Fraud and Abuse

Beware of Scam Email Sent to TMA Members - 08/21/2019

An unauthorized email that claimed to be from the Texas Medical Association recently was sent to some TMA members stating that the individual member’s dues statement and insurance policy update was included. If you received this email, please know that it did not originate from nor was it authorized by TMA or the TMA Insurance Trust, and you should discard it.


Beware of Phony TMB or DEA Agents - 07/03/2019

The Texas Medical Board (TMB) is warning physicians and pharmacies of a scam involving criminals who sometimes pose as TMB officials. TMB passed along a report from the U.S. Drug Enforcement Administration (DEA) that says physicians registered with the DEA are receiving calls and emails from criminals who identify themselves as DEA personnel or other law enforcement agents.


Scammers Targeting Texas Pulmonologists Seeking $500 - 06/19/2019

The Texas Medical Association is warning pulmonary physicians to be aware of a scam involving a letter from a phony medical board that seeks $500 “for Pulmonary Disease Certification Status Verification.” Two Texas pulmonologists contacted TMA to report a letter from the “American Board of Pulmonary Disease” notifying them of a “very important requirement to continue certification in pulmonary disease at this time. You are on record having failed to previously register, and must comply.”


Alert: Scammers Demanding Bogus Fines For Drug Purchases - 04/01/2019

The Texas Medical Association and the Texas Medical Liability Trust (TMLT) are warning physicians about scammers posing as a U.S. Drug Enforcement Administration agent trying to defraud doctors into paying a nonexistent federal fine for allegedly intercepting illegal prescription drugs the doctor had sent through the mail.


Greenway Clients Entitled to Free EHR Upgrade After Fraud Settlement - 02/12/2019

Electronic Health Record vendor Greenway Health has been ordered to offer its clients free upgrades to its latest version of Prime Suite as part of a settlement in a multimillion-dollar fraud case.  


Don’t Fall for Credentialing Scam, Blue Cross Says - 10/23/2018

Blue Cross and Blue Shield of Texas warns physicians to be aware of a scammer that is offering to help doctors become credentialed with the insurance company for $250.


What To Do When Employees Steal: Medical Practices Are a Ripe Target for Embezzlement - 09/14/2018

Medical practices are a ripe target for embezzlement.


EHR Vendors Behaving Badly; What Can You Do? - 08/27/2018

Have you had a problem with your electronic health record vendor not following through on its contractual obligations? Many practices don’t know how or where to get help.


Kyle Janek: The Texas Medicine Interview - 04/24/2018

New Texas Health and Human Services Executive Commissioner Kyle Janek, MD, has concerns about Medicaid - about having enough physicians to care for patients, about how to improve the health insurer, and other thoughts he shares with Texas Medicine magazine. In this interview he covers that, fraud investigations, women's health and other key issues he and the state face.


New Medicaid Inspector General Appointed - 01/19/2018

Gov. Greg Abbott has appointed Sylvia Hernandez Kauffman inspector general for the Texas Health and Human Services Commission.


Tax Fraud - 07/06/2017

A nationwide identity theft scheme is targeting physicians and leaving the Internal Revenue Service liable for hundreds of thousands of dollars in fraudulent tax refunds. As of June, more than 100 Texas Medical Association members notified the association someone had stolen their Social Security numbers and attempted to claim their tax refunds. The association has learned the crime's victims also include physician assistants, advanced practice registered nurses, dentists, podiatrists, and pharmacists. Texas is one of 49 states and the District of Columbia affected by this con.


Fraud, Waste, and Abuse Training: Not Just for Medicare Advantage Plans - 01/27/2017

Medicare requires annual fraud, waste, and abuse training for physicians contracted with any Medicare Advantage plan and their staff. But all practices should provide this type of training to all employees, regardless of health plan participation, says TMA.


Identify Your Own Fraud and Abuse Red Flags - 09/26/2016

One way to help keep your practice operations squeaky clean and in compliance with fraud and abuse laws is to develop an internal set of warning indicators.


What Triggers a Coding Audit? - 06/03/2016

What Triggers a Coding Audit?


Waiving Copays - 06/03/2016

Waiving Copays


Verify Drug, Device Sources - 06/03/2016

The Texas attorney general is cracking down on physicians who purchase medical products and drugs deemed illegal to use in the United States. Here’s how you can verify the legitimacy of a distributor, drug, or medical product:


Use RAC Discussion Period to Communicate About Medicare Audit - 06/03/2016

If I receive a letter from the Medicare Recovery Audit Contractor regarding overpayment, do I have any options other than to either pay up or launch an appeal?


TMLT Policies Cover RAC Audits - 06/03/2016

Texas Medical Liability Trust (TMLT) policyholders audited under Medicare's Recovery Audit Contractor (RAC) program are now covered.


RACs Back On - 06/03/2016

Centers for Medicare & Medicaid Services officials say the Recovery Audit Contractor (RAC) program will resume after the agency resolved a protest that delayed its attempt to recoup improper Medicare payments to physicians and health care professionals.


OIG Focuses Fraud Efforts on Physician Compensation - 06/03/2016

A recent U.S. Office of Inspector General (OIG) fraud alert warns that physician compensation arrangements may result in significant liability.


New Toolkit Helps Doctors Navigate Medical Audits - 06/03/2016

The Physicians Advocacy Institute and the American College of Emergency Physicians collaborated to develop the Toolkit for Physicians Facing Medical Audits, which provides practical information and tips to help physicians anticipate medical audits, respond to auditors’ requests for medical records, and appeal erroneous audit findings.


Avoid These Six Practices to Stay Clear Medicare Fraud Charges - 06/03/2016

Cracking down on fraud, waste, and abuse in government health care programs has taken a front seat in the U.S. government’s drive to control health care costs. Here are the six top things it is looking for as indications of possible fraud.


Tax Refund Fraud Scheme Affects Texas Physicians - 05/20/2016

Physicians are the latest victims in a tax refund fraud scheme making waves across the nation. The American Medical Association reports it's working with federal officials in the investigation, headed by the Internal Revenue Service and the Secret Service. While the exact source of the identity theft hasn't been detected, several theories exist.


Fighting for Fairness - 05/13/2016

When the Texas Health and Human Services Commission Office of Inspector General (OIG) adopted "program integrity" rules physicians couldn't live with, the Texas Medical Association took action to protect physicians. The association fought during this year's legislative session to improve due process in OIG fraud investigations and secured legislation that lends greater transparency to the agency's investigative and payment hold processes.


No Longer an Option - 05/13/2016

The U.S. Department of Health and Human Services Office of Inspector General used to encourage physicians in Medicare and Medicaid to adopt voluntary compliance programs. But now it's the law. Under the Patient Protection and Affordable Care Act, compliance programs are no longer voluntary. As a condition of enrollment in federal health programs, including Medicare and Medicaid, the health system reform law requires physicians to establish a compliance program that features specific core elements.