Investigators are honing in on several high-profile cases of fraud in Texas, thanks in part to an 82-year-old grandmother. The grandmother’s undercover video appeared on ABC News’s investigation of a Texas doctor for Medicare fraud. In it, she is shown explaining to the physician that she is generally in good health.
Subsequently, someone in the doctor’s office filled out a patient referral form for home health services that contained false diagnoses. A similarly inaccurate official certification was sent to Medicare, although Medicare was never actually billed. The doctor’s attorney said that while there was an error in the woman’s diagnosis, the doctor did not fill in the false diagnoses on the referral form and did not submit the Medicare certification.
Texas Medicare and Medicaid Fraud
This instance of alleged fraud was not an isolated occurrence, according to ABC News. In fact, the Department of Health and Human Services considers Texas’ Rio Grande Valley a hotbed for Medicare and Medicaid fraud. In 2011, ten Texas physicians billed nearly $200 million in one specialty, according to DHHS Inspector General’s office senior adviser Tim Menke. The office has charged several Texas physicians and health care agencies with Medicare fraud and is investigating others.
The Texas Medicaid Orthodontics program is also having major issues with fraud. According to KHOU.com, Texas spends more on braces for poor children than all other states combined, an indication of significant fraud. One dentist settled with Texas and the federal government for $1.2 million after allegations that he submitted false Medicaid claims for several years. Many dentists and orthodontists are under investigation, and some have had their state funding suspended.
According to a Pittsburgh Tribune-Review op-ed, however, fraud is the exception, not the rule. Not every physician, health care agency and dentist is a bad apple. Far from it, and accordingly, prosecutors must prove that inaccurate diagnoses or billing were fraudulent, not mistakes.
Those under investigation for Medicare or Medicaid fraud or charged with a crime should contact a reputable, aggressive criminal defense attorney who will fight to protect your legal rights and defend your case.