Subpar provider enrollment screening processes continue to plague Medicare and Medicaid, leaving both programs vulnerable to fraud and contributing to nearly $90 billion in improper payments in 2015, according to testimony during a House subcommittee hearing. In her testimony Tuesday, Ann … Read More
Bolstered by the federal health care law, the number of lower-income kids getting health coverage continues to rise. During 2014, the first full year of the law’s implementation, 91 percent of children who were eligible for Medicaid or the Children’s … Read More
Picture yourself as a physician, health care administrator, or nurse. The government initiates a False Claims Act (FCA) investigation and you (or your company), as a provider, commence an immediate internal investigation. The findings are brought to the government, you … Read More
Since 2012, there have been a large number of outstanding but here-to-date sealed False Claims Act lawsuits against Texas dentists who billed Medicaid for orthodontic treatment from 2007 to 2011. Some are known and high profile but there are 46 pages … Read More
Four federal lawmakers from New Mexico – Sen. Martin Heinrich, Sen. Tom Udall, Rep. Ben Ray Luján and Rep. Michelle Lujan Grisham – filed a bill last week to guarantee due process rights to Medicaid providers across the country who are … Read More
When agencies that receive Medicaid reimbursements are accused of fraud, it can impact that provider as well as its patients for months at a time—regardless of whether any parties are ever found guilty.Four U.S. lawmakers recently introduced a bill meant … Read More
Commentary: U.S. Sens. Tom Udall and Martin Heinrich, and U.S. Reps. Ben Ray Luján and Michelle Lujan Grisham introduced the Medicaid Program Integrity Enhancement Act of 2016. The bill protects Medicaid patients by establishing clear guidelines that ensure that state agencies investigating … Read More
Last year, the Medicaid program celebrated its golden anniversary. A lot has changed over the last 50 years. Originally created in 1965 as a joint federal-state program to provide health care coverage for low-income, vulnerable Americans, it is now the … Read More
Republican presidential front-runner candidate Donald Trump on Wednesday unveiled proposals for reforming U.S. healthcare that included repealing Obamacare, allowing prescription drugs to be imported, and turning the Medicaid program for the poor into block grants to states. The plan also … Read More
Law360, Washington (March 2, 2016, 7:46 PM ET) — The U.S. House of Representatives on Wednesday unanimously passed a bill, with the backing of the White House, intended to ensure Medicaid providers terminated for fraud or quality issues in one … Read More
Six individuals, including two Dallas-area doctors, were charged in a superseding indictment that was unsealed today for their alleged participation in a $13.4 million health care fraud scheme involving fraudulent claims for home health services. Assistant Attorney General Leslie R. … Read More
In the five years he served as U.S. Attorney for the Eastern District of Tennessee, Bill Killian oversaw dozens of healthcare fraud cases. By the time he resigned from his post Dec. 5, Killian’s district had collected more than $200 million … Read More
One of the least well-understood scandals of the Obama era is the effort to cripple the auditing system for Medicare payments, allowing sectors of the healthcare industry that helped get Obamacare passed into law to reap billions of dollars in … Read More
WASHINGTON—The co-owners of a home health company in Dallas and two nurse employees were charged in an indictment unsealed yesterday for their alleged participation in a $13.4 million health care fraud scheme involving fraudulent claims for home health services. Assistant … Read More
PLANO, TX—A Denton County, Texas, nurse has been convicted of 9 counts of health care fraud in the Eastern District of Texas, announced U.S. Attorney John M. Bales today. Florence Kroma a/k/a Florence Kamara a/k/a Florence Koroma a/k/a Florence Bangura, … Read More
The Centers for Medicare & Medicaid Services (CMS) knew as far back as 2008 that certain Medicare Advantage plans were pocketing billions in overpayments, but officials still held back on auditing the plans and recouping payments tied to inflated risk … Read More
In the latest government blow against rampant Medicare fraud, two doctors and a registered nurse in New Orleans were given stiff prison sentences and millions of dollars in fines this week in federal court for their roles in a long-term $50 … Read More
HHS says few states have taken it up on an offer to receive federal funding for data-mining, which would allow their Medicaid fraud units to search claims. States say they don’t need it, even though the improper payment rate has … Read More
HOUSTON – Regent Management Services L.P. has agreed to pay approximately $3.199 million to settle allegations that it received kickbacks from various ambulance companies in exchange for rights to its more lucrative Medicare and Medicaid transport referrals. Several government officials, … Read More
Republicans are openly feuding over whether to seek drastic changes to Medicare, Social Security and other entitlement programs, risking a potentially damaging intraparty battle ahead of the 2016 elections. The rift was exemplified this week by the GOP stars of … 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
The Obama administration just announced that fighting Medicaid fraud is going to be a “key priority” for the final year of the president’s term. That’s a tall order. Last year, the program lost more than $17 billion to fraud. That’s … Read More
Washington, DC – The nation’s second-largest nursing home pharmacy, PharMerica Corp., has agreed to pay $9.25 million to resolve allegations that it solicited and received kickbacks from pharmaceutical manufacturer Abbott Laboratories in exchange for promoting the prescription drug Depakote for … 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
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
TYLER (KYTX) – Law enforcement officers in East Texas have arrested multiple individuals charged in a Medicare fraud scheme.A federal grand jury returned an 18-count indictment charging 12 individuals with Three Angels Home Heath, Inc., in a scheme to defraud … Read More
WASHINGTON, D.C. — Three in four Americans (75%) last year perceived corruption as widespread in the country’s government. This figure is up from two in three in 2007 (67%) and 2009 (66%). Source: 75% in U.S. See Widespread Government Corruption Gallup
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
Costs almost always spiral higher on big government projects because of “deception and mismanagement” by Congress, federal managers and contractors, according to scholars at the Cato Institute. “Cost overruns on large government projects are pervasive,” wrote Chris Edwards and Nicole … 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
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
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
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
On the streets of Managua, the shuttle bus wrapped in a giant ad for free health care stood out. “Medicare for people living abroad,” it proclaimed above the image of a cheerful older woman playing golf. But Medicare, the American … Read More
The CMS has awarded SafeGuard Services a contract worth up to $300 million to help prevent and identify Medicare fraud. SGS is a subsidiary of Hewlett-Packard Enterprise Services and performs data analysis, investigations and medical reviews to detect, prevent, deter … Read More
DALLAS – Alexis C. Norman, 47, of Midlothian, Texas, appeared in federal court this morning before U.S. Magistrate Judge David L. Horan and pleaded guilty to one count of health care fraud, announced John Parker, U.S. Attorney for the Northern … Read More
The transition from a reactive approach to relying on claims data to better predict and prevent fraudulent payments has led to significant progress in fighting Medicare and Medicaid fraud, former Centers for Medicare & Medicaid Services (CMS) Administrator Don Berwick told the … Read More
What GAO Found GAO identified four key issues facing the Medicaid program, based on prior work. Access to care : Medicaid enrollees report access to care that is generally comparable to that of privately insured individuals and better than that … Read More
