Latest news with #MedicareMedicaid
Yahoo
06-07-2025
- Health
- Yahoo
Justice Department's $15 Billion Crackdown Hits 22 Houston Fraud Cases
(Texas Scorecard) – As part of the U.S. Department of Justice's crackdown on healthcare fraud, more than a dozen individuals from the Houston-area have been charged. Nationwide, 321 individuals have been charged with multiple healthcare-related crimes, including wire fraud, bribery, and other fraudulent schemes. In total, the DOJ uncovered nearly $15 billion in fraudulent claims, and the United States has seized over $245 million in cash, luxury vehicles, and other assets in connection with the takedown. Attorney General Pam Bondi commented on the operation, stating: 'This record-setting health care fraud takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers. Make no mistake – this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.' According to the DOJ, 22 cases were announced Monday in Houston alone. These cases involve a wide array of healthcare fraud schemes, including unlawful distribution of controlled substances—some of which ended up on the black market—along with hospice fraud, kickbacks, and Medicare/Medicaid scams involving unnecessary genetic testing, durable medical equipment, and more. Among the most notable cases are Dera Ogudo (39) and Victoria Martinez (35), both of Richmond, who are accused of running a hospice facility that billed Medicare and Medicaid for end-of-life care while deceiving patients into believing they were receiving standard palliative or in-home services. Ogudo also allegedly paid bribes and kickbacks to Dr. Carlos Munoz, who certified patients for hospice care. The total fraud scheme is estimated at $110 million, with Munoz allegedly receiving over $300,000. Keilan Peterson and Kimberly Martinez of Houston have been charged with their alleged roles in a cash-for-prescriptions scheme operating through Relief Medical Center and GroveCare clinics. According to the indictment, Peterson paid three licensed physicians to give him, Martinez, and other clinic staff access to their electronic prescribing credentials. This allowed them to issue a high volume of prescriptions for controlled substances—including hydrocodone, carisoprodol, and oxycodone—without legitimate medical need. The indictment further alleges that Peterson funneled a portion of these prescriptions to his own business, Next Level Pharmacy, where he obtained the drugs and redistributed them illegally on the black market. In total, Peterson and his associates are accused of issuing more than two million pills, most of which were dispensed without medical justification and outside accepted professional standards. Dr. David Jenson, a podiatrist based in The Woodlands, and his business partner, Nestor Rafael Romero Magallanes, were charged with 14 counts of healthcare fraud for allegedly billing Medicare for expensive bioengineered skin grafts intended for chronic wound treatment. The pair allegedly received over $45 million in reimbursements. Brandy Williams, a Houston pharmacy owner, is accused of paying kickbacks to an unnamed podiatrist in exchange for unnecessary prescription referrals. Her pharmacy reportedly received over $4 million through the scheme. Tyneza Mitchell, a licensed nurse practitioner, allegedly received $2.1 million in Medicaid reimbursements for COVID-era treatments that were never provided. Chad Harper of Pearland is accused of using shell companies to pay bribes and kickbacks to marketers who generated business for his laboratories. The indictment claims Harper was reimbursed around $73 million by Medicare. Rami Abunakira, a Richmond resident involved with a lab in Dallas, is charged with billing Medicare $33.5 million for unnecessary genetic testing. Mahmood Sami Kahn and Suhaib Ahmad Chaudry, two Houston men charged in Illinois, are accused of masterminding a fraudulent COVID-19 testing operation. The pair allegedly manipulated labs in Texas and Illinois to submit false claims through a federal reimbursement program, receiving over $293 million, which they then laundered through multiple bank accounts. Kahn is also charged with wire fraud. U.S. Attorney Nicholas J. Ganjei responded to the sweeping operation: 'Americans rely on Medicare for needed treatments and life-saving care. Those [who] bilk this fund to unlawfully enrich themselves are ultimately stealing from the taxpayer and damaging public confidence in our health system. Today's takedown is a reminder to would-be medical fraudsters that the Department of Justice is always standing guard over the public fisc.'
