Tag: Fraud

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A minor SNAFU points to a much bigger risk.

 
 

From <https://www.providencejournal.com/story/news/politics/2023/03/01/ri-medicaid-rolls-had-hundreds-of-ineligible-state-workers/69958231007/>

 
 

 
 

Katherine Gregg

The Providence Journal

0:14

0:57

PROVIDENCE − At least 369 state employees who make too much money to qualify were nonetheless being carried on the state’s Medicaid health-insurance rolls until January, when a routine data analysis by the auditor general’s office found their state pay exceeded federal income limits.

The discovery of ineligible state workers came to light Wednesday when a Jan. 23 letter from the state’s interim auditor general, David Bergantino, to top state officials was made public for the first time at a legislative hearing.

While a case-by-case analysis “would be time consuming,” Bergantino noted the state pays a monthly fee “ranging from approximately $300 to $900-per-month-per-covered-individual (or more if family coverageis applicable)” even if “their current state employment income makes them ineligible to still qualify for Medicaid.”

The back-and-forth with state Health & Human Services Secretary Ana Novasi and Department of Administration Director James Thorsen did not put blame on the state workers the state was still carrying on its Medicaid rolls.

In fact, the auditor’s letter said: “Many of these individuals are not actively using their Medicaid coverage because they also have health insurance as a state employee.”

But the finding − along with a warning about “operational issues with the critical income validation controls” − led worried lawmakers to question whether Rhode Island was on the brink of another “UHIP debacle.”

“UHIP all over again,” said House Oversight Committee Chairwoman Patricia Serpa, citing the botched 2016 rollout by the Raimondo administration of a new computerized eligibility-verification system that left scores of struggling Rhode Islanders without benefits and others with double payments or letters telling them their very-much-alive children were dead.

Echoed Rep. Michael Chippendale, the House minority leader: “My concern is the bottleneck. You clearly don’t have the staff to handle it…. You guys are going to get buried, 2016-level buried.”

Issue may hint at deeper troubles as COVID public emergency ends

The auditor general’s letter provided the first public look at the kinds of undetected problems state officials may face, starting April 1, when they resume the recertification of Medicaid recipients, a routine process suspended for the duration of the COVID-19 public health emergency.

During the suspension, states were barred from removing people who were ineligible.

Big picture: the state’s numbers-crunchers predicted last November that the number of Medicaid recipients would shrink from 360,000 down to 338,000 when recertification resumed.

Testimony on Wednesday indicated the number of state employees on the original “ineligible” list had been whittled down to 156.

But Bergantino said the deep dive by state auditors found even more basic − and serious − problems that merit “immediate investigation.”

How did these workers end up on the Medicaid rolls?

A Jan. 30 letter put the state on notice: “We identified operational issues with the critical income validation controls and supporting data that are designed within the State’s RIBridges system to prevent individuals that exceed the program income guidelines from being enrolled in Medicaid.”

(RIBridges is the name the state is currently using for the much-criticized UHIP computer eligibility-verification system.)

“Our audit work in this area … identified some serious concerns in relation to income validation procedures within the RIBridges system that require immediate investigation,” Bergantino wrote.

The problems came to light during a House Oversight Committee meeting on the impact of the wind down of the federal public health emergency on people enrolled in state administered public assistance programs.

In every state, participants in the Supplemental Nutrition Assistance Program, commonly known as food stamps, faced the loss of the extra pandemic-related benefits Wednesday. In Rhode Island, more than 300,000 people receive SNAP benefits.

Heading into the hearing, the lawmakers sought answers from the head of health and human services arm of the McKee administration on how the state plans to deal with a deluge of potential questions and concerns from people facing the immediate or imminent loss of benefits, when the call center is closed on Wednesdays to give staff time to catch up on the backlog.

Acting Department of Human Services Director Kim Merolla-Brito tried to assure the lawmakers her agency is ready for the April resumption of Medicaid certifications and has the capacity to hire up to 48 contract employees if necessary.

And Novais attributed some of the problems the auditor general’s office uncovered to a mismatch between the data the state reviews monthly, and the quarterly employment reports from the state’s Department of Labor & Training.

According to Department of Administration spokeswoman Laura Hart, the administration has convened a work group to go through the case files of state employees who “may have unnecessarily remained enrolled in Medicaid during FY 21 and FY 22” when the state was barred from removing people.

