Author: MM_ADMIN
STATE NEWS (TN) Tennessee to be the first to offer diapers through Medicaid: Here’s what to know
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: One of the early benefits of TN’s innovative block grants- diapers.
Nashville Tennessean
Tennessee could soon be the first state in the nation to cover part of the cost of diapers for babies on the state’s Medicaid program, TennCare.
With $30 million in funding approved last month by the state legislature, TennCare is working to get federal approval and implement a benefit offering half of the diapers a baby needs for the first two years of life. The benefit is expected to be in place by January.
“We are the first state that provides relief for the cost of diapers for mothers for the first two years,” Gov. Bill Lee told reporters during a recent news conference. “I think we’re in a really unique spot in Tennessee, we have the only Medicaid waiver in the country that is this modified block grant.”
Tennessee has not expanded Medicaid under the Affordable Care Act, and Democrats have criticized Lee and legislative Republicans for not doing so. The expansion would expand coverage to as many as 200,000 additional Tennesseans.
Instead, the Lee administration pursued a modified block grant approach to TennCare, with the goal of using savings to add additional benefits.
A burden lifted:Tennessee to offer first-of-its-kind Medicaid diaper benefit
“This is a model for other states potentially to… expand the number of people that can be served, expand the services that we can provide to Medicaid recipients, and to do so, not only without additional cost to the state, but in a way that actually incentivizes lowering the cost of health care to those who receive it,” Lee said.
Here’s what to know about the new benefit:
Why diapers?
Unlike food, diapers are not targeted by any in-kind federal assistance program – no food stamps, or WIC benefits cover them. About one in three families in Middle Tennessee struggle to provide the diapers their infants need.
Without enough diapers to keep a baby clean and dry, infants are at higher risk for diaper dermatitis and urinary tract infections. Most daycare facilities require parents to provide a day’s worth of diapers for their child – which poses a significant burden to families facing financial insecurity.
Lee proposed the benefit during his first State of the State address since the overturning of Roe v. Wade as a “pro-life” and “pro-family” use for savings realized in the state’s new Medicaid block grant funding structure.
When will the benefit be available?
Implementation of the new benefit now depends on approval from the federal Centers for Medicare and Medicaid Services. CMS approval involves a formal proposal by TennCare, followed by an open comment period for the public to respond.
“This is a first-of-its-kind Medicaid benefit,” TennCare Communications Director Amy Lawrence told The Tennessean. “No other state has done this, so it might take a little bit more time for CMS to approve it, but we’re hopeful that they will.”
If CMS moves quickly to approve the plan, the benefit could become available to families on TennCare by January 2024.
How many diapers are covered?
TennCare will provide half of the total average number of diapers needed by an infant each month for each child eligible for the benefit. TennCare is working to calculate the quantity of diapers the benefit will provide each month.
Who is eligible?
Any child who is a TennCare member under 2 years of age at that time will be eligible for diapers until they turn 2 regardless of when they enrolled into TennCare, Lawrence said. Mothers, parents and caretakers are not required to be TennCare participants to obtain the diaper benefit for their child.
Where does the money come from?
Funding for the benefit comes from the $330 million in savings the state realized by restructuring how the state receives Medicaid funding from the federal government in a new system known as a modified block grant.
Lawmakers approved $30 million in funding last month specifically for the diaper benefit, which will first become available when the state budget goes into effect on July 1.
Where will families be able to get diapers through TennCare?
Right now, TennCare is planning to run the benefit through participating pharmacies, similar to how the department handles over-the-counter drugs.
“We would get participating pharmacies to code it, bill it to us and then people could go through their pharmacy to get diapers,” Lawrence said.
A variety of diaper brands will be covered by the benefit to allow parents to choose the best fit for their child, and account for skin sensitivities and other needs. Approved brands are still being determined.
PHE- Early numbers show nearly 70% of Oregonians keep Oregon Health Plan benefits in first round of renewals
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: Oregon shows that the wind-down can be done without everyone losing their minds. This is the way.
