News and Commentary
Attorney General’s News Release
August 7, 2007
Nixon recovers $462,926 in ongoing Medicaid fraud investigation in Dekalb County
Jefferson City, Mo. — Attorney General Jay Nixon announced today that the Missouri Medicaid program will be receiving $462,926 from a pharmacy in DeKalb County that is under investigation for Medicaid fraud. Nixon said the Medicaid Fraud Control Unit in his office has recovered the money from the Randolph Drug Store in Maysville.
The United States Attorney’s Office
Southern District of Texas
August 6, 2007
LOCAL PHYSICIAN SENTENCED TO PRISON FOR DEFRAUDING INSURANCE COMPANIES OF $10 MILLION
(HOUSTON) Dr. Ira Klein, a physician who specialized in treating Hepatitis C patients, has been sentenced to more than 11 years in federal prison, without parole, for health care and mail fraud, United States Attorney Don DeGabrielle announced today.
Any test which doctors provide themselves (self-referral) is an opportunity for fraud. To identify suspect cases, measure the number of tests per 1,000 patients for doctors performing the test themselves, compared to those who refer patients to another provider. You may need to make adjustments for patient diagnosis or health status.
Of course looking to evidence is most important. Are these doctors qualified to perform the service? Is the diagnostic test effective as a screening tool or should its uses be more limited? Does the test result in more treatment? Is the treatment effective?
Here are some highlights from an article from the New York Times about a product with high fraud potential:
It’s been a long time since I’ve sent out a newsletter. Many of you have probably never received a newsletter from me and don’t even remember signing up for them. This month, I’m sending you articles that focus mostly on Medicaid fraud, from old standards like transportation fraud to new themes like fraud rings in New York. Check the website next week for a more thorough examination of transportation fraud and best practices for fighting it. Enjoy!
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“ANGOLA, Ind. - A dentist accused of diagnosing cavities that did not exist will not face prison time, according to an agreement filed in Steuben Circuit Court.
Tuesday, October 24, 2006
Attorney General Abbott’s Investigators Arrest Pharmacy Owner Indicted For Medicaid Fraud
Erasmo Cantu arrested in Brownsville; over $5 million in theft alleged
BROWNSVILLE - Texas Attorney General Greg Abbott today announced the arrest of a Cameron County pharmacy owner who was indicted by a grand jury on Oct. 18 for felony offenses involving more than $5 million in alleged fraudulent Medicaid reimbursements for excessive prescription refills.
Department of Law
The State Capitol
Albany, NY 12224
For More Information:
For Immediate Release
October 25, 2006
STATE INVESTIGATION REVEALS WIDESPREAD MEDICAID FRAUD
Doctor and pharmacists among those indicted for multi-million dollar fraud
Attorney General Eliot Spitzer and State Medicaid Inspector General Kimberly O’Connor today announced that, after a 4-month undercover investigation, prosecutors and investigators have dismantled a Medicaid fraud ring involving a doctor, pharmacists, several city pharmacies, millions in fraudulent Medicaid billings and large monetary transfers to individuals in Pakistan.
Major Medicaid Fraud Ring Dismantled - North Country Gazette -
“ALBANY-Following after a four-month undercover investigation conducted by the state Attorney General’s office and the state Medicaid Inspector General’s office, prosecutors and investigators have dismantled a Medicaid fraud ring which involving a doctor, pharmacists, several city pharmacies, millions in fraudulent Medicaid billings and large monetary transfers to individuals in Pakistan.
Sixteen individuals and five corporations have been indicted in the ongoing investigation and a civil action has been filed against 20 individuals and entities freezing assets and seeking the recovery of more than $22 million…”
“Since so much money is involved here, the federal government certainly has a very keen interest in how it is spent,” Donald White, spokesman for the HHS inspector general, said yesterday of the nationwide look at Medicaid transportation costs.
Federal Audit of Medicaid Transportation Costs To Determine … - Kaiser network.org -
Federal Audit of Medicaid Transportation Costs To Determine …
Kaiser network.org, DC
… Health care consultant Robin Mathias said Medicaid programs can lose as much as 30% to 50% of nonemergency transportation spending to fraud and abuse, adding …
US probing Medicaid transportation Science Daily (press release)
US probing Medicaid transportation Market-Day.net