“Additionally, this month, DOA and EOHHS plan to reach out proactively to these employees, and when appropriate, request that they unenroll from the program themselves before they are automatically dropped from Medicaid. The ‘continuous coverage’ requirement for all states ends on March 31, 2023.” 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Jennifer stole $148k using a services-not-provided scheme she ran out of her counseling business.

 
 

 
 

Clipped from: https://www.courant.com/2023/02/28/ct-psychologist-who-submitted-false-medicaid-bills-totaling-over-148k-gets-prison/

 
 

Dreamstime/Dreamstime/TNS

A Colebrook psychologist was sentenced to nine months in prison after pleading guilty to submitting false Medicaid bills totaling $148,102.80.

A Colebrook psychologist was sentenced to nine months in prison after pleading guilty to submitting false Medicaid bills following an investigation by the Medicaid Fraud Control Unit at the Office of the Chief State’s Attorney, authorities said.

Jennifer Lefebre-McGevna, 46, received a prison sentence of five years, suspended after nine months served, followed by five years of probation. She pleaded guilty in Hartford Superior Court on Jan. 10 to one count of first-degree larceny by defrauding a public community and one count of health insurance fraud.

Lefebre-McGevna was enrolled as a provider in the Connecticut Medicaid program. She was also the owner of Healing the Child from Within, LLC and enrolled in the Connecticut Medicaid Assistance Program as a private practice that performed psychotherapy services, according to state authorities.

From April 2017 through December 2020, Lefebre-McGevna reportedly submitted Medicaid claims for counseling services when no services were rendered, according to court records. There were over 1,000 claims submitted for unperformed services totaling $118,028.96. She utilized unlicensed people to perform services and submitted billings as if she performed them for bills totaling $24,961.66, court records said, and also submitted billings for canceled and missed appointments, totaling $5,112.19. The overall amount of fraudulent bills totaled $148,102.80, according to court records.

After paying $30,000 upon sentencing, she was ordered to pay the remaining restitution during her probationary period. She was also ordered to not act as a provider in the Medicaid program, according to state officials.

Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Medicaid Fraud Control Unit at the Chief State’s Attorney’s Office at 860-258-5986.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Harvey caused a mountain of destruction with his pill mill. And stole $118k of your tax dollars in the process.

 
 

 
 

Clipped from: https://newstalkkzrg.com/2023/02/27/man-from-oklahoma-pleads-guilty-to-medicaid-fraud/

 
 

OKLAHOMA CITY – A former Oklahoma City physician, charged in 2016 with 29 felony counts and one misdemeanor, pleaded guilty last week to Medicaid fraud and multiple drug offenses. Harvey Jenkins operated Aria Orthopedics in south Oklahoma City, where he prescribed large volumes of opioids and other narcotics from January 2010 to February 2015.

His plea is the result of an investigation conducted by the Oklahoma Attorney General’s Medicaid Fraud Control Unit.

“Our investigation ended Harvey Jenkins’ reckless medical practice and brought justice for the patients he endangered and the taxpayers he defrauded,” said Attorney General Gentner Drummond. “I appreciate the work that the attorneys and others in the Medicaid fraud unit put into this investigation to bring about a successful resolution.”

The investigation revealed that Jenkins cared for approximately 90 patients a day, most of whom were insured through Medicaid. In addition to the prescriptions he wrote, Jenkins also used another doctor’s signature to write prescriptions without her permission.

Jenkins’ plea agreement includes a 20-year suspended prison sentence, probation and fines, investigative costs and restitution in the amount of $181,474. He agreed to make an initial payment of $60,000 within 30 days and to make monthly payments of at least $600, beginning in May, for the remaining balance. Jenkins also agreed to surrender his medical license and never to seek employment relating to the practice of medicine or caring for children or vulnerable adults.

The counts he pleaded guilty to include:

• Eleven counts of illegal possession, distribution, dispensing, prescribing controlled dangerous substances within 2,000 feet of a public park.
  
• One count of conspiracy to illegally possess, distribute, dispense, prescribe controlled dangerous substances within 2,000 feet of a public park.
  
• One count of maintaining a place, building where controlled dangerous substances are kept.
  
• One count of conspiracy to defraud the state by making or causing to be made false claims under the Oklahoma Medicaid program.
  
• Six counts of making or causing to be made false claims under the Oklahoma Medicaid program.
  