Oregon Health Authority
SALEM, Ore. (KTVZ) – The Oregon Health Authority and Oregon Department of Human Services are committed to transparency and will be sending monthly information about medical coverage among Oregonians as the agencies continue to track the state’s progress in determining eligibility for medical programs.
Background
When the COVID-19 pandemic began, the federal government allowed states to keep people on Medicaid once they became eligible and did not require annual eligibility renewals. During this historic health emergency, the Oregon Health Plan (OHP), Oregon’s Medicaid program, grew to nearly 1.5 million people.
In April, Oregon began the process of redetermining eligibility for everyone on OHP. While most people will continue to qualify for existing benefits, OHA is required to review eligibility for all OHP and Medicare Savings Program (MSP) members by mid-2024.
OHP redeterminations started in April
In April, Oregon began processing eligibility redeterminations for all 1.5 million members receiving OHP and other Medicaid-funded services and supports. The federal government requires Oregon to disenroll any members who are no longer eligible or fail to respond to renewal notices.
All OHP households will receive a renewal notice over the next 10 months. People are encouraged to check that their contact information is up to date so that they can be contacted by the state and receive renewal notices.
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Oregon will be able to process many renewals automatically. This means that every OHP member will receive a renewal notice, and the notice will explain whether the member needs to provide additional information or take action to keep their coverage.
OHP members encouraged to respond quickly
Although the state has taken many steps to prepare, the large number of OHP redeterminations, along with renewals of long-term services and supports, is expected to cause greater wait times, delays, and possible interruptions to people’s OHP benefits. OHP members are encouraged to respond as quickly as possible after they receive a request for information to avoid any possible delays. The fastest way members can provide an update is by going to benefits.oregon.gov and logging into their ONE account.
Members losing OHP coverage have other coverage options and will receive at least 60 days advance notice. Many people will be eligible to enroll in health plans through the Oregon Health Insurance Marketplace (OHIM) with financial help. Other people may be eligible for Medicare or employer coverage.
April OHP redeterminations data
- April was the first month Oregon began processing medical renewals, during this reporting period: 133,232 individuals, or 75,436 cases have had their OHP renewed.
- 46,894 individuals, or 29,072 cases needed to provide more information to complete the process.
- 13,208 required individuals to review, sign and send back their renewal packet.
- 8,394 people were ineligible and received a 60-day notice of termination of coverage. When people are ineligible, they are referred to the Oregon Health Insurance Marketplace for other options for health care coverage.
Early data for May shows 66% of people will retain benefits.
Members losing coverage should report changes to their income or household information immediately if any of the information used to make the decision is inaccurate. They also should apply for other health coverage as soon as they know their coverage ending date to prevent a gap in coverage.
Data dashboards in place for tracking progress
Two new dashboards became available in April for the public to track Oregon’s progress.
- Medical Redeterminations Dashboard for tracking the state’s progress in determining eligibility for medical programs. This dashboard is updated daily. The types of data in this dashboard will expand over the next few months.
- ONE Customer Service Center Dashboard for monitoring the customer service experience for people calling the ONE Customer Service Center to apply for or ask for help with medical, food, cash and child care benefits. The ONE Customer Service Center Dashboard is updated every day.
Extending health coverage
To get help, people can also:
- Learn more about how to renew your Oregon Health Plan medical coverage.
- Call the ONE Customer Service Center: 800-699-9075 (all relay calls are accepted, and help is available in multiple languages).
- Stop by a local ODHS office or Area Agency on Aging Office. People can find their local office at: https://www.oregon.gov/dhs/Offices/Pages/one-services.aspxm
- Visit a community partner for free, in-person help. To find one near you visit https://oregonhealthcare.gov/GetHelp (English) or orhim.info/ayuda (Spanish).
Get help finding other health coverage at OregonHealthCare.gov/GetHelp
STATE NEWS (CNMI)- CNMI Medicaid to limit, reduce, or suspend services
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: This is what it looks like when you can’t exceed your funded Medicaid amount.
(Office of the Governor) — Under the waiver authority of Section 1902(j) of the Social Security Act, the Commonwealth Medicaid Agency will limit, reduce, or suspend services due to financial constraints and cost-cutting measures.
In an effort to sustain the program and ensure medically necessary services are not disrupted, temporary limitations, restrictions, or suspensions will be implemented and taken into effect on June 1, 2023, and end no later than September 30, 2023.
The affected services are:
Suspended
Dental Services
Outpatient Physical Therapy and Related Services
Home Health Physical Therapy, Home Health Aide, or Medical Social Worker services
Prosthetic Devices
Vision Services
Children ages 0-20 years may be excluded from the limitations, reductions, or suspensions of services for the purposes of Early and Periodic Screening, Diagnostic, and Treatment services through prior authorization. Prior Authorization requests must accompany physician certification of medical necessity.
Limited
Home Health Services* – Skilled Nursing Services only
Durable Medical Equipment will be restricted to monthly rental only
Accessories required for the use of a DME and Medical supplies will be restricted to critical cases
Prescribed Drugs**
Transportation**
*Children ages 0-20 years may be excluded from the limitations, reductions, or suspensions of services for the purposes of Early and Periodic Screening, Diagnostic, and Treatment services through prior authorization. Prior Authorization requests must accompany physician certification of medical necessity.
**Prescribed Drugs will be limited to generics only. Prescribers and pharmacists are required to make good faith efforts in ensuring first-line therapies are available in generic.
**Transportation: Air transportation will be reimbursed for medically necessary and emergency purposes and shall be enforced by the Health Network Program. Ground non-emergency transportation must accompany a Physician’s Certification Statement of necessity.
Restricted to
The Commonwealth Healthcare Corporation, Tinian Health Center, Rota Health Center, or a Federally Qualified Health Center or FQHC:
Outpatient Hospital Services
Laboratory and X-Ray Services
Family Planning and Pregnancy-Related Services
Physician, licensed practitioner, and any other medical care services
Clinic Services
Exceptions may be made if CHCC or the FQHC is unable to provide the services in a timely manner by a written authorization signed by the designated staff. The Service Provider Exception Authorization Form must be completely filled and signed by the two entities.
Exclusions
Dialysis Services will remain available at any of Medicaid’s approved provider networks in the CNMI.
For more information, please contact the Commonwealth Medicaid Agency:
Saipan
Gov’t Bldg 1252, Capital Hill
Monday – Thursday
Closed on Fridays & Holidays
7:30 a.m. – 1 p.m.
Contact no.
(670) 664-4880/4882
Tinian
Tinian Health Center
Monday – Friday
7:30 a.m. – 4:30 p.m.
Contact no.
(670) 433-9263/33
Rota
Rota Health Center
Monday – Friday
7:30 a.m. – 4:30 p.m.
Contact no.
(670) 532-9461/62
RX- Biden-Harris Administration Announces Proposal to Advance Prescription Drug Transparency in Medicaid
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: In which CMS will dive deeper on exactly how RX manus set prices. Or will try to, anyway.
New HHS proposal would shed light on cost of prescription drugs and save states and federal government money in Medicaid
The Biden-Harris Administration has made lowering prescription drug costs in America a key priority — and President Biden is continuing to deliver results. Today, the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), is proposing steps to further drive down prescription drug costs in Medicaid and build on President Biden’s executive order to lower prescription drug costs for Americans. CMS’ latest notice of proposed rulemaking (NPRM) would shed light on the actual cost of drugs covered by Medicaid. Under this proposal, Medicaid would have increased ability to hold drug manufacturers accountable for what Medicaid programs pay for drugs.
“President Biden is not only committed to protecting Medicaid, but continues to take bold actions to strengthen the program,” said HHS Secretary Xavier Becerra. “With today’s proposed rule, we are advancing unprecedented efforts to increase transparency in prescription drug costs, being good stewards of the Medicaid program, and protecting its financial integrity. This proposed rule will save both states and the federal government money.”
“This proposed rule prioritizes CMS’ role as a good steward of Medicaid dollars while also strengthening program integrity and the management of pharmacy benefits for people with Medicaid coverage,” said CMS Administrator Chiquita Brooks-LaSure. “We’re committed to preserving access to life-saving treatments and securing fiscal sustainability for the Medicaid program, which remains a lifeline for millions of people.”
