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Sunday, May 27, 2012

The Federal Government and Many States Including Texas Are Expanding Medicaid Recovery Laws To Detect Medicaid Fraud and Encourage More Health Care Professionals to Expose Medicaid Fraud by Texas Hospital System Medicaid Fraud Lawyer, Health Care System Medicaid Fraud Lawyer, Health System Medicaid Compliance Fraud Lawyer, Hospital Medicaid Fraud Whistleblower Lawyer, Health System Medicaid Reimbursement Fraud Lawyer, & Hospital Medicaid Compliance Whistleblower Protection Lawyer Jason S. Coomer

Medicaid is a public health care problem in the United States that provides health care, dental care, and orthodontic care for eligible individuals and families with low incomes and resources. The Medicaid Program is jointly funded by state and federal governments, but is managed by the states.  Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States and the Medicaid program has been increasing.  The fastest growing aspect of Medicaid is nursing home coverage and this is expected to continue as the Baby Boomer generation begins to reach nursing home age. 

Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state operates its own Medicaid system.  Each state's Medicaid Program must conform to federal guidelines in order for the state to receive matching funds and grants.  For many states Medicaid has become a major budget issue as on average the state's matching costs of the Medicaid program is about 16.8% of state general funds. According to CMS, the Medicaid program provided health care services to more than 46.0 million people in 2001. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly persons, and disabled individuals. Federal Medicaid outlays were estimated to be $204 billion in 2008.  Medicaid payments currently assist nearly 60 percent of all nursing home residents and about 37 percent of all childbirths in the United States. The Federal Government pays on average 57 percent of Medicaid expenses.

Texas Medicaid Whistleblowers with Original and Specialized Information of Medicaid Fraud Are Eligible to Collect Large Financial Rewards for Filing Texas False Claims Act Lawsuits, Texas Medicaid Fraud Whistleblower Recovery Lawsuits, Texas Medicaid False Billing Whistleblower Award Lawsuits, Texas Medicaid Double Billing Fraud Lawsuits, Texas Medicaid Fraud False Billing Lawsuits, Texas Unnecessary Medical Treatment Relator Lawsuits, and Texas Medicaid Fraud Whistleblower Lawsuits by Texas Hospital System Medicaid Fraud Lawyer, Texas Health Care System Medicaid Fraud Lawyer, Texas Health System Medicaid Compliance Fraud Lawyer, Texas Hospital Medicaid Fraud Whistleblower Lawyer, Texas Health System Medicaid Reimbursement Fraud Lawyer, & Texas Hospital Medicaid Compliance Whistleblower Protection Lawyer Jason S. Coomer

In Texas, the Medicaid program is administered by the Texas Health and Human Services Commission. More than 3.7 million Texans are eligible for Medicaid, and there are more than 57,000 active Medicaid providers. A provider can be any person, group of people, or health care facility that supplies medical services to Medicaid recipients. Providers include doctors, medical equipment companies, podiatrists, dentