Medicaid Fraud Is Big (BIG) Target of Both Federal Authorities and Texas Law Enforcement in 2013

Health care fraud — fake billing to Medicare or Medicaid — can be very profitable for doctors, dentists, hospitals, care facilities, home health care providers, equipment suppliers: really, it’s a big temptation for anyone who is in a position to file a payment request to either federal government health care program. Which means that both state and federal authorities are very interested in finding and prosecuting people for crimes based upon allegations of either Medicare Fraud or Medicaid Fraud.

That’s right — even though it’s federal money involved in the payment of Medicaid and Medicare claims, the State of Texas is involved in prosecuting Medicaid Fraud right there with the Justice Department.

Texas Dentist Pleads Guilty to Medicaid Fraud

This week, the Federal Bureau of Investigation announced that an Abilene dentist named Tuan (”Terry”) Truong pled guilty to health care / medicaid fraud in a federal court and now Dr. Truong will await sentencing by U.S. District Judge Jorge Solis on one count of making a false statement in connection with a health care matter. According to the information filed by the prosecution, the dentist worked with kids at a place called Kool Smiles and as a pediatric dentist on a salary, he was said to have boosted his pay by filing fake Medicaid bills for procedures he never did.

While the money from Medicaid when to his employer, Dr. Truong benefited here by getting bonuses paid to him for working more than the daily requirements set by his boss. For the 13 month period that formed the basis of the Medicaid fraud case filed against him, the children’s dentist billed Medicaid for fake procedures totalling between $120,000 and $200,000; records show his bonuses totalled around $33,000.00.

September 2013: New Law Effective to Increase Investigation of Dentists Committing Medicaid Fraud

After reports that the Public Health Committee of the Texas House of Representatives was inundated with complaints about the failure of the Texas State Board of Dental Examiners not doing its job to curtail Medicaid fraud by dentists in this state, a new procedure for investigating fraud cases akin to Dr. Terry Truong’s case was debated by the Texas Legislature this year.

Effective September 1, 2013, a new Texas law creates a new process for dentists in the State of Texas to be investigated for complaints against them. Now, dentists practicing in Texas will face a similar process that has already been vetted for doctors by the Texas Medical Board. Now, within 60 days of the complaint being received, the Texas State Board of Dental Examiners must complete an investigatory process (where complaints are reviewed by experts like dentists, lawyers, and other specialists) and make a decision.

The Texas Medicaid Fraud Unit of the Office of the Texas Attorney General

Medicaid Fraud isn’t just the target of the boards that oversee their own (dentists, doctors), there’s also the State of Texas’ own Medicaid Fraud Control Unit which is run by the Attorney General’s Office.  From its website is the following description of the work undertaken by this department:

“ [it] conducts criminal investigations of Medicaid providers who are suspected of cheating the Medicaid Program. The Unit also investigates allegations of physical abuse and neglect in health care facilities which receive Medicaid funding. The Unit employs investigators, auditors and attorneys who conduct investigations and assist in the prosecution of Medicaid providers who defraud the system or abuse the elderly. The unit has its administrative headquarters and an investigative team in Austin and field offices located in eight cities across Texas.”

The eight field offices for Texas Attorney General investigations into Medicaid fraud include branches in Dallas, Tyler, El Paso, Houston, San Antonio, Austin, and Lubbock.

Texas’ interest in investigating and prosecuting Medicaid fraud is big. Consider this, the Medicaid Fraud web site notes to its readers that:

If you have a reason to believe that someone is defrauding the Medicaid program or is abusing a Medicaid recipient, contact the Medicaid Fraud Control Unit headquarters in Austin or one of the field offices.

You can also report the abuse or neglect to the Texas Department of Aging and Disability Services by calling (800) 458-9858. You can also contact local or state law enforcement.

A CRIMINAL OFFENSE: If you own or work in a nursing home or other facility and believe that a resident has been or may be the victim of abuse or neglect, you must report it. Failure to report suspected abuse or neglect is a Class A misdemeanor (Texas Health & Safety Code Section 242.122).

MEDICAID FRAUD DRIVES UP THE COST OF HEALTH CARE FOR ALL OF US. We each have a moral responsibility and a legal duty under Texas law to report Medicaid fraud.

Federal Settlement of Texas Medicaid Fraud Case Against Planned Parenthood

Over at the U.S. Attorney’s Office for the Eastern District of Texas, Medicaid Fraud has been a focus, as well. Recently, the big news has been that there has been a cash settlement in a case advanced against Planned Parenthood for Medicaid Fraud, and that Planned Parenthood agreed in settlement of a federal civil (not criminal) lawsuit to pay $4.3 million where allegations were that Planned Parenthood had billed Medicaid for fake services or unneeded services for many years (2003 – 2009) performed in its clinics here in Texas.

This was not a criminal case, but a civil lawsuit brought about by an ex-employee of a Planned Parenthood clinic in Lufkin, who became a whistleblower reporting that Planned Parenthood was requesting payment from Medicaid for things that never happened — or for services done that weren’t needed.

Why not a criminal case? Good question.