Today’s proposed rule to improve the Medicaid Drug Rebate Program follows the Biden-Harris Administration’s historic creation of the Medicare Prescription Drug Inflation Rebate Program. As part of President Biden’s new prescription drug law, for the first time ever, drug companies must now pay rebates to Medicare when their prescription drug prices increase faster than the rate of inflation for certain drugs dispensed to people with Medicare.
Increase Transparency of Prescription Drug Costs
This rule would allow CMS to have more insight into what the most expensive drugs on the market today actually cost to manufacture and distribute. The proposed regulation would give CMS and states additional tools, like a drug price verification survey, which would result in greater transparency into manufacturers’ drug prices. This survey would verify drug prices to increase transparency about why certain drug prices are expensive for Medicaid and help states better negotiate what the Medicaid program pays for high-cost drugs. With this information, state Medicaid agencies would be able to operate their pharmacy programs more effectively while helping more people get vital drug treatments. This increased transparency under Medicaid would advance the Biden-Harris Administration’s efforts to complement the Inflation Reduction Act and further drive down prescription drug costs without impacting coverage of drugs for Medicaid beneficiaries. For additional information on the drug price verification survey, visit Medicaid.gov.
Increase Transparency of Managed Care Plans
Another proposed provision aims to enhance transparency into the costs of administering drug benefits in Medicaid-managed care plans. Managed care plans cover more than 75% of Medicaid beneficiaries. Managed care plan pharmacy benefit managers (PBMs) often negotiate and administer the pharmacy benefit, though there has been a lack of transparency into the amount plans have paid to PBMs for administering the drug benefit and the amount pharmacies have been paid for the drugs. This lack of transparency has raised concerns about PBMs using spread pricing arrangements to increase their profit margins by charging an MCO more for a drug than the amount a PBM pays a pharmacy. To address this issue, CMS is proposing that contracts between states, Medicaid-managed care plans, and third-party contractors, such as PBMs, reflect transparent reporting of drug payment information among third-party contractors. This proposal will help ensure that taxpayer dollars are actually going to pay for drugs and not increased profits.
Increased Transparency in Drug Classifications
The NPRM also focuses on the potential misclassification of drugs as brand name or generic. The proposed rule includes provisions to ensure states would receive the appropriate rebates to which they are entitled, since states receive a higher percentage of rebate dollars for brand-name drugs compared to generics. With increased transparency, states would be able to determine if manufacturers appropriately classified their covered outpatient drugs, and if they did not, give CMS the ability to take action to correct the misclassification.
For additional information on these and other provisions in the NPRM, please visit Federal Register. CMS looks forward to accepting public comment on the NPRM through July 25, 2023.
FWA (GA) Atlanta man, healthcare provider indicted on Medicaid fraud
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: “Atlanta man” did something. In 2018, and in 2020.
ATLANTA — An Atlanta healthcare provider has been indicted on 26 counts of Medicaid fraud and three counts of felony forgery after he allegedly submitted fraudulent claims, according Georgia Attorney General Chris Carr’s office.
The 55-year-old man was indicted last Monday after the Attorney General’s Office Medicaid Fraud Division presented evidence to a Fulton County Grand Jury.
“We are working each day to protect taxpayer dollars by putting a stop to Medicaid fraud in our state,” Attorney General Carr said.
He allegedly submitted the claims for fake services he didn’t provide under his company to get a reimbursement payment from the government program in 2018.
He was a licensed healthcare provider in Georgia, according a court document.
Court documents also show that the 55-year-old also forged a few documents in 2020, the indictment stated.
“Ensuring the integrity of providers and services is a key part of our efforts. Georgia’s Medicaid program is meant to care for our most vulnerable, and we will not tolerate those who would abuse this public trust,” Carr added.
The indictment comes after Georgia received it’s own Medicaid fraud division which receives majority of its funding from the U.S. Department of Health.
If convicted, the man could pay up to a fine of three times what the government program lost and $11,000 for each fraudulent claim, according to the U.S. Department of Health and Human Services.