• One count of conspiracy to fraudulently obtain the personal identity of another person.
  
• Four counts of fraudulently obtaining the personal identity of other persons.
  
• One count of conspiracy to practice medicine without a license.
  
• Four counts of illegally practicing medicine without a license.
  

Several agencies aided the investigation, including the Oklahoma Bureau of Narcotics and Dangerous Drugs Control, Oklahoma Board of Medical Licensure and Supervision, Oklahoma City Police Department, City of Oklahoma City’s Public Works Administration and the Oklahoma State Board of Pharmacy.

The Oklahoma Attorney General’s Office Medicaid Fraud Control Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $4,381,834.00 for Federal fiscal year (FY) 2023. The remaining 25 percent, totaling $1,095,458.00 for FY 2023, is funded by the State of Oklahoma. The federal fiscal year 2023 is defined as October 1, 2022, through September 30, 2023.

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: These two yahoos stole $907k from Medicare and $218k from Medicaid- but really they stole the full $1.1M from you, the taxpayer.

 
 

Clipped from: https://www.texasattorneygeneral.gov/news/releases/investigation-paxtons-medicaid-fraud-unit-results-11m-restitution-health-care-programs

An investigation by Attorney General Paxton’s Medicaid Fraud Control Unit has led to the sentencing for health care fraud of two individuals in federal court in Del Rio, Texas.  

Melody Ann Villarreal and Oscar Gutierrez, Jr. were both found guilty of submitting fraudulent run sheets for ambulance transports that did not occur and submitting them to both Medicare and Medicaid for payment.  

Villarreal and Gutierrez were ordered to pay $907,376.41 in restitution to Medicare and $218,651.23 to Medicaid. Villarreal was sentenced to 48 months of incarceration, followed by three years of supervised release, and Gutierrez was sentenced to 60 months of incarceration, also followed by three years of supervised release. 

“My office will continue to crack down on those who commit fraud, drive up the cost of health care for Texans, and try to compromise the integrity of our health care system,” said Attorney General Paxton. “I’m proud to say that the hard work of my Medicaid Fraud Control Unit and our law enforcement partners has ensured that justice was done in this case and that Texas taxpayer funds were recovered.” 

The case was investigated by Lieutenant Jeff Winney, Investigative Auditor Michael Youngs, and Captain Raúl González of the Medicaid Fraud Control Unit, in cooperation with the Department of Health and Human Services’ Office of the Inspector General and the FBI. The case was prosecuted by Assistant United States Attorney Rex Beasley out of the Western District of Texas. 

The Texas Medicaid Fraud Control Unit is responsible for investigating and prosecuting Medicaid fraud and patient neglect and abuse. If you suspect Medicaid fraud or abuse, or patient neglect, please report it by calling (512) 371-4700 or visiting the Texas Attorney General’s website.  

 
 

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The state IG says the Medicaid agency owes CMS a lot of cash because of poor oversight of personal care services payments. The Medicaid agency disagrees, and now its up to CMS to decide.

 
 

 
 

Clipped from: https://www.stltoday.com/business/local/missouri-should-refund-34-million-in-medicaid-payments-federal-agency-says/article_9e65305d-2863-5d94-9046-7f963962c1fd.html

ST. LOUIS — A federal agency is pushing Missouri to refund more than $34 million in Medicaid payments, after an audit raised issue with some of the state’s policies for programs that help patients with day-to-day tasks.

In the audit, the Health and Human Services Office of Inspector General looked at claims filed for personal care assistance, which offers help with daily tasks like meal preparation, shopping, grooming and bathing.

The audit found that in some cases, time sheets couldn’t be provided or lacked detail. In other cases, documentation was missing for the attendants who provided the care.

It also looked at what emergency preparedness policies the state had during that period. Because the audit looked at the 2018 and 2019 fiscal years, it looked at plans in place prior to the COVID-19 pandemic.

When HHS looked for “backup plans,” meant to ensure that patients are safe in the event that they can’t be reached in an emergency, in some cases it found little or no information or instructions.

The state objected to many of the audit’s findings. It said the federal agency looked at just a small sampling of claims. It argued that some of the documents it cited had all the information that is legally required. And it noted that the state health department established a Quality Assurance Unit in late 2020.

Still, HHS issued recommendations for repayments and policy changes this month, including a recommendation that the state refund at least $34.2 million to the federal government.

