McALLEN — The billions lost to fraud and the thousands of uninsured here are interconnected inside the broad and complicated world of health care.
To address the topics, the two-day Rio Grande Valley Healthcare Fraud and Compliance Conference was held at the McAllen Convention Center. It ended Wednesday and brought hundreds of healthcare providers together to learn more.
Keynote speaker Majorie McColl Petty said 4.8 million uninsured Texans will be able to enroll via a state Health Insurance Marketplace, created under the federal Affordable Care Act (ACA), beginning Oct. 1.
President Barack Obama appointed Petty as director of region VI — which includes Texas, New Mexico, Oklahoma, Arkansas and Louisiana — under the U.S. Department of Health and Human Services.
In Hidalgo and Cameron counties, there are 328,941 uninsured residents, according to information Petty provided. The area, she said, is among the top seven in the nation with large uninsured populations.
Employers and existing federal insurance programs like Medicaid and Medicare — for the low-income and elderly, respectively — already provide insurance, Petty said.
“But, there’s a large population that is left uncovered,” she explained, saying state marketplaces are aimed at this group.
Starting Jan. 1, 2014, plans selected via the marketplace will take effect.
The Texas marketplace, or insurance exchange, will be run by the federal government because state leaders have said they will not implement it. Texas is also one of more than a dozen states that have opted out of the ACA’s Medicaid expansion, though residents will still pay federal taxes for the program.
An obvious proponent of the ACA, Petty listed a number of points about the federal legislation she said has begun to shift people’s thinking on health care and spark important dialogues.
The federal reform, she said, has also allowed for changes in the way services are carried out that help curtail fraud.
“I don’t think we could be at a better place in time,” she told a large audience, adding that healthcare reform has been a hot topic for decades.
Rachanna Rodriguez, director of programs for Senior Community Outreach Services, Inc. — the nonprofit group hosting the event — said it was the first of its kind on such a large scale. FBI representatives and other officials spoke to healthcare providers about how to avoid, prevent and report fraud.
McAllen Mayor Jim Darling attended a session with Petty along with officials from other cities, public agencies and hospital administrators. He said for cities, health care is a crucial economic component also tied to the well-being of residents.
“It’s important that we do it right,” he said. “It’s hard to get that kind of education in any one place, so I think this is a fantastic opportunity for (healthcare providers). It’s a great program.”
Petty couldn’t immediately point to federal data supporting the widespread claim that the Valley is the second-ranked hot spot for federal healthcare fraud. She declined to discuss factors why, saying it would be speculation.
“It’s everybody’s responsibility to, just like with the Senior Medicare Patrol, to monitor it — to be certain that all of us are being responsible and scrutinizing our bills,” she said.
Senior Medicare Patrol, a federally funded program, recruits volunteers who conduct outreach about healthcare fraud among seniors.
As Rodriguez, who is also involved with the SMP, closed her own remarks, she said fraud has damaged the reputation of healthcare providers here.
“That overshadows anything and everything that you do that’s good,” she said to the audience.
Fraud is so widespread, Rodriguez said, that most people at the conference likely know of someone who’s been busted.
“So, today I end with a question: Who’s next?” she said.
Go to www.healthcare.gov/ to learn more about the ACA and state marketplace.
More than 300,000 uninsured in Valley, federal official says at healthcare fraud conference - The Monitor: Local News