Thread: FEDS CONTINUE CRACKDOWN ON WIDESPREAD MEDICARE ABUSE NEAR TEXAS BORDER

FEDS CONTINUE CRACKDOWN ON WIDESPREAD MEDICARE ABUSE NEAR TEXAS BORDER

Breitbart Texas / Ildefonso Ortiz

by ILDEFONSO ORTIZ 19 Jun 2015

MCALLEN, Texas – More than $100 million has been paid out through one form of government medical aid in the border county of Hidalgo, from January to May. However, investigators believe a large part of that money may be tied to Medicare abuse.

The statement was made by one of the top agents for the Department of Health and Human Services Office of Inspector General during a news conference announcing a large national crackdown on Medicare and Medicaid abuse.

While these government-funded programs are needed by many Americans, home health care agencies have become a quick way to make money by charging the government for services that are not needed by the patient, or by having the patient accept home health care for excessive amounts of time, said Mike Fields, the Special Agent in Charge of the DHHS- OIG.

According to Fields, home health care is one of the most abused parts of the program. In a matter of months the government has paid out more than $100 million in Hidalgo County alone, with much of the money going to cases where authorities believe the patient didn’t require the services.

As previously reported by Breitbart Texas, federal and state authorities teamed up in order to investigate and prosecute a series of cases where health care providers targeted government-funded health programs for fraud.

During the press conference, officials announced that the effort based in South Texas was part of a nationwide crackdown. The large operation resulted in more than 240 arrests, with 46 of those being doctors, nurses and other healthcare professionals, who along with representatives for home health care agencies and other individuals tied to medical care are believed to have been behind more than $712 million in false billings.

Along the Texas border, U.S. Attorney for the Southern District of Texas Ken Magidson announced that his prosecutors had been able to get six indictments tied to the medical fraud practice with four in the McAllen area (previously reported by Breitbart Texas), one in Laredo, and one in Brownsville.

“This effort we expend a tremendous amount of resources in going after the fraud where it leads and we found fraud here, we put investigators on the cases … and brought the indictments today as part of the national takedown,” Magidson said during the news conference attended by Breitbart Texas.

“We had fraudulent billing in over 8 million in these investigations and total paid was almost $7 million in fraudulent claims.”

In order to carry out the investigations, agents with HHS-OIG, the FBI, Texas DPS and the Texas Attorney General’s office worked for months at a time gathering the evidence needed to prosecute the cases.

“You may say this is a victimless crime. It is not victimless,” said Chris Comb, the Special Agent in Charge for the FBI San Antonio Division during the conference. “For every dollar that is spent fraudulently, that’s a dollar that cannot be spent on Americans who truly need those services… This crime costs billions of dollars a year.”

Combs said the task force is continuing to look at several other cases, and will continue investigating any allegation of fraud.

“If you are involved any type of fraud the FBI and the task force will come talk to you,” Combs said. “If we find you have been involved in fraud, we will come after you and we will have you prosecuted.”

http://www.breitbart.com/texas/2015/...-texas-border/

That is really a shame, because such fraud puts at risk a program that many patients do need following hospital or rehab treatment. But I can see how easy it is for over-billings, bad or fraudulent judgment in approving the home health care, and worse, having home health care that is actually detrimental because the skill levels of the home health care workers and the protocols for treatment aren't right for the patient. Home health consists only of physical therapists, usually with the work done by a physical therapist assistant, and a nurse usually with the work done by a nurse assistant and worse usually supervised by a Nurse Practitioner instead of a Medical Doctor. By ensuring the patient does not improve in certain areas, extends the time the home health care agency sticks around, especially on the nursing side, whereas the physical therapy side shortens the time unless certain progress is made. The protocols result in a conflict where the patient actually needs the physical therapy but can't do it because the nursing side isn't progressing, so the patient is left with just the nursing that isn't working and is denied the physical therapy they actually needed under the program.

All in all though, it's a tremendous benefit when it works well and right, and it's a shame that anyone would wish to threaten this program by commiitting fraud under it and wasting these precious Medicare dollars that most patients actually need and benefit from.

Having had one in the household on home health care for 31 months nearly continuously due first to cancer, then for a very deep staph infection, we have experienced some of the very worst. Luckily for nearly 30 months now, we believe we have experience some of the very best. I have accused TX of being to lax about medical licensing. I have suggested to our great provider that they should be more aggressive about reporting the poorer providers. I do not think that those suggestions received any consideration. Home health providers though in my opinion would walk a thin ice rink policing their own would likely just lead to a war leading to more investigators without improving investigations.

Last fall we discovered that the nursing home/rehab providers are great liars and cheaters, also. One caused Roxie to have to go back to the hospital and back to surgery, and consequently extended her need for care, by how much we do not know yet. But, the home still operates, probably still cheating and furnishing poor nursing.

I will get off this one just by saying I am very careful about who provides us health care. However, calling out all perps, sometimes you are limited by what Medicare will provide, and that is often not adequate.

http://www.alipac.us/f19/feds-charge...-fraud-320470/