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Northside Medical Center Incorrectly Billed Medicare Inpatient Claims with Severe Malnutrition

“Northside Medical Center (The Hospital), in Youngstown, Ohio complied with Medicare billing requirements for diagnosis codes 261 and 262 for 2 of the 100 claims that were reviewed,” according to an audit conducted by the Office of Inspector General. However, the Hospital did not comply with Medicare billing requirements for the remaining 98 claims. For…

AG Paxton Announces $8.45 Million Settlement with MB2 Dental Solutions

Attorney General Ken Paxton today announced a settlement with MB2 Dental Solutions (MB2) and 21 affiliated pediatric dental practices. MB2 agreed to pay the United States and the State of Texas $8.45 million for alleged violations of the federal False Claims Act (FCA) and the Texas Medicaid Fraud Prevention Act (TMFPA). Three lawsuits were resolved…

Owner Of Utah-Based Pharmaceutical Distributer Pleads Guilty To $100 Million Health Care Fraud Scheme

Fraudster, Randy Crowell, put people with life-threatening diseases at risk by distributing black-market, off-market replacements to pharmacies defrauding the federal government to the tune of $100 million. Preet Bharara, the United States Attorney for the Southern District of New York, announced that RANDY CROWELL, a/k/a “Roger,” pled guilty today before United States District Judge Edgardo…

Owner Of Harrisburg Healthcare Services Firm Sentenced For False Statements, Money Laundering And Identity Theft

HARRISBURG – The United States Attorney’s Office for the Middle District of Pennsylvania announced today that Rose Umana, age 49, of Mechanicsburg, Pennsylvania, was sentenced on December 21, 2016, by United States District Court Judge Sylvia H. Rambo to 36 months in prison for making false statements relating to health care matters, engaging in monetary…

New Jersey Claimed Medicaid Adult Mental Health Partial Care Services That Were Not in Compliance With Federal and State Requirements

“Most of the New Jersey Department of Human Services’ (State agency) claims for Federal Medicaid reimbursement for partial care services did not comply with Federal and State requirements,” is stated in a compliance report issued by the Office of Inspector General, U.S. Department of Health and Human Services. “The partial care services program provides individualized…

Bennington Family Convicted Of Multiple Counts Of Medicaid Fraud

Family Affair Ends in cumulative 18 counts of fraud. Patrick Morse, 64, Ellie May Morse, 43, and Donald Morse, 23, of Bennington, Vermont, were convicted in Vermont Superior Court, Windsor Criminal Division, of multiple felony counts of Medicaid Fraud arising out of their scheme to defraud the Vermont Medicaid Children’s Personal Care Services (“PCS”) Program….

OIG/HHS Review of CMS’s Management of the Quality Payment Program

Two systems designed to measure, score, report on and assign value to the quality of care will take effect January 1, 2017 with payment adjustments taking effect January 1, 2019. This is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) with the intention of putting measurable focus on the of quality…

John P. Benson, Verisys COO Featured in HCCA’s Compliance Today Magazine

John P. Benson, COO of Verisys Corporation featured in the next edition of Compliance Today magazine published by HCCA. Receive CCB CEU credits by reading John’s article: “Compliance 101: Telemedicine, Part 1: The origin and drivers of telehealth care.” Join the HCCA today!

Linebacker Monty Grow defrauds the US Government of $2 Billion

Taking the concept of doping to a new level, Monty Grow defrauded the US Government in kickback scheme to push unnecessary compounded drugs on those who serve and have served in the military and subsequently collect from Tricare. As seen on, written by Garry Smits – “Former University of Florida and Jaguars linebacker…

Taxpayers Could See More than $27 Billion Saved As the Result of HHS OIG Work, New Report Says

Washington, DC-America’s taxpayers could see $27.76 billion in misspent Medicare, Medicaid and other health and human services dollars saved in fiscal 2016. This savings is as the result of work by the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS), according to a report released recently. This year’s…