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FWA (NC)- Attorney General Josh Stein Reaches $150,000 Medicaid Fraud Settlement with Rockingham Health Care Provider
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: Compassionate Counseling stole $150,000 of your tax dollars with bogus service claims.
Clipped from: https://ncdoj.gov/attorney-general-josh-stein-reaches-150000-medicaid-fraud-settlement-with-rockingham-health-care-provider/
For Immediate Release:
Wednesday, May 17, 2023
Contact: Nazneen Ahmed
919-716-0060
(RALEIGH) Attorney General Josh Stein today reached a $150,000 settlement with Compassionate Counseling Services in Rockingham to resolve allegations that the company submitted false claims to the North Carolina Medicaid program. The settlement funds will be returned to the program.
“Health care providers that receive Medicaid resources need to use those resources properly,” said Attorney General Josh Stein. “When providers fail to responsibly steward taxpayer dollars, my office will hold them accountable. I’m grateful to the U.S. Attorney Hairston and her office for their continued partnership to protect health care resources.”
From June 7, 2016, to Jan. 8, 2021, Compassionate allegedly billed Medicaid for diagnostic assessments that were backdated or not properly signed and dated by the required professional. Because of the lack of proper documentation, Compassionate failed to support that the assessments were properly rendered or that the services were necessary.
The civil claims resolved by settlement here are allegations only, there has been no judicial determination or admission of liability, and Compassionate denies the allegations.
The investigation and prosecution of this case was conducted by the United States Attorney’s Office for the Middle District of North Carolina and the Medicaid Investigations Division of the North Carolina Attorney General’s Office.
About the Medicaid Investigations Division (MID)
The Attorney General’s MID investigates and prosecutes health care providers that defraud the Medicaid program, patient abuse of Medicaid recipients, patient abuse of any patient in facilities that receive Medicaid funding, and misappropriation of any patients’ private funds in nursing homes that receive Medicaid funding.
To date, the MID has recovered more than $1 billion in restitution and penalties for North Carolina. To report Medicaid fraud or patient abuse in North Carolina, call the MID at 919-881-2320. The MID receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,106,236 for Federal fiscal year (FY) 2022. The remaining 25 percent, totaling $2,035,412 for FY 2022, is funded by the State of North Carolina.
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FWA (KY) – Boyle County woman pleads guilty to Medicaid fraud
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: Amber Turner stole about $200,000 of your tax dollars. She did not say thank you.
Clipped from: https://www.amnews.com/2023/05/22/boyle-county-woman-pleads-guilty-to-medicaid-fraud/
Published 7:26 pm Monday, May 22, 2023
By Special to The Advocate-Messenger
NEWS RELEASE
An investigation and prosecution by the Kentucky Attorney General’s Medicaid Fraud Unit led to a guilty plea of a Boyle County woman for defrauding the Kentucky Medical Assistance Program, also known as Medicaid.
Attorney General Daniel Cameron announced Monday that Amber Turner, 36, of Danville, appeared at Boyle County Circuit Court last week, and entered a guilty plea to the charge of devising or engaging in a scheme to defraud the Kentucky Medical Assistance program of $300 or more, a Class D Felony. She will be placed on a five-year period of pretrial diversion, but still faces up to a five-year prison sentence if she does not successfully complete the period of diversion.
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As part of the plea agreement, Turner was also ordered to pay restitution to the Kentucky Medical Assistance Program in the amount of $200,000.
The Attorney General’s Medicaid Fraud Unit investigated the case. David R. Startsman, an attorney with the Medicaid Fraud Unit, prosecuted the case on behalf of the Commonwealth. If you wish to file a Medicaid fraud or abuse complaint, go to ag.ky.gov/MedicaidFraud or call the Medicaid Fraud and Abuse Hotline at 1-877-ABUSE-TIP, or 1-877-228-7384.
The Kentucky Attorney General’s Office of Medicaid Fraud and Abuse Control receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award of $6,333,333 for Federal fiscal year 2023. The remaining 25%, totaling $1,583,333 for FY 2023, is funded by the state.
3 Memphis women indicted in TennCare fraud scheme
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: Latissa, Shaqunna and Syretta worked together to use a child as a billing number to steal your tax dollars.
