Safeguarding the $17 billion Texas Medicaid program from waste, fraud and abuse is a complex and difficult task that requires many partners.
Medicaid is a joint state-federal initiative that provides health care to needy Texans. To reduce abuse, the program makes payments directly to Medicaid providers. Unfortunately, some providers think they can take advantage of the system and bill Medicaid for services to the poor that were never really provided. Fortunately, Texas has a tight-knit community of law enforcement officials who work together to crack down on Medicaid fraud and protect taxpayer dollars.
The Office of the Attorney General’s Medicaid Fraud Control Unit (MFCU) works with local and federal law enforcement to protect senior Texans from physical abuse, neglect, financial exploitation, and fraudulent reimbursement claims for services or products not provided.
For example, MFCU investigators are working with the Ellis County District Attorney’s Office to investigate and prosecute theft in a Waxahachie nursing home. MFCU investigators found evidence that the nursing home’s office manager stole from 110 residents. Her elaborate scheme, which involved moving money through various accounts and forging 145 checks, accounted for $350,000 in diverted funds. The woman also controlled an individual resident’s personal check book, and wrote checks totaling more than $34,000 from that account.
Last month, the suspect was indicted on theft charges. The MFCU is jointly prosecuting the case with the Ellis County District Attorney’s Office.
The Office of the Attorney General also works closely with federal law enforcement agencies. In March, the MFCU, with special agents from the Federal Bureau of Investigation, the Internal Revenue Service, the U.S. Department of Health and Human Services, and the U. S. Department of Justice investigated the owner of a Dallas ambulance company.
MFCU investigators found that an ambulance company owner used his company to defraud the state Medicaid program by falsely certifying dialysis patients for ambulance trips. A jury found that the owner and his company had obtained $750,000 from the fraudulent scheme and convicted him on 40 counts of health care fraud.
Increased funding from the Texas Legislature has enabled the Office of the Attorney General to dramatically expand the MFCU. To save additional taxpayer dollars and improve protection for Texas seniors, the unit, which handles allegations of criminal fraud and abuse, has established field offices in Corpus Christi, Dallas, El Paso, Houston, Lubbock, McAllen, San Antonio, and Tyler.
Some police departments have also created specialized task forces, such as the Special Victims Unit in El Paso, which conducts domestic violence and senior abuse prevention training. These initiatives offer valuable resources and services to victims and families.
Protecting Texas taxpayers and families from Medicaid fraud abuse is an on-going battle, but thanks to cooperative effort by law enforcement, Texas is winning this fight.
POINTS TO REMEMBER
PROTECTING TEXANS FROM MEDICAID FRAUD
Report financial exploitation or physical abuse or neglect of a resident in a Medicaid-funded facility:
MEDICAID FRAUD CONTROL UNIT
Office of the Attorney General
Telephone: (512) 463-2011
Fax: (512) 320-0974
For more information on the Medicaid Fraud Control Unit or other senior issues:
OFFICE OF THE
Sign up online to receive Senior Alert E-mails:
For Nursing Home Ombudsman assistance and benefits counseling:
TEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES
Area Agencies on Aging