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Law officers, MFCU fight Medicaid fraud across Texas
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Law officers, MFCU fight Medicaid fraud across Texas
  Texans correctly expect their government to carefully monitor spending and root out waste, fraud and abuse to ensure responsive stewardship of taxpayer dollars. For example, local, state and federal law enforcement agencies often must work cooperatively to reduce fraud in the Medicaid system. Our joint efforts protect both the Texans who rely on Medicaid for health care and the taxpayers who pay for the program. From September 1, 2003, to August 31, 2007, our Medicaid Fraud Control Unit identified more than $200 million in suspected Medicaid overpayments and obtained more than 300 criminal convictions. At the end of the 2007 fiscal year, MFCU was conducting more than 1,300 investigations.  Medicaid fraud cases are often very complex, and the MFCU’s success depends on its working relationships with prosecutors, investigators and peace officers at every level. When state, local and federal authorities combine to fight Medicaid fraud, Texans across the state reap the benefits. For example: *In North Texas, MFCU helped shut down a scheme that advertised itself as a community outreach facility for low-income families who needed assistance with their utilities and rent. Instead, the facility’s owner used the outreach center as a cover to obtain the families’ Medicaid information and fraudulently bill the Medicaid program $2 million for counseling services that were never provided. Last May, the owner was sentenced to more than nine years in federal prison and ordered to pay $2 million in restitution.  *In East Texas, MFCU helped break up an ambulance scheme that billed Medicaid and Medicare almost $3 million for needlessly transporting non-qualifying dialysis patients to their regular treatment appointments. In November, the ringleader was sentenced to 97 months in federal prison. He and his companies were ordered to pay $2.7 million in restitution. *In Central Texas, MFCU worked with the Bell County District Attorney’s Office to investigate a nurse’s aide who sexually assaulted a nursing home resident. Last September, he was sentenced to 99 years in prison.  *In South Texas, MFCU helped investigate a chemical dependency counselor who billed Medicaid almost $2 million for services not rendered. In March 2007, she was sentenced to 10 years in state prison and ordered to pay $1.9 million in restitution. *In West Texas, MFCU’s work led to criminal penalties for a counselor and her husband for billing Medicaid for services that were never rendered. The counselor received 10 years probation and was ordered to pay more than $300,000 in restitution. Her husband, who also was her billing manager, received a five-year federal prison sentence and was ordered to pay more than $600,000 in restitution.  These cases illustrate the variety of fronts on which MFCU and law enforcement authorities fight fraud, waste and abuse within the Medicaid system. Equally important, they also demonstrate the system’s vulnerability. As a third-party payment system, the Medicaid program is one in which participants do not spend their own money and therefore may not have incentive to recognize financial waste or abuse. To protect both the taxpaying public and those who depend upon Medicaid for health care, we will continue cultivating a strong network of local, state and federal law enforcement agencies that are committed to ending fraud, waste and abuse in the Medicaid system.  |
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