Clipped from: https://www.actionnews5.com/2023/05/19/3-memphis-women-indicted-tenncare-fraud-scheme/
(Left to right) Latissa Johnson, Shaqunna Jackson, and Syretta Jenkins(TBI)
MEMPHIS, Tenn. (WMC) – An investigation by special agents with the Tennessee Bureau of Investigation (TBI) Medicaid Fraud Control Division has resulted in the indictment and arrest of three women from Memphis.
In December 2022, TBI received a tip from BlueCare, a TennCare-managed care contractor, alleging fraudulent billing for TennCare services in Memphis.
During the investigation, agents developed information that between June 2022 to October 2022, 37-year-old Latissa Johnson, who is the mother of a TennCare recipient, schemed with her child’s home care provider, 27-year-old Shaqunna Jackson, to submit claims for care that were never provided.
Agents also determined Jackson’s supervisor, 42-year-old Syretta Jenkins, participated in the scheme.
On May 2, a Shelby County Grand Jury returned indictments charging Johnson, Jackson, and Jenkins each with TennCare fraud and theft of property ($10,000 to $60,000).
On Tuesday, Jackson and Jenkins surrendered to authorities.
Friday, with the assistance of the Memphis Police Department Fugitive Team, Johnson was taken into custody.
All three were booked into the Shelby County East Women’s Facility on a $25,000 bond.
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FWA (MS) – Mississippi man sentenced for $1.4 million in fraudulent medical charges
MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: Marion Lund stole $1.4M of your tax dollars. He did not say thank you.
Clipped from: https://www.picayuneitem.com/2023/05/mississippi-man-sentenced-for-1-4-million-in-fraudulent-medical-charges/
Published 4:07 pm Friday, May 19, 2023
A Panola County man was sentenced Monday to two years in prison following his conviction for his role in a scheme to defraud Medicare and TRICARE by prescribing and dispensing medically unnecessary foot bath medications and ordering medically unnecessary testing of toenails in exchange for kickbacks and bribes. According to court documents, Marion Shaun Lund, D.P.M., 54, of Batesville, owned and operated a podiatry clinic, as well as an in-house pharmacy in Oxford. Lund routinely wrote prescriptions for and dispensed antibiotic and antifungal drugs to be mixed into a tub of warm water for patients to soak their feet. Rather than prescribing drugs based on the individualized needs of patients, Lund prescribed foot bath medications in order to maximize reimbursements from Medicare, TRICARE and other health care benefit programs, regardless of medical necessity.
In addition, Lund took toenail clippings and wound cultures from patients and sent them to a lab for diagnostic testing, even though such testing was not medically necessary. From April 2020 through March 2022, Lund caused the submission of over $1.4 million in claims to Medicare and TRICARE for unnecessary prescriptions of foot bath medications and diagnostic testing of toenails, resulting in over $700,000 in reimbursements. In exchange for his prescriptions and orders, Lund was paid cash kickbacks by a purported marketer. On Feb. 2 Lund entered a plea of guilty to one count of conspiracy to commit health care fraud. On Monday morning, U.S. District Judge Glen Davidson sentenced Lund to 24 months in prison, followed by three years of supervised release and ordered Lund to pay restitution in the amount of $851,428. Lund is the fourth defendant, including three medical professionals, to plead guilty and be sentenced for a role in the scheme. In October 2021, Logan Hunter Power pleaded guilty to one count of conspiracy to defraud the United States and to pay and receive kickbacks, and in October 2022, Power was sentenced to 25 months in prison. In August 2022, Jared Lee Spicer, D.P.M., pleaded guilty to one count of conspiracy to commit health care fraud and was sentenced to serve a term of three years probation. In September 2022, Carey “Craig” Williams, D.P.M., pleaded guilty to one count of conspiracy to commit health care fraud and was sentenced to serve 42 months in prison. Trial Attorney Sara E. Porter and Assistant Chief Justin M. Woodard of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Clayton A. Dabbs of the Northern District of Mississippi prosecuted the case.
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The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, composed of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes.