At the the start of a new year, it’s traditional to hope for changes that would improve on last year. And yet, some very dysfunctional aspects of our lives are bound to stay the same, even deteriorate — and the same happens to be true … Read More
AUSTIN — The White House’s signature health care law is loathed by Texas’ political leadership, and the idea of expanding Medicaid likely remains a non-starter when the Legislature reconvenes this month. But Gov.-elect Greg Abbott and many top conservatives support … Read More
When investigators suspected that Houston’s Riverside General Hospital had filed Medicare claims for patients who weren’t treated, they moved to block all payments to the facility. Then politics intervened. Rep. Sheila Jackson Lee, a Texas Democrat, contacted the federal official … Read More
WHY WE DID THIS STUDY Examining access to care takes on heightened importance as enrollment grows in Medicaid managed care programs. Under the Patient Protection and Affordable Care Act, States can opt to expand Medicaid eligibility, and even States that … Read More
CMS Attempts to Curb Medicare Fraud The Centers for Medicare and Medicaid Services (CMS) is issuing new rules to help prevent Medicare fraud and abuse by barring physicians with unpaid debt from re-entering the system and ejecting providers who have … Read More
Texas and the federal government tentatively resolved a high-stakes health care funding inquiry on Monday, averting a major disruption to hospital funding. The Texas Health and Human Services Commission and the federal Centers for Medicare and Medicaid Services reached the … Read More
The State agency complied with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud. In addition, the Surveillance and Integrity Review Section implemented its policies and procedures to address … Read More
First Annual Recovery to Exceed $5 Billion; Over 700 Whistleblower Lawsuits for Second Consecutive Year The U.S. Department of Justice obtained a record $5.69 billion in settlements and judgments from civil cases involving fraud and false claims against the government … Read More
One of the nation’s largest nursing home chains will pay $38 million to settle federal claims that the company inappropriately billed for physical therapy and provided poor care that was “effectively worthless,” the Department of Justice reported. The agreement reached … Read More
Medicaid has long been the second biggest drain on Illinois taxpayers behind the public-pension crisis – mostly due to the fact that more than half (51.3%) of state Medicaid recipients were ineligible to receive it, according to previous audits . In fact, … Read More
This past week, the Texas Health and Human Services Commission published on their website a circular about the process for audits being done by the Centers for Medicare and Medicaid Services (CMS) on Medicaid providers in Texas. All Medicaid providers in … Read More
Federal officials are planning a wide range of audits into billing and government spending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly expanding under … Read More
On October 22, 2014, the Department of Justice (DOJ) announced that DaVita Healthcare Partners, Inc. (DaVita), a provider of dialysis services, has agreed to pay the U.S. Government $350 million for allegedly violating several provisions of the False Claims Act … Read More
Oct 27 (Reuters) – The United States on Monday joined a lawsuit accusing New York City and Computer Sciences Corp of defrauding Medicaid into making millions of dollars of improper reimbursements by exploiting a computerized billing system that the company … Read More
ANCHORAGE – An Anchorage personal-care provider was raided by federal agents Tuesday night, as part of a joint investigation with state prosecutors into alleged Medicaid fraud at the facility. Kevin Donovan, assistant special agent in charge of the FBI’s Anchorage … Read More
The federal government wants Texas to pay back more than $30 million for incorrectly claimed Medicaid reimbursements. An audit to be released Wednesday by the Office of Inspector General within the U.S. Department of Health and Human Services describes how … Read More
Last Updated: Tuesday, 21 October 2014 06:10 Read Complete Document (pdf, 522.97 KB) October 20, 2014 – Observers often cite fraud as an important contributor to high health care spending, particularly in federal programs. This report describes how CBO estimates the … Read More
A Florida managing member of a shell company pleaded guilty today in federal court in Tampa, Florida, for his role in a multi-million dollar health care fraud and money laundering scheme. Assistant Attorney General Leslie R. Caldwell of the Justice … Read More
October 13, 2014 — Last week, three Federal Trade Commission (FTC) staff members responded to an invitation for public comments on two rules proposed by the Texas State Board of Dental Examiners with a letter addressed to Simone Salloum, assistant … Read More
Summary Some of the New York State Department of Health’s (Health Department) claims for Federal Medicaid reimbursement for supported employment services did not comply with certain Federal and State requirements. On the basis of our sample results, we estimated that … Read More
