3 McAllen doctors, clinic to pay $5.5M for Medicaid fraud claim settlement - HispanicBusiness.com

3 McAllen doctors, clinic to pay $5.5M for Medicaid fraud claim settlement - HispanicBusiness.com

Nov. 21 -- MCALLEN -- Three local doctors and their clinic entered into a settlement with the Texas Attorney General's Office to avoid further proceedings tied to the state's action against them for Medicaid fraud. As part of the settlement, Carlos Mego , Pedro Mego , Subbaro Yarra and their clinic, Valley Heart Consultants , will have to pay $5.5 million in a five-installment plan beginning next month. The settlement doesn't affect the doctors' status as medical providers in the Texas Medicaid program, said Thomas Kelley , a spokesman with the AG's Office. The settlement was reached earlier this month, confirming the state's allegations that the cardiology practice improperly billed Medicaid patients for a series of unnecessary tests that were performed by unlicensed technicians and below the required standards of practice. Carlos Mego and Yarra were also named in a similar settlement for $27 million reached with the federal government in 2009 that named five other doctors and South Texas Health System in a scheme that resulted in more than $50 million in Medicare payments, Monitor archives show. 

Texas Makes Changes To Medicaid Laws And Programs

Last Updated: June 24 2013

Article by Kimberly J. Gold and Ellyn L. Sternfield

Texas Governor Rick Perry signed a series of bills into law last week modifying some of the state's Medicaid statutes and programs.  The laws will take effect on September 1, 2013.

While the legislation was purportedly aimed at enhancing the state’s ability to detect and prevent Medicaid fraud, waste, and abuse, in fact many of the statutory provisions were added to comply with federal mandates necessary to secure ongoing federal funding for the Texas Medicaid program to ensure  continued eligibility for incentive recoveries under its civil false claims act. 

The highlights of the new laws are as follows:

• S.B. 746 brings the state's civil false claims act, the Texas Medicaid Fraud Prevention Act (TMFPA), into compliance with the federal requirement that the state statute be "at least as effective" in rewarding and facilitatingqui tam actions as the federal false claims act.  The U.S. Department of Health and Human Services Office of Inspector General gave Texas until September 1, 2013 to amend the TMFPA so that the state may continue toqualify for a 10-percentage-point increase in its share of recovery of civil Medicaid false claims judgments and settlements.

The bill extends false claims liability to any person who or entity that commits an "unlawful act" by conspiring to otherwise violate the TMFPA, or who conceals, avoids or decreases their obligations to repay funds to Medicaid.   The bill also makes procedural changes to the state civil false claims statute of limitations and public disclosure provisions, resulting in provisions that parallel those in the federal false claims act.

• Another bill, S.B. 1803, amends the Texas Government Code to meet federal requirements allowing the state to continue receiving matching funds from the federal government for the state's Medicaid program. Among other provisions, the bill requires the Texas Medicaid program's Office of Inspector General to conduct preliminary investigations of any complaint of Medicaid fraud or abuse, mandates referrals of fraud to the Texas Medicaid Fraud Control Unit or other law enforcement entities, and requires the Medicaid program to impose a payment hold on claims for reimbursement when credible allegations of fraud exist.
• S.B. 8 amends the Texas Government Code to require the Medicaid program to establish a data analysis unit intended to detect data trends and identify anomalies relating to compliance with Medicaid and Children's Health Insurance Program (CHIP) requirements.  The bill also limits the marketing activities of CHIP and Medicaid providers and changes the licensure of non-emergency medical transportation companies and emergency medical services providers, with a two-year moratorium on new licenses for emergency medical services providers beginning September 1, 2013.
• H.B. 658 amends the Civil Practice and Remedies Code so that plaintiffs cannot collect post-judgment interest on any portion of a damages award that includes money subject to Medicare subrogation.  The bill responds to concerns that post judgment interest accrues in Medicare subrogation lien cases, causing defendants to pay additional costs due to the delay of a third party's issuance of a demand letter.

While at first blush the bills appear technical in nature, the result may be increased Medicaid program oversight and enhanced opportunities for whistleblowers and state enforcement authorities to bring Medicaid-based civil false claims actions in Texas.  These new laws, combined with the swelling ranks of Medicaid Recovery Audit Contractors and similar entities, mean that Texas health care providers will likely see more scrutiny of their Medicaid billing activities.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

http://www.mondaq.com/unitedstates/x/246714/Healthcare/Texas+Makes+Changes+To+Medicaid+Laws+And+Programs

New Downloadable Article "Has HHSC-OIG Misled the Texas Legislature?"

Dallas, Tx (PRWEB) June 11, 2013

A new 8-page downloadable article is now available online questioning testimony given by representatives of the Texas Health and Human Services Commission Office of the Inspector General in January and February, 2013, to various Texas legislative committees regarding the agency's investigations into Medicaid fraud.
The article is entitled "Has HHSC-OIG Misled the Texas Legislature?" and begins with the following introductory paragraphs:
"Over the last year, the Health and Human Service’s Commission Office of the Inspector General (“OIG”) has been in the spotlight on Texas Medicaid. Representatives of OIG -- Inspector General Douglas Wilson and his apparent deputy for enforcement Jack Stick -- have made numerous public statements regarding Medicaid fraud in Texas, in particular about dental orthodontic services.
"One of OIG’s chief purposes is to interdict Medicaid fraud. Certainly every decent person is in favor of stopping fraud. But OIG has painted a picture of rampant fraud by orthodontic dentists -- a picture which is not, at this point, borne out by court decisions.
"In fact, OIG has only had its claims on rampant fraud tested in court (the State Office of Administrative Hearings, “SOAH”) one time. That decision, which upended OIG's claims, has been upheld by an HHSC administrative judge. This precedent-setting decision -- that of Harlingen Family Dentistry (“HFD”)* -- came out last September and was upheld in early January of this year."
"This precedent-setting case is well-known to OIG, Medicaid providers and their attorneys. Yet OIG statements to the legislature this session ignored this legal decision and its implications for future orthodontic cases. In fact, OIG has seriously downplayed the facts in several instances. One could even go so far as to say that legislators were misled."
The article goes onto compare testimony given to various committees of the Texas Legislature in this light.
The article can be downloaded here.

• SOAH Docket No. 529-13-3180 Harlingen Family Dentistry vs. Texas Health and Human Services Commission

Read the full story at http://www.prweb.com/releases/office-of-inspector/general-texas/prweb10813691.htm

Read more: http://www.digitaljournal.com/pr/1297473#ixzz2X7tR1MCv