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Medicaid Fraud

Recent Posts in Medicaid Fraud Category

  • Prime Healthcare Primed to Pay $65M in FCA Settlement

    Prime Healthcare Services and its CEO recently agreed to pay $65 million to settle a whistleblower suit alleging that 14 Prime hospitals in California violated the False Claims Act (FCA) by “upcoding” the care of Medicare patients. See Press Release, U.S. Dep’t of Justice, Prime Healthcare Services and CEO to Pay $65 Million to Settle False Claims Act Allegations (Aug. 3, 2018), ...
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  • Don’t Mess with Texas Medicaid

    Texas Reaches $15.2M Settlement with Fraudulent Medicaid Providers Texas Attorney General Ken Paxton announced on May 30, 2018 that the state of Texas reached settlements totaling $15.2 million with a group of Dallas-Fort Worth area Medicaid rehabilitation therapy providers that were accused of making false statements and conspiring to avoid repaying unauthorized Medicaid benefits. Background ...
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  • Physician In McAllen, Texas Convicted of Healthcare Fraud After Eighteen Years

    For 18 years, Jorge Zamora-Quezada, a physician based in McAllen, Texas, enjoyed a lavish lifestyle—flying in private jets, driving luxury vehicles, and purchasing high-end clothing—at the mercy of his patients who underwent numerous medical treatments upon false diagnosis. Zamora-Quezada and his co-conspirators traveled between the Rio Grande Valley and San Antonio conducting unwarranted ...
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  • Government Indicts California Docs for Falsified Medical Records

    Reading, and understanding, medical billing and records almost requires a medical degree, with the variety of tests, codes, and terms used to define each procedure. Capitalizing on the technicalities of medical billing, some providers have presented fraudulent billing to insurers and the government through Medicare and Medicaid. According to a report by the Office of the Inspector General, medical ...
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  • HHS Introduces Proposal for Medicaid Fraud Control Unit Program Changes

    In September 2016, a new rule was proposed that would codify statutory changes and amend several provisions of the Medicaid Fraud Control Unit (MFCU) program. MFCUs operate in 49 states, as well as the District of Columbia, and are designed to facilitate the integrity of the Medicaid program by combatting fraud and abuse. Only twice in its nearly forty-year history has the program itself been ...
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