The owner of a home health services company was sentenced to serve five years in prison for his leading role in a conspiracy to structure over $1.8 million in bank withdrawals to conceal a $4.5 million healthcare fraud scheme. Assistant … Read More
A New Orleans grand jury today indicted seven defendants for their roles in a $56 million Medicare fraud scheme that operated in New Orleans and surrounding communities. Thirteen defendants have now been charged in this case, three of whom pleaded … Read More
ATLANTA, GA – The United States Attorney’s Office announced it has reached settlements with Banks-Jackson-Commerce Hospital and Nursing Home Authority d/b/a Banks Jackson Commerce Medical Center (BJC) and Dr. Narasimhulu Neelagaru that total over $500,000. “Kickbacks pervert our health care … Read More
The former owner of a Long Beach, California, medical supply company was sentenced today to serve 30 months in prison and ordered to pay $1,490,532 in restitution for his role in a scheme to provide unnecessary power wheelchairs to Medicare … Read More
NORFOLK, Va. – W. Wayne Perry, Jr., 55, and his wife, Angela Perry, 52, formerly of Suffolk, Va., were convicted after a three-week trial late yesterday afternoon by a federal jury of one count of conspiracy to commit health care … Read More
WASHINGTON – Lewis J. Levine, 57, a chiropractor who practiced in Southeast Washington, pled guilty today to a federal charge of health care fraud for his role in a scheme involving fraudulent claims to the District of Columbia Medicaid program. … Read More
Preet Bharara, United States Attorney for the Southern District of New York, announced today that AKIM MURRAY, an employee of the Medicaid Reimbursement Unit of the New York City Human Resources Administration “HRA”, pled guilty before U.S. District Judge Richard … Read More
Funding creates an estimated 4,750 new jobs; Helps newly insured access care Health and Human Services Secretary Sylvia M. Burwell announced today $295 million in Affordable Care Act funding to 1,195 health centers in every U.S. State, the District of … Read More
Signed into law in 1965, Medicaid ensures health coverage for nearly 60 million Americans today. Since the Medicaid program was established, the costs and responsibilities for administering it have been shared between the States and the Federal Government. However, a … Read More
The Louisiana Department of Health & Hospitals State agency did not always pay Medicaid electronic health record EHR incentive payments in accordance with Federal and State requirements. The State agency made incorrect EHR incentive payments to 20 hospitals totaling $4.4 … Read More
Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, announced today that on September 3, 2014, Christopher Spivey, 30, pled guilty to submitting false and fraudulent bills in relation to personal assistant services in the Home Services … Read More
Data mining is the process of identifying fraud through the screening and analysis of data. On May 17, 2013, the Department of Health and Human Services (HHS) issued the final rule "State Medicaid Fraud Control Units; Data Mining" (78 Fed. … Read More
HOUSTON—Andrea Michelle Tellison, 47, has been ordered to federal prison for eight years following her convictions of 14 counts of health care fraud and seven counts of aggravated identity theft, announced United States Attorney Kenneth Magidson. A jury convicted Tellison … Read More
Department of Justice Office of Public Affairs FOR IMMEDIATE RELEASEWednesday, August 20, 2014 Michigan Home Health Agency Owner Pleads Guilty to Participating in $22 Million Medicare Fraud Scheme A greater Detroit-area owner of three home health agencies pleaded guilty today … Read More
The former owner of a Los Angeles medical clinic management company pleaded guilty today in connection with his role in a scheme to defraud Medicare. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney … Read More
Texas is “ultimately responsible” for millions of misspent Medicaid dollars, according to a new federal audit, because a state agency failed to properly oversee the contractor that reviewed the medical necessity of Medicaid claims. For nearly five years, the Texas … Read More
Not all of the Medicaid direct medical service costs that the Kansas Department of Health and Environment, Division of Health Care Finance (State agency), claimed for school-based health services (SBHS) were reasonable, adequately supported, or otherwise allowable in accordance with … Read More
The Nebraska Department of Health and Human Services, Division of Finance and Support (State agency), did not always comply with Federal Medicaid requirements for billing drug manufacturers for rebates for physician-administered drugs. To collect these rebates, States submit to the … Read More
Last Wednesday, the Department of Health and Human Services, Office of Inspector General released the results of its long anticipated audit of Texas Medicaid orthodontic spending. The feds conducted the audit because Texas Medicaid payments for orthodontic services rose from … Read More
The Idaho Department of Health and Welfare (State agency) did not ensure that Molina Medicaid Solutions (Molina) implemented adequate information system general controls over the State agency’s Medicaid Management Information System (MMIS). We identified 21 reportable weaknesses, which we consolidated … Read More
