In Medicaid Fraud Investigations, a Controversial Tool
This article is the third of an occasional series on the consequences of state efforts to curb spiraling health costs, and the dollars lawmakers might target in the future.
When it comes to finding cost savings in the state’s unwieldy Medicaid program, the Health and Human Services Commission’s Office of Inspector General gets high marks.
The division, charged with investigating fraud among health providers paid to treat poor children and the disabled, has dramatically increased both its caseload and the potential monetary returns associated with it over the last fiscal year, a spike that has won rave reviews ...
Comments (8)
Holly Zimmerman via Texas Tribune on Facebook
Who watches the Watchmen?
Rudy Gonzales
HHSC has the power and the mandate to protect insureds and shut down Medicaid and Medicare abuses. HHSC is overseen and respond to the people of Texas with oversight by CMS and back to the president who has shown his preponderance to act in the peoples favor rather than those who want to abuse the system. Medicaid and Medicare abuses must be pursued to the limits of the law. Medicare and Medicaid is not the doctors, but the peoples. State governors cannot make changes to abuse the system or have any direct influence on use of funds. Sounds like they are doing a fine job.
Audrey Fisher via Texas Tribune on Facebook
In the real world, most have this thing called Corporate Responsibility and demand Due Diligence. When the best defense the Tx Med Ass. can come up with is a legal whine - one should consider this as "baffle with BS" and attempt to throw up a legal smokescreen. Did everyone forget the NewYorker article a few years back: South TX MD said that he performs many duplicate tests because he can - not because they were necessary. While that technically isn't fraud, it is exactly why the State of TX should embrace ACA....and now they are whining about the Waiver's they Demanded - hysterical!
Will Garner via Texas Tribune on Facebook
The TMA does their own research prior to advocating for a specific provider. They do not blindly defend any practice that complains. Having personally witnessed one of these OIG "investigations", I found the lack of due process and complete ignorance of basic medical knowledge astounding.
Rudy Gonzales
Insurance companies, like every other business, is in business to make money. You are not covered. The insurance companies are the one covered with small print full of exceptions, limitations and other liability curbs for the insurance companies themselves. It just like going to the local casino. It doesn't matter what you are insuring, the company is the one protected.
There is no question that Perry’s true interests lie—that being with the extreme right wing of a political party, which refuses to criticize or hold to account its leaders who thumb their noses at the rule of law—the Governor pretty much puts it right out there when suggesting that that the expansion of Medicaid in his state would not result in more affordable care or better patient protection for Texans.
How can Perry logically state the the Medicaid expansion, with the bill to be picked up almost exclusively by Uncle Sam, does not result in more affordable care or better patient protection? That simply makes no sense…not that Rick Perry has ever shown much in the way of concern when it comes to applying common sense. Truth is he can't.
Under the Affordable Care Act, the first three years of the expansion would be 100 percent paid for by the federal government, followed by two years where 95 percent would be covered by the Feds. Thereafter, Texas would only be responsible to pay 10 percent of the cost of Medicaid expansion.
Given that Texas has, to date, operated one of the skimpier Medicaid programs in the nation, the state actually stands to benefit more than any other as a result of the Affordable Care Act’s Medicaid expansion. However, if Governor Perry has his way, this opportunity will be missed—all to improve his status among the Tea Party elite.
TEA party extremes say they believe in limited government, but push or allow government imposed Sonogram/Ultrasound on women. TEA party extremes say they believe in Free speech, but interrupt loudly at any meeting and have disrupted meetings in the past. TEA party extremes say they believe in the 2nd amendment while taking loaded guns openly displayed to gatherings.
TEA party extremes say they believe in our military, but offer nor retort to people like Jim DeMint of South Carolina, who put a hold on legislation was to be voted on for medical help or assistance to women and children as well as military personnel of Marine Base Camp Lejeune which had their water system contaminated with trichloroethylene, tetrachloroethylene, benzene and vinyl chloride. TEA party extremes say they believe in secure borders and support extremist like the governor and legislature of Arizona who stepped across the line on immigrant legislation issues.
TEA party extremes say they believe in our country, but conspire to execute their fringed views onto the masses without regard to freedoms of others. TEA party extremes say they believe in restricting voter rights going against federal laws. TEA party extremes say they believe Muslims should have no rights in America and have been totally critical of those who do.
TEA party extremes say they believe in free speech but would disallow Mosques built in America. TEA party extremes say they believe in Free speech, but fight the LGBT community. TEA party extremes are bigots, racist and demigods steeped in their own private world much like Adolph Hitler wanted.
e sodaro
A physician or dentist would have to be out of his or her mind to accept Medicaid.
The absence of due process, the incentive nature of prosecution unburdened by civil liberties, and reimbursement at less than the cost of doing business creates an untenable situation.
James Moriarty via Texas Tribune on Facebook
The folks that are whining about the "atomic bomb" being dropped on their business need to be practicing "I take the 5th" rather than whining about working for free for poor kids whose moms put them to bed with sippy cups of Mountain Dew, which serves to explain how they ended up with an 8 pack. And we aren't talking about Bud either. If this pay is so bad, how is it some of the finest homes in the country belong to dentists who "serve" Medicaid children?
Christine Lund
I am sick of hearing doctors and dentists complain about how little they are paid by Medicaid. Since when in modern days, did ministering to sick and injured become a for-profit profession? I know that there is enough food to feed us in America yet children, women and men go to bed with no dinner every night. I know that if you got sick, the nuns and church would minister you. The finest, most compassionate care possible. Now, the corporations have bought out the local hospitals and sold them off. Leaving only one of two places to go in most places, even in big cities.
I know that after dedicating your life to a career and the high expense of it, you'd think you'd want to make a difference? Many of the doctors(?) are arrogant and uninterested. Dispassionate, tired, bored or uncaring. Many of those I've met seemed put out to tend to me. Doctors were once treated almost like your priest. You always felt cared about. That is not happening. The very thought that your doctor would be a thief is unimaginable to me. These people need more than fines and long sentences. We need to ensure these thieves don't just change cities and start over.
Let me say that I appreciate the fine physicians that are working hard to help heal this world. The ones that are stuck working shorthanded, due to budget demands. But for young doctors to profess their desire to help and expect to be rich withoutpaying their dues is amazing. And the middlemen, who are selling expensive equipment (at great profit) and selling drugs (so overpriced) that no one can afford care or drugs. And the legislators that give favors to these people.
Why does Texas have the largest medical center in the world and we can't get an appointment for months and then it's months off. Go to the ER and wait forever and a day. I know we're better than this.