Tag: Medicaid fraud

MCALLEN, Texas - Anna Ramirez-Ambriz, owner of Compassionate Medical Supply in Edinburg, Texas, has been sentenced to 78 months in jail and ordered to pay more than $3 million in restitution for fraudulently billing Texas Medicaid for incontinence supplies. From 2007 through 2013, Ramirez-Ambriz billed the Medicaid program for higher quantities and more costly incontinence supplies than were actually delivered to more than 100 beneficiaries. As a result, Texas Medicaid suffered a loss of $3.1 million.

NEW YORK - The owner of Monack Medical Supply has been indicted on charges of Medicaid fraud, according to a press release from the New York Attorney General's Office. Kester Atumonyogo allegedly billed Medicaid and Healthfirst, a Medicaid managed care organization, $1 million for an expensive nutritional formula while supplying patients with a lower-priced formula. According to the indictment, Atumonyogo used a fraudulent social security number to enroll Monack Medical Supply in the Medicaid program,...

WASHINGTON - The House of Representatives has followed the Senate and introduced a bill last week that would increase Medicare reimbursement for ventilators by 20% on Jan. 1, 2017.H.R. 6012, known as the BREATH Act, would also establish policies and standards for determining appropriate use for ventilators.The bills are in response to CMS's decision late last year to reduce the number of codes for ventilators from five to two, and to reduce reimbursement by about 33%. The agency has been concerned...

WASHINGTON - A nationwide sweep led by the Medicare Fraud Strike Force has resulted in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals.The individuals have been charged for their alleged participation in Medicare fraud schemes involving about $712 million in false billings, the Department of Health and Human Services announced last week.“This action represents the largest criminal health care fraud takedown in the history of the Department...

I like the heat CMS and its contractors are getting for their audit activities as of late. The lead for this story in Bloomberg Businessweek, based on a recent report from the Government Accountability Office (GAO), pretty much says it all:“A program to fight fraud in the Medicaid health system for the poor has cost the U.S. at least $102 million in auditing fees since 2008 while identifying less than $20 million in overpayments, investigators found.”In other words, the government spends...