States are wasting millions of taxpayer dollars under ObamaCare by failing to regularly check the eligibility of recipients under the law’s massive Medicaid expansion, critics say. Source: States wasting millions by keeping ineligible recipients on ObamaCare’s Medicaid rolls, critics say … Read More
While the Medicaid Recovery Auditor (RAC) program has continued to struggle to return funds to the Medicare program, state Medicaid Fraud Control Units (MFCUs) continue to see significant financial returns. Released at the end of April, the U.S. Department of … Read More
A Topeka man was ordered yesterday to repay the Kansas Medicaid program for charges relating to home health care fraud, Kansas Attorney General Derek Schmidt said. Source: Topeka man to repay Kansas Medicaid program for home health care fraud
A Pullman dentist will serve 90 days in the Latah County Jail after being convicted of intentionally submitting false claims to Idaho Medicaid for dental work he did not provide. Alfred Fairbanks, 69, was sentenced to five years in prison, … Read More
Senate Bill 207 which details legislative reforms to be made to the structure and function of the Health and Human Services Commission Office of Inspector General as recommended by the Sunset Advisory Commission has cleared the Texas Senate and is set … Read More
CARSON CITY — An audit of the state Medicaid program released Monday identified more than $1 million in overpayments and improper billings. Legislative Counsel auditors identified $780,000 in overpayments for behavioral health claims, and $285,000 in overpayments and improper billings … Read More
This past week, the Texas Health and Human Services Commission in its monthly In Touch newsletter announced that Deputy Executive Commissioner Chris Traylor is retiring as of May 31st. Traylor has been in the Texas public service for 25 years … Read More
U.S. Also Elects to Intervene Against Novartis Pharmaceuticals Corporation in Claims that Novartis Gave Kickbacks to Accredo in Exchange for Increased Refills of Exjade Drug, and Understated Exjade’s Serious and Potentially Life-Threatening Side Effects to Patients Accredo Admits to Conduct … Read More
In June 2014, Phil Hermanson resigned as the KanCare inspector general, amid scrutiny of his lack of experience, past bankruptcy and driving under the influence. The resignation brought an end to one saga only to begin another, more protracted one. … Read More
After years of criticism that it is soft on fraud, the Minnesota Department of Human Services has dramatically intensified efforts to combat illegal overbilling in the state’s publicly funded health insurance program Source: Minnesota’s crackdown on Medicaid fraud yields millions … Read More
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
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
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
Yesterday, the Texas Senate passed and sent down to the House of Representatives Senate Bill 207, the bill setting out much needed reforms to the Health and Human Services Commission Office of Inspector General that came out of the Sunset … Read More
The U.S. Department of Health and Human Services Office of Inspector General issued a report today detailing the cumulative efforts of state Medicaid Fraud Control Units in dealing with Medicaid fraud, waste and abuse in 2014. Pharmaceutical settlements are largest … 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
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
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
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
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
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
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
Law360, Dallas (April 03, 2015, 3:38 PM ET) — A Texas appeals court on Thursday dismissed defamation claims against AOL Inc. and a reporter brought by a Dallas-area dentist who claimed an online article falsely represented to the public that … Read More
John Keel, the Texas State Auditor, just issued his report on the Health and Human Services Commission, its Office of Inspector General and their controversial and scandal-laden, no-bid acquisition of Medicaid fraud detection software from Austin firm 21CT. Workplace not … Read More
Two El Paso dental clinics are involved in a multimillion dollar lawsuit settlement.Smile Magic Dental Clinic was accused of defrauding Texas Medicaid. In March, they were ordered to pay $4.5 million to thestate as a settlement.Four offices were named in … Read More
Medicaid scam arrests in New York City have revealed an elaborate scheme of false Medicaid billings – all in a shameless exploitation of the indigent who needed shoes. In the indictment this week, investigators said that between October 2012 and … Read More
You have to feel for the healthcare fraudsters out there. It’s not as easy as it once was to rake in millions of insurance dollars on false claims scams. These days, you really have to work for your money–or at … Read More
Over the past year, false claims prosecution under the “worthless services” theory has picked up traction. Now that the Department of Justice (DOJ) plans to simultaneously prosecute civil and criminal whistleblower claims, this legal approach may take on an even larger … Read More
An advisory opinion released last week by the U.S. Department of Health and Human Services Office of Inspector General (OIG) advises labs not to enter exclusive agreements with physician practices that would cover patient fees for certain insurance plans. This … Read More
WHITLEY COUNTY, Ky. (WKYT) – A Whitley County dentist entered a plea in a Medicaid fraud case. The State Attorney General says Ronald Hungerbuhler billed medicaid for dental exams he should have performed on patients at a local nursing home, … Read More
Recent stories in the news seem to suggest that health care fraud is running rampant. We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in Greensboro for alleged Medicaid fraud, and, … Read More
Ohio’s Medicaid office searched for ways to continue paying hundreds of healthcare services providers after uncovering "credible allegations of fraud," violating the Affordable Care Act. The state agency came up with "good cause" to continue funneling money to providers strongly … Read More
Good morning, Mr. Chairman and distinguished Members of the Subcommittee. Thank you for the opportunity to testify about fraud, waste and abuse in our Medicare program. My experience working in law enforcement and private practice has taught me that, notwithstanding … Read More
The State agency did not always comply with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud between July 1, 2011, and June 30, 2013. Of the 401 cases … Read More