The Missouri Department of Social Services and the Department of Health and Senior Services reiterated Tuesday that they disagreed with the recommendations. The agencies do not believe “that any of these funds should be disallowed,” DHSS spokesperson Lisa Cox said in an email.

The suggestions by HHS will be reviewed by the U.S. Centers for Medicare and Medicaid Services, or CMS, which will make the final decision about what actions the state must take and whether it must make any refunds. If the state disagrees with CMS’ determination, it will have the option to appeal.

HHS called the state out for similar issues a decade earlier, also with personal care services. In a 2012 audit, the agency found problems like missing care plans and unsigned time sheets.

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A doc in Arkansas appears to not be doing much at all.

 
 

 
 

 
 

Clipped from: https://www.nwahomepage.com/news/nwa-doctors-medicaid-billing-suspended-after-fraud-allegations/

 
 

FAYETTEVILLE, Ark. (KNWA/KFTA) — A Northwest Arkansas psychiatrist has had his Medicaid billing privileges suspended following allegations of fraud.

According to a letter from the Arkansas Office of Medicaid Inspector General Elizabeth Smith, Dr. Brian T. Hyatt of Rogers was informed of the suspension on February 24. It stated that the decision was made to suspend “all payments for Medicaid services” performed by Hyatt after the office received a “credible allegation of fraud.”

The suspension does not pertain to other individual members of the group provider “Brian T. Hyatt, MD, PLLC dba Pinnacle Premier Psychiatry,” but it added that no payments will be made to Hyatt’s provider number during the suspension.

Court denies NWA doctor’s international travel request before sexual assault trial

“This suspension is temporary and will continue until either the investigation authority determines there is insufficient evidence of fraud, or the legal proceedings related to the alleged fraud are completed,” it noted.

The letter added that illegal participation in the Arkansas Medicaid Program is a class A misdemeanor punishable by up to one year in jail and a fine of up to $2,500. Hyatt has the right to appeal the suspension within 30 calendar days of receiving notice.

Hyatt was named the medical director of the behavioral unit at Northwest Medical Center in Springdale in 2018 and worked there until he was “abruptly terminated” in May, 2022, according to court documents. The Medicaid Control Fraud Unit was contacted by a whistleblower and confidential informant (CI) who worked in that unit and indicated that Hyatt was only on that employee’s floor “a few minutes each day” and that the doctor had “no contact with patients.”

“The CI described him walking up and down the hall with a computer on wheels and never entering the rooms or meeting with patients. The CI said Dr. Hyatt did not want the patients to know his name and that he directed staff to mark through his name on the armbands of patients.”

Probable cause statement, Medicaid Fraud Investigator, January 17

The informant also provided investigators of a photo of a posted sign instructing staff to cross out his name on patient armbands, according to court documents. The CI believed that Hyatt was “fraudulently billing Medicaid, Medicare, and other health insurance companies.”

A probable cause report filed as part of the investigation noted that “some of the patients were being held against their will” and noted that “only a physician could make the decision to impose a 72-hour hold” under Arkansas law. It added that any false statement made in a claim that resulted in an overpayment of $2,500 or more is a felony offense.

Springdale psychiatrist appointed vice chairman of State Medical Board

That filing continued by stating that the fraud investigators obtained approximately two months of surveillance video from the behavioral unit at the Northwest Medical Center. Agents “have reviewed several days and hundreds of hours of video and have yet to observe Dr. Hyatt enter a patient’s room or otherwise have direct contact with a patient.”

“Sometimes he pauses at the rooms and may even look in,” it stated. “But he does not enter the room or have patients come out into the hall.” It went on to explain that the use of data analytics “identified several red flags,” and noted that Hyatt “is a clear outlier, and his claims are so high they skew the averages on certain codes for the entire Medicaid program in Arkansas.”

In January, investigators were granted a search warrant to obtain data from Hyatt’s cell phone through his wireless provider.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: John stole $1M of your tax dollars and put kiddos at risk by not ensuring “providers” in his organization had basic background checks or licenses.

 
 

 
 

A South Plainfield man who works as a behavioral health provider has been ordered by the state to repay Medicaid more than $1 million for improperly billing the program.

John Gore, a licensed drug and alcohol counselor at Clear Conscience Counseling on Park Avenue in South Plainfield, also allowed behavioral assistants to provide services to minors in one-on-one settings without conducting criminal background checks on the staffers, an audit by the Office of the State Comptroller (OSC) found.

The audit determined that Gore improperly billed and received Medicaid payments of $1.1 million.

The audit also found Gore failed to comply with state regulations in about a third of claims the State Comptroller’s office sampled.

The OSC also found Gore billed for unsubstantiated services, maintained inaccurate and incomplete records and failed to ensure that his providers had current and valid drivers’ licenses before allowing them to provide services to Medicaid patients, according to a news release from the agency.

Other deficiencies discovered in the audit include Gore assigned cases to behavioral assistants without confirming they had the required professional licenses. The audit found that six did not.

Gore also failed to ensure that behavioral assistants had the required training certifications and the audit discovered 24 did not, according to the agency.

As a result of the audit’s findings, OSC has urged the New Jersey Division of Medicaid Assistance and Health Services (DMAHS), part of the Department of Human Services, to issue a rule requiring intensive in-community (IIC) providers to undergo fingerprint background checks before being allowed to treat children and young adults.

Get the Daily Briefing – Bridgewater newsletter in your inbox.

Start your day with the morning’s top news

Delivery: Daily

Your Email

IIC providers are now required to obtain criminal background checks of behavioral assistants, but there is no government oversight to enforce that requirement and no requirement for a fingerprint check, according to the OSC.

“It’s standard practice for teachers, doctors, coaches, and many others who work with children to undergo fingerprint checks. Children who are in these Medicaid-funded community programs are entitled to the same protection,” Josh Lichtblau, director of OSC’s Medicaid Fraud Division, said in the release.

In November 2021, the State Comptroller’s office notified DMAHS about flaws in the regulations and the risks they posed to children.

Almost a year later, in September 2022, DMAHS told providers that they should contact the state’s Children’s System of Care to initiate fingerprint background checks, but it left the responsibility for compliance on the provider.

DMAHS proposed a new rule in January that did not address the fingerprint requirement and state oversight.

“Our findings are serious. When providers fail to ensure that employees have clean criminal backgrounds, they’re placing vulnerable children in potentially unsafe circumstances,” said Lichtblau. “The state should work quickly to close this gap in oversight.”

Email: srussell@gannettnj.com

Suzanne Russell is a breaking news reporter for MyCentralJersey.com covering crime, courts and other mayhem. To get unlimited access, please subscribe or activate your digital account today.

 
 

From <https://www.mycentraljersey.com/story/news/health/2023/02/23/nj-health-care-john-gore-medicaid-insurance/69936127007/>

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Another member stole more money using NEMT. This is getting to be a thing.

 
 

 
 

Clipped from: https://www.doj.nh.gov/news/2023/20230217-hayes-medicaid-fraud.htm

Concord, NH – Attorney General John M. Formella announces that Stacey Hayes, age 49, of Hudson, New Hampshire, has been indicted for theft and Medicaid fraud in connection with fraudulent claims for non-emergency medical transportation services.

On February 15, 2023, the Merrimack County Grand Jury indicted Hayes on charges of Theft by Deception, Medicaid Fraud – False Claims, and Medicaid Fraud – False Records. The indictments allege that between September 1, 2020, and September 30, 2021, Hayes, pursuant to one scheme or course of conduct, created false records that were kept as documentation of expenses for Medicaid services, which caused false claims for payment of Medicaid services to be filed, resulting in Hayes obtaining more than $1,500.00 in Medicaid funds. During that timeframe, Hayes allegedly submitted fraudulent mileage reimbursement forms for 337 non-emergency medical appointments that did not exist, which resulted in her receiving $7,232.18 for reimbursement of mileage expenses that she did not incur.

The maximum penalty on the Theft by Deception charge, a class A felony, is 7½ to 15 years in the New Hampshire State Prison. The maximum penalty for the False Claims and False Records charges, both class B felonies, are each 3½ to 7 years in the New Hampshire State Prison.

Hayes is next scheduled to appear in Merrimack County Superior Court at 8:30 a.m. on February 27, 2023. The charges and allegations are merely accusations, and Hayes is presumed innocent unless and until proven guilty.

