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In the fall of 2012, as part of an investigation examining Medicaid fraud in Texas, the state Medicaid program began auditing All Smiles. [4] The Federal Government charged Malouf with fraudulent Medicaid billing for four years ending in the year 2007; the charges did not include his large Medicaid brace expenditures. [7]
The Medicaid program is only supposed to cover orthodontics if it corrects severe conditions such as cleft lip and palate or complications from another condition, such as Down's syndrome or muscular dystrophy. [10] The Office of Inspector General of the commission had investigated several companies in Texas for orthodontic Medicaid fraud. [9]
From the program's start in 1997 through December 2019, SMP projects and staff have recovered about $129 million in Medicare and Medicaid funds, and between 2016 through 2019, the program led 107,000 group education sessions and reached an estimated 6.5 million people through community education events. [1]
Conflicting information, computer systems not working, denials before verification and more problems come to the surface from whistleblowers, advocacy groups.
Aug. 25—A Pembroke woman has been indicted on felony charges for allegedly stealing more than $16,000 from the Medicaid program by filing fraudulent claims. A Merrimack County Grand Jury ...
Health care fraud includes health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare (United States) or equivalent State programs. The manner in which this is done varies, and persons engaging in fraud are always ...
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As Inspector General, Bowen's role involved preventing, detecting, and deterring fraud, waste, and abuse within the Texas Health and Human Services System. [7] On October 22, 2015, Bowen accused Planned Parenthood of misconduct and informed them all of the state's Planned Parenthood affiliates were being dropped as a Medicaid health care provider.