Travis County jury on Monday convicted former state representative and Texas Health and Human Services general counsel Jack Stick of drunken driving, the latest chapter in year of problems for the former prosecutor and state lawmaker. Stick, 49, was … 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
More than three years after he was originally arrested, Jack Stick, a former state representative and previous inspector general for the Texas Health and Human Services Commission, went on trial Friday for a drunk-driving charge he has fiercely contested in … 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
What’s the first thing that comes to mind when you think about Coca-Cola? Is it the dozens of executives who reside in the company’s corporate offices? Or do you think about polar bears?Unless you are one of those corporate executives, … Read More
On Sept. 11, 2015, the House Energy and Commerce Committee’s Health Subcommittee held a hearing, entitled “Strengthening Medicaid Program Integrity and Closing Loopholes,” to discuss six bills related to improving Medicaid program integrity and closing eligibility loopholes in the program. … 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
House Republicans are pushing a slew of bills that attempt to cut back on Medicaid fraud by reforming eligibility and closing loopholes that enable lottery winners to get coverage.But Democrats are concerned that some of the measures could have unintended … Read More
A federal appeals court has upheld a $4.7 million jury verdict against two former officials in the Medicaid fraud unit of the state Attorney General’s office who were accused of presenting false evidence to a grand jury. A unanimous panel … Read More
VANCOUVER, Wash. – A Vancouver dental office is accused of filing around $1 million in false and inflated Medicaid claims over the past five years, the state Attorney General’s office said.The civil lawsuit filed on Thursday alleges that doctors Liem … 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
A three-year-old Washington state law that allows whistleblowers to bring Medicaid fraud lawsuits is working. That’s according to a review by legislative auditors that urges lawmakers to renew the law before it expires next year. Medicaid is a nearly $10 … Read More
Back in May of 2014, the State of Texas terminated Xerox as the state’s Medicaid claims administrator and filed suit against the company. The state is seeking recompense for hundreds of millions of taxpayer dollars paid out by the company for … Read More
From March 2011 through September 2013, Washington failed to suspend Medicaid payments to 48 providers being investigated for credible allegations of fraud, according to a report from the Office of Inspector General. Source: OIG report: Washington needs better policies for suspending providers … Read More
At Texas Senior Medicare Patrol, program director Barbara McGinity regularly hears troubling stories from elderly victims targeted by medical scams. There was the 90-year-old San Antonio woman who wanted to buy a bedside commode and called a company advertising such … Read More
PHOENIX — A prosecutor says an executive who oversaw procurement for the Arizona Medicaid program may have skimmed more than $10 million through an elaborate scheme over the past nine years.A judge on Thursday ordered 63-year-old Michael Veit held on … Read More
Alarmed by the tens of billions of dollars in Medicare and Medicaid fraud and overpayments annually that are draining the federal health care system, the Obama administration has quietly stepped up its auditing and enforcement efforts to crack down on … Read More
Law360, New York (September 3, 2015, 10:12 AM ET) — Recent Office of the Inspector General physician guidance, personnel and budget increases, and a Third Circuit decision, all point to the same thing -— physicians who participate in Medicare and … Read More
Dallas TV station WFAA is losing its long-time, award-winning investigative reporter Byron Harris to retirement. Harris announced a few weeks ago that he would be leaving the station in October, after spending 40 years with WFAA. It goes without saying … Read More
McALLEN — A Pharr woman pleaded guilty Friday for her role in connection with a federal healthcare insurance fraud scheme, prosecutors said. Martha Lidia Flores admitted to engaging in a kickback scheme of exchanging referrals of Medicare beneficiaries for money … Read More
Channel 8’s Byron Harris announced Friday that he’ll retire in October. Ed Bark posted a solid story Monday about the investigative reporter and his 40 years at the TV station. I’d like to go in a slightly different direction. Harris … Read More
Another 100 Florida hospitals — 17 of which are in the Tampa Bay area — will be audited by the state to determine whether they’re receiving more in Medicaid payments than legally allowed, Gov. Rick Scott said Monday. They join … Read More
Empire State Home Care Services has agreed to pay $6 million as part of a settlement with the New York state attorney general to resolve allegations of improper Medicaid billing. Source: Brooklyn Medicaid Fraud Case Settled
Health care fraud is one of the government’s costliest problems. It’s a hall of mirrors where billions of dollars are lost to swindlers looking to cash in on the millions of transactions generated by insurance-paying agencies every day. Last year, … Read More
