ENFORCEMENT WATCH · Updated June 23, 2026

Texas Medicare Enforcement Watch

Who's getting caught in Houston and across Texas — home health, hospice, DME, and clinics — for how much, and the documentation failures that did it. Every entry traces to a public record from the DOJ, HHS-OIG, CMS, or the Texas Attorney General.

This is a curated record of public enforcement, not legal advice. The live government feeds we draw from are linked at the bottom so you can verify the latest yourself.

$14.6B

Intended fraud loss — 2025 National Health Care Fraud Takedown

324 defendants charged · June 30, 2025

Source: DOJ ↗

~50

Defendants charged in the Southern District of Texas in that takedown

22 cases · 18 medical professionals · $360M+ billed

Source: HHS-OIG ↗

$28.8B

Medicare fee-for-service improper payments, FY2025 (6.55% error rate)

Most improper payments are missing documentation — not always fraud

Source: CMS ↗

−1.3%

CY2026 Medicare home health payment update (−$220M vs. 2025)

Final rule CMS-1828-F · issued Nov 28, 2025 · effective Jan 1, 2026

Source: CMS ↗

The case log — Texas & Houston, 2025–2026

Charges and convictions in the Southern District of Texas and statewide. Click any row to open the government record.

United Palliative & Hospice Co. (UPHC) — Ogudo, Martinez, Shaw + 4

$110M+ billed

HospiceOct 21, 2025

43-count indictment — kickbacks to group-home owners and bribing a physician to falsely certify patients as terminally ill.

Source: HHS-OIG ↗

Marizel Yukee — Wound Medic LLC & affiliated clinics (Pearland)

~$906M billed / ~$297M paid

Wound-care clinicsJune 18, 2026

Indicted — health care fraud, wire fraud, kickbacks, money laundering. Medically unnecessary amniotic wound grafts on elderly and hospice patients; records altered after the fact.

Source: ABC13 / court records ↗

Paul Njoku — Opnet Health Care Services (Fort Bend County)

$400K+ billed / $360K+ paid

Home healthConvicted May 21, 2025 · sentenced Aug 28, 2025

Guilty on all counts — Medicare fraud and aggravated identity theft. Cut and taped old doctor and nurse signatures onto falsified records. 75 months in prison.

Source: HHS-OIG ↗

Jeremiah & Maria Yzaguirre — Southwest Medical Homepatient (Harlingen)

~$14M scheme

DME (power wheelchairs)Guilty plea Apr 2025

Pleaded guilty to defrauding Medicare with false claims for replacing wheelchair parts — over $736K billed for a single beneficiary.

Source: HHS-OIG ↗

Texas AG Medicaid Fraud Control Unit — two nurses

~$1.5M

Home health / nursing2025

Both sent to prison for defrauding Medicare.

Source: Texas AG ↗

Texas AG MFCU — home health company owner

$1.4M

Home health2025

57-month prison sentence.

Source: Texas AG ↗

Texas AG MFCU — home health care fraudster

$3M+ restitution

Home health2025

60-month prison sentence.

Source: Texas AG ↗

Texas AG MFCU — clinic owner

$15M Medicare scheme

Clinic2025

84-month prison sentence.

Source: Texas AG ↗

Dollar figures reflect amounts billed or alleged in the charging documents unless an outcome (restitution, sentence) is stated. Indictments are allegations; a defendant is presumed innocent until proven guilty.

What actually gets agencies caught

Strip away the headlines and the 2025 OIG audits keep finding the same six failures. They are documentation failures — and they're exactly what ClaimGuard audits for, before a reviewer ever sees your claim.

01Homebound status not supported

The eligibility linchpin auditors test first. If the record doesn't prove the patient is confined to the home, the whole episode is at risk.

02Skilled need / medical necessity not met

Services billed without documentation showing a skilled need — one of the largest improper-payment buckets in CMS's home health review.

03Invalid or missing face-to-face encounter

Named explicitly in 2025 OIG home health compliance audits. A missing or non-compliant F2F encounter denies the claim outright.

04Plan-of-care doesn't match the orders

Services billed that don't match what the physician ordered in the plan of care — a routine denial trigger on review.

05OASIS / comprehensive-assessment deficiencies

Called out by name in 2025 OIG audits. Assessment gaps undermine the eligibility and coding the rest of the claim rests on.

06Unsupported diagnosis / HIPPS coding (upcoding)

The single most common pure-billing error in the 2025 audits — codes the documentation doesn't actually support.

Would your documentation survive this?

Upload a de-identified home health document and ClaimGuard scores it against these exact failure points in under a minute — with the Medicare rule cited and the fix written for you. Three free audits, no credit card.

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The pressure that makes this matter now

Texas RCD is active through ~2029

The Review Choice Demonstration for home health was extended five years effective June 1, 2024. Texas agencies (MAC: Palmetto GBA) choose pre-claim review or postpayment review — and need 90%+ affirmation to ease up. CMS ↗

Payments cut 1.3% for CY2026

The CY2026 final rule lowers aggregate home health payments by ~$220M. Tighter margins make a denied claim — $2,200–$3,800 each — hurt more. CMS ↗

WISeR prior-auth launched Jan 2026

CMS's AI-assisted prior-authorization model is live in Texas — for 13 other service categories, not home health, but it signals where review is heading. CMS ↗

We watch these so you don't have to

The public feeds behind this tracker. Bookmark them — or let ClaimGuard keep score for you.

DOJ — U.S. Attorney, Southern District of Texas↗HHS-OIG — Enforcement Actions database↗Texas Attorney General — Medicaid Fraud Control Unit↗CMS — Newsroom (rules & program integrity)↗