Tag Archives: fraud

HHS moves to block chain of dental clinics from receiving Medicaid

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

David Heath

David Heath

Small Smiles, one of the nation’s largest dental chains, is facing exclusion from Medicaid, David Heath of the Center for Public Integrity reported this week.

The chain has been accused of performing unnecessary treatments on children to boost profits. With Medicaid dental providers in short supply in many communities, the ouster of Small Smiles from the program could send thousands of poor families in search of new dentists.

“The inspector general of the Department of Health and Human Services notified the chain last week that after years of monitoring, the company remains out of compliance with the terms of a 2010 settlement of a whistleblower lawsuit brought by the Justice Department,” Heath wrote in his March 11 report. Continue reading

Congressional update at GSA touches on upcoming stories

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

What’s really happening with aging policy in Washington? At last week’s annual Gerontological Society of America Conference in New Orleans, a standing-room-only audience was privy to updates from key Congressional committee staffers.

Erika Salway, policy adviser for the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging, discussed the committee’s work on issues affecting older adults, including federally qualified health centers, primary care, oral health, mental health and the Older Americans Act. Funding for the OAA is $1.8 billion, which may sound high, but she reminded the audience that its programs serve 10 million seniors every year and funding constitutes less than .06 percent of the federal budget. The OAA funds essential services such as Meals on Wheels, job training, caregiver support, transportation and elder abuse services. It expired in 2011 but continues to receive federal funds under the old legislative formula. Continue reading

Webcast will cover implications of federal spending deal on Medicare

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

AHCJ webcastMedicare reform is a hot topic on the agenda for the bipartisan congressional budget committee whose Dec. 13 deadline for a compromise deal on a federal spending plan is looming. Both political parties have proposed raising the Medicare eligibility age and premiums on older adults, among other changes.

In the midst of this debate, two policy experts will join AHCJ’s topic leader on aging, Liz Seegert, to help members understand: Continue reading

HHS investigative unit set to lose hundreds of staff

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

Despite the Obama administration’s focus on cutting health care costs and fraud in the Medicare and Medicaid systems, the office charged with investigating such things plans to cut 400 staffers by the end of 2015.

Fred Schulte at The Center for Public Integrity reports that the news came to light during a June 24 congressional hearing about prescription drug abuse in Medicare.

The Department of Health and Human Services’ Office of Inspector General  is responsible for investigating fraud and abuse in the system. Last year the office shut down investigations into 1,200 complaints because of a lack of resources, according to Gary Cantrell, deputy inspector general for the OIG Office of Investigations.

Cantrell blames the cuts on “a mix of budgetary issues which he called ‘expiring funding streams.’” Schulte reports that no one at HHS would discuss the situation.

Schulte has previously reported on electronic health records and linked them to higher health care costs. He points out one potential impact of the cuts:

One major project that’s likely to be scaled back is an ambitious plan to “identify fraud and abuse vulnerabilities” in electronic health records. The federal government is spending about $36 billion in economic stimulus funds to help doctors and hospitals purchase the digital technology in the hopes that it will ultimately reduce waste from duplicative tests and make health care more efficient and less costly.

The OIG’s 2013 Work Plan outlines the office’s focus and new and ongoing projects, including reasonableness of Medicare payments, coding of medical equipment claims, questionable billing patterns, review of claims submitted by “error-prone” providers and more. Meanwhile, ProPublica, the Center for Public Integrity, The Wall Street Journal and other publications have documented fraudulent and wasteful practices in Medicare.

Health care watchdog agency provides ideas for stories in coming year

Len Bruzzese

About Len Bruzzese

Len Bruzzese is the executive director of AHCJ and its Center for Excellence in Health Care Journalism. He also is an associate professor at the Missouri School of Journalism and served for nearly 20 years in daily journalism.

The HHS Office of Inspector General (OIG) has unveiled its FY 2013 OIG Work Plan , a blueprint for the watchdog agency’s work in the upcoming year and beyond.OIG 2013 Outlook Webcast at oig.hhs.gov

For enterprising health care reporters, this publication is like a catalog of story ideas, featuring hundreds of summaries of OIG’s upcoming reports, descriptions of its investigative and legal work, plus an overview of guidance it provides to the health care provider community.  Topics of upcoming reports include same-day hospital readmissions, oversight of poorly performing nursing homes, and FDA’s process for investigational new drug applications.

Also, on Oct. 24, OIG will launch its OIG Outlook 2013 webcast.  The free online event will include OIG’s senior leadership discussing emerging trends in combating fraud, waste and abuse in federal health care programs, OIG’s top priorities for 2013, and upcoming projects outlined in the Work Plan.

OIG’s mission is to protect the integrity of HHS’s 300+ programs – including Medicare and Medicaid – and the well-being of beneficiaries by conducting audits, evaluations, and investigations; providing guidance to the health care industry; and imposing civil monetary penalties, assessments and administrative sanctions.

Investigators look into allegations of Medicaid dental recruiting of Dallas children

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

Byron Harris of WFAA-Dallas reports authorities there are investigating cases in which at least six children allegedly were recruited at a convenience store, paid $10 and then taken to a dental clinic where they underwent procedures without parental consent.

WFAA obtained one child’s medical records and found the clinic billed Medicaid for more than $2,000 for 25 procedures.

The clinic, All About Dentistry, “admits it employs recruiters to bring in new Medicaid patients, but will not reveal how much it pays for each new patient a recruiter brings in.”

In July, Harris reported that Texas is cracking down on “questionable Medicaid dental payments” and, as a result, dentists who previously treated Medicaid patients are turning those patients away because their claims are being rejected.

Tens of thousands of patients are affected. In 2010, Medicaid paid for braces on about 80,000 kids in Texas. Treatment commonly takes two years.

Last year, Harris and producer Mark Smith, in a nine-month investigation, found that Texas regulators seldom deny procedures for hundreds of thousands of children. WFAA aired a half-hour news special, “Crooked Teeth,” raising questions about other Medicaid reimbursements nationally, including a troubling payment policy by one of the nation’s largest government contractors.

Strict Medicaid regulations prohibit payment for braces installed for merely cosmetic reasons. WFAA-TV, however, discovers through statistical analysis and basic “gumshoe” reporting that Medicaid orthodontic payments are widespread in Texas. In fact, dental offices have signs and advertisements that promise “free” braces and travel to children.

Elsewhere in Texas, a jury has indicted an Amarillo orthodontist on 11 counts of Medicaid fraud of more than $1.5 million. Authorities allege he performed services he knew were solely cosmetic and scheduled dozens of patients on a daily basis.

In another recent case, a Brooklyn, N.Y., dentist “pleaded guilty to fraud, admitting he paid recruiters to solicit homeless Medicaid patients with cash.”