CNN
07-05-2025
- Health
- CNN
HHS to build Medicare, Medicaid database on autism, other chronic illnesses
See all topics The US Department of Health and Human Services on Wednesday unveiled a pilot program for the National Institutes of Health to tap into Medicare and Medicaid data in its search for the root causes of autism The database — which HHS said will draw from insurance claims, medical records, and data from wearable technology such as smartwatches — is one of the first steps in HHS Secretary Robert F. Kennedy Jr.'s bid to find the causes of autism 'by September.' Yet early signals from health officials that they would build a database to track autism were met with swift rebuke from advocacy organizations and doctors. NIH Director Dr. Jay Bhattacharya's initial description last month of a 'new autism registry' with 'broad coverage' of the U.S. population raised red flags and questions about privacy, the Autism Science Foundation said in a statement shortly after the news. The Autism Self Advocacy Network lambasted the project as an example of how this administration has 'completely frozen out autistic people.' HHS nodded to those concerns in its announcement Wednesday. It said NIH and Centers for Medicare & Medicaid Services will start with a data use agreement focused on Medicare and Medicaid enrollees diagnosed with autism spectrum disorder, then establish a 'secure tech-enabled mechanism' that will share data with 'timely, privacy and security compliant data exchange.' The agencies will eventually build the pilot database out to share data on chronic illnesses and their economic burden, HHS said. 'Ever since the registry was first announced, there was an enormous sense of fear in the autism community, and they have concerns: Who's going to have access to data? How are those data going to be used?' Helen Tager-Flusberg, director of Boston University's Center for Autism Research and leader of the Coalition of Autism Scientists, told CNN. There are also limitations to CMS data, Tager-Flusberg said. 'If you're talking about Medicare and Medicaid, that only focuses on certain portions of the population.' Medicaid is a federal and state partnership covering low-income adults and children. Medicare is a federal program primarily for Americans 65 and older, although younger people with disabilities are also enrolled. There are permissible uses of CMS data for medical research but very stringent privacy laws, Jeff Wurzburg, former HHS general counsel and a health care regulatory attorney at Norton Rose Fulbright, told CNN before Wednesday's announcement. 'One of the primary, overarching goals of CMS is protection of the beneficiary. So it's certainly legitimate and reasonable to raise questions about how this data will be collected and protected.' Autism advocates and scientists have also questioned Kennedy's claim that health agencies would find the causes of autism by September, a timeline that Bhattacharya already appeared to walk back. 'Science happens at its own pace. We're accelerating and cutting the red tape that normally comes with putting together a scientific program like this,' he told reporters on April 22. 'We'll have, I hope, in September, something that in place where the scientists that want to want to compete for these awards will be able to do that.'
Yahoo
09-04-2025
- Health
- Yahoo
Texas bill for hospital safety barriers clears critical vote
The Brief Legislation was passed requiring the installation of safety barriers at the entrances to most hospitals in Texas This comes after a car crashed into a North Austin hospital, killing the driver and injuring several others If the legislation clears the House, and is later signed by the Governor, hospitals without the safety systems need to have them in place by January 2026 AUSTIN, Texas - A deadly crash into an Austin hospital in 2024 brought about action at the Texas Capitol. Legislation was passed requiring the installation of safety barriers at the entrances to most hospitals in Texas. The backstory At the entrance of St. Davids North Medical Center security barriers known as bollards are in place. They were not there back in February 2024. A car smashed through the entrance, killing the driver and injuring several people at St. David's. The night of the incident, FOX 7 spoke to witnesses who saw the sedan break through the glass doors at high speed. "It was such an intense experience, and it'll take a while to get the sounds of everyone's screams off my head," said Michelle Cruz when interviewed in 2024. What they're saying On Tuesday in the Texas Senate, Dallas Democrat Royce West spoke about the Austin crash and others like it. "There have been over 400 crashes into medical facilities within the last decade. And 22 of those have resulted in fatalities," said Senator West during the Floor Discussion. SB 660 filed by West requires hospitals to install bollards or other similar safety barriers. They are to be located at emergency room entrances that are close to vehicle traffic. "I was shocked that we didn't have [barriers] at hospitals. To the hospital's credit, some of them already have safety mechanisms in place," said Sen. West. West put in an exemption to address cost concerns. The opt-out is for hospitals in rural counties with populations of less than 68,000 people, and for hospitals designated as critical Medicare Medicaid access facilities. West said the barriers should be a consideration, beyond hospitals. "I think it is a wake-up call to make certain that all the businesses that we have, that they kind of look at the safety of the security of their particular buildings. And if you have some areas that are unsafe, where we have a lot of customers and patients come in, that you need to kind of look at it to make sure that those people are secure," said Sen. West. What's next Back in June, the Austin City Council passed a hospital safety barrier ordinance. It requires crash-tested bollards at all new hospitals that are built in Austin. The bill passed its second reading vote 21 to 9. If the legislation clears the House, and is later signed by the Governor, hospitals without the safety systems need to have them in place by January 2026. The Source Information from a Texas legislative session hearing
