The Illinois General Assembly opted to expand Medicaid through Obamacare in May 2013. This expansion created a new Medicaid category for able-bodied adults ages 19-64 with incomes below 138 percent of the federal poverty level. But the Medicaid program was … Read More
The Office of Audit Services of the HHS-OIG released a report today that they found Florida’s Agency for Health Care Administration was paying state MCOs their capitation rate for deceased Medicaid beneficiaries. They estimated that “these overpayments amount to approximately 2 … Read More
At 59 years old, Bill Miller is starting to have neck and back problems. Thirty-two years of bending over to check patients’ teeth and gums will do that, he said.Miller is the only dentist in Hill City, a community of … Read More
A Charlotte woman was sentenced in federal court this week to 16 years in prison for orchestrating an $11 million Medicaid fraud scheme, authorities said Thursday.Cynthia Teresa Harlan, 49, was sentenced Wednesday following a July conviction on one count each … Read More
The three for-profit companies managing Iowa’s Medicaid program continue to lose tens of millions of dollars on the project, a report released Wednesday shows.The companies, Amerigroup, AmeriHealth Caritas and UnitedHealthcare, reported losses ranging from 18 percent to 25 percent for … Read More
Operators of two Fort Defiance medical transportation companies have been sentenced to prison for health-care fraud after collecting more than $3 million from a government health program for thousands of trips that never occurred, federal prosecutors said.Sylvia Begay, 50, who operated Hozho Nahasdlii … Read More
A nursing home chain’s lawsuit against the state of Kansas hinges largely on the state’s failure to implement an electronic system to verify the assets of people applying for Medicaid. But Kansas is far from the only state to fall … 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
Zwanger-Pesiri Radiology will pay more than $10 million in a settlement over Medicare and Medicaid fraud the firm committed.Attorney General Eric T. Schneiderman and United States Attorney Robert L. Capers announced Wednesday that Zwanger & Pesiri Radiology Group, LLP, Zwanger … Read More
Massachusetts auditor Suzanne Bump’s office identified $15.45 million in public benefits fraud in fiscal 2016, a 12 percent increase over last year, according to an annual report released Tuesday.”This is not an indication of more fraud, but that we are … Read More
RICHMOND — A new report suggests that when it comes to oral health, Virginia has room for improvement. The state earned a C+ on a new report card released by the Virginia Oral Health Coalition, which was compiled by examining data … Read More
A metro Atlanta dentist has pleaded guilty to defrauding the Georgia Medicaid program of nearly $1 million. Dr. Oluwatoyin Solarin, who had offices in Doraville and Duluth, had some employees of her Care Dental practice back-date claims for patients whose … 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
No sooner had Donald Trump shocked the political world by winning the presidency than Texas Republicans turned to a new discussion: How much influence will the Lone Star State have in the next White House? Throughout his campaign, Trump cultivated … Read More
Medicaid Commissioner Stephanie Azar urged lawmakers not to abandon a plan to change to a system of managed patient care, a sweeping change that might be in jeopardy because of uncertain funding. The Legislature’s contract review committee today temporarily blocked … 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
MIAMI (AP) — A fall 2017 trial date is set for a South Florida businessman accused of orchestrating a $1 billion Medicare and Medicaid fraud scheme.Court records show a Miami federal judge on Wednesday scheduled 48-year-old Philip Esformes’ trial for … Read More
PULASKI COUNTY (KATV) — A 33-year-old Malvern woman was arrested for more than $700 in Medicaid fraud. Marquita Morgan faces a charge of Medicaid fraud. She is accused of billing more than $700 for services she didn’t receive in 2015, … Read More
There is a rumor circulating that the Texas Health and Human Services Commission is putting together a new request for proposals (RFP) for dental managed care organizations for Texas Medicaid. While this may or may not be the case as … Read More
A group of physicians from around the state is suing federal health officials over a regulation that requires the doctors to repay some Medicaid reimbursements. Twenty-one primary care doctors are challenging how the U.S. Centers for Medicare and Medicaid Services … Read More
Even as the share of children in Texas without health insurance continues to decline, the state still has nearly twice the national average, according to a new study. A Georgetown University Center for Children and Families report released Thursday found that Texas … Read More
SANTA FE, N.M. New Mexico is pursuing federal authority to charge medical co-payments and some other costs to patients enrolled in Medicaid health care for the poor and disabled, the state Human Services Department secretary told lawmakers on Wednesday.Secretary Brent … Read More
GRAND RAPIDS, MICH. (WZZM) – A former state lawmaker who pleaded guilty to health care fraud “considered himself beyond all reproach as a physician,’’ federal prosecutors said in asking that he be sentenced like any other person convicted of “serious … Read More
States are beginning to turn to hospitals to cover the cost of Medicaid expansion once the federal match begins to drop next year.The Affordable Care Act provides 100% federal financing for those made newly eligible for Medicaid under the law. … Read More
A Valdosta dentist pled guilty to one count of health care fraud Friday morning.According to the United States Attorney’s Office for the Middle District of Georgia, Dr. Stanley Marable billed Medicaid nearly $800,000 for teeth extraction that he did not … Read More
PULASKI COUNTY (KATV) — A 49-year-old Conway woman was arrested accused of $3,500 in Medicaid fraud.Georgia Broady faces one count of Medicaid fraud. The arrest was announced by Arkansas Attorney General Leslie Rutledge. Source: Conway woman arrested for $3,500 in … Read More
Access to dental care appears to be a struggle for Central Oregon’s Medicaid patients, according to a new report based on surveys from about 3,900 members.The region’s coordinated care organization, the group that takes in state funding and uses it … Read More
A decadent, eight-bedroom mansion with its own water park in the backyard is hitting the market for $32million. You’d be forgiven for thinking the manor was owned by a European lord in the French countryside, but the Dallas, Texas, estate … Read More
ATLANTA–(BUSINESS WIRE)–Amerigroup Community Care, a Georgia statewide provider of Medicaid managed care services, has partnered with DentaQuest to launch Dental Home services to its members. The Patient-Centered Dental Home model connects each member to a personal dentist who leads a … Read More
It all started with a battle over information: In one corner was the Texas Health and Human Services Commission. In the other were Texas lawmakers. The commission holds the details of the state’s Medicaid contracts with large pharmaceutical companies, which show … Read More
Two of Tenet Healthcare Corp.’s former subsidiaries admitted to conspiring to defraud Medicaid by using referral contracts for translation services to funnel pregnant patients through their doors.Atlanta Medical Center and North Fulton Hospital in Georgia each pled guilty to one … Read More
Nearly 300 East Texas children with disabilities who are part of the state’s Early Childhood Intervention program have no one to provide them with medically necessary therapies after the region’s lone provider closed its doors this week in response to hefty budget cuts … Read More
The Alaska Department of Health and Social Services has settled its complaints with Xerox over management of Medicaid claims, resetting its health-care contract with the business giant for an agreed-upon series of performance standards.The state’s claim against Xerox State Healthcare … Read More
The president of the Kansas Dental Association said he has stopped taking patients from two of the state’s three KanCare insurance companies because of a 4 percent Medicaid reimbursement cut initiated by Gov. Sam Brownback’s administration. John Fales, a pediatric … Read More
In a quick action on Monday, the three counts of alleged Medicaid fraud against the former owner of Bluegrass Autism in Danville were dismissed amid allegations of misconduct by an attorney general’s office investigator. Judge Darren Peckler granted the request … Read More
The state of West Virginia accused Mylan NV of Medicaid fraud for inflating the price of the EpiPen by 500 percent and has asked the company to turn over documents related to Medicaid reimbursements. Heather Bresch, Mylan’s chief executive officer, … Read More
A few changes are coming soon for Medicaid patients in Missouri after another veto was overturned, this one concerning health. Senate Bill 608 might not have been one of the hot topics during this year’s veto session, but certainly is one that … Read More
Texas lawmakers on Thursday revisited the fate of a $150 million cut in state funding to Medicaid payments for disabled children’s therapy made in 2015 — though the outcome of that cut remains uncertain as a legal battle over its … Read More
A federal judge faulted the state Medicaid program in a strongly worded order, ruling the program had improperly denied 2,000 out-of-network emergency claims submitted by a nonprofit health care provider that treated indigent children.U.S. District Judge Keith Ellison ruled last week that the state … Read More