Senior Assistant Attorney General Thomas T. Worboys and Attorney Andrew Yourell of the Attorney General’s Medicaid Fraud Control Unit are prosecuting this case. Investigator Eric Shirley, also of the Attorney General’s Medicaid Fraud Control Unit, investigated the matter based on a referral from the New Hampshire Department of Health and Human Services’ Program Integrity Unit and AmeriHealth Caritas New Hampshire’s Special Investigations Unit.

The Medicaid Fraud Control Unit investigates and prosecutes fraud by healthcare providers who treat Medicaid beneficiaries. Healthcare providers include, but are not limited to, hospitals, nursing homes, doctors, dentists, pharmacies, ambulance companies, and anyone else who is paid for providing healthcare services to Medicaid beneficiaries. If you would like to report a case of provider fraud, please contact the Medicaid Fraud Control Unit at (603) 271-1246.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: We reported on this several months back, and now the sentencing has happened. Dewan gets between 2 and 20 years for the giant identity theft scam he ran to steal $11M of your tax dollars.

A Detroit man accused of stealing personal information from thousands of people to commit Medicaid fraud has been sentenced to two to 20 years in prison, Attorney General Dana Nessel said Tuesday.

Dewan Williams, 47, of Detroit, was charged with several crimes in October and pleaded guilty in January to conducting a criminal enterprise, a 20-year felony, and identity theft, a five-year felony, according to court records.

Initially, Williams was also charged with three counts of using a computer to commit a crime, each a seven-year felony, and three counts of welfare fraud over $500, each a four-year felony.

Wayne County Circuit Court Judge Mariam Bazzi handed down the sentence last week and ordered Williams to pay restitution. Williams is required to turn himself in at an adjourned sentencing date of June 29, according to Nessel’s office.   

Authorities said Williams bought Social Security numbers of identity theft victims on the dark web and used the information to obtain free cellphones under a federal Medicaid program. After he received the phones, he would sell them for a profit.

An investigation into Williams’ scheme began after the Michigan Department of Health and Human Services – Office of Inspector General received complaints from multiple victims about their identities being used to fraudulently apply for government aid. The department contacted the Attorney General’s Office, which turned to the Michigan State Police.

A joint investigation between the health department and state police uncovered the scheme and led to a search of Williams’ house. Investigators found 150 new and pre-packaged cell phones as well as the stolen personal information of about 7,000 identity theft victims.

“Identity theft is on the rise in Michigan,” said Department of Health and Human Services Inspector General Alan Kimichik said in a statement. ” … The OIG is committed to protecting the integrity of public assistance programs and ensuring the appropriate use of available public resources.”

Get the COVID-19 Update newsletter in your inbox.

Updates on how the coronavirus is affecting your community and the nation

Delivery: Varies

Your Email

Officials said Williams’ operation cost the state $11 million in unnecessary payments. After the accounts were determined to be fraudulent, the state shut them down and recouped its money, they said.

“The threat of identity theft is real,” Nessel said in a statement, “and I urge Michigan residents to educate and protect themselves against potential victimization.”

From <https://www.detroitnews.com/story/news/local/detroit-city/2023/02/21/detroit-man-47-gets-2-20-years-for-medicaid-fraud/69927817007/>

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: They “fixed” it all except for that last little bit about actually recovering the money.

 
 

 
 

Clipped from: https://cbs6albany.com/news/you-paid-for-it/show-me-the-money-years-later-nys-medicaid-overpayments-still-not-recovered-you-paid-for-it-comptroller-dinapoli-department-of-health

 
 

 
 

ALBANY, N.Y. (WRGB) — Medicaid overpayments that were discovered by the New York State Comptroller’s Office more than two years ago have still not been recovered — and you paid for it.

The overpayments involved those who were dual eligible for both Medicaid and Medicare

According to the comptroller, “A prior audit report, issued in December 2020, identified about $50 million in actual and potential Medicaid overpayments, cost-savings opportunities, and questionable payments for services provided to recipients enrolled in Medicare-covered hospice care. The follow-up found that the Department of Health made some progress in addressing the problems identified, but more actions were needed. Namely, the Office of the Medicaid Inspector General had yet to materially recover the overpayments.”

MORE: NY Assembly rule now allows votes, without even showing up to the floor

Among the things the health department has done in the wake of the audit was implement a tracking system to identify those so called dual eligibles in hospice care.

Of the initial report’s nine audit recommendations, three had been implemented, five had been partially implemented, and one had not yet been implemented.

The full audit report can be found here: Department of Health: Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up) (state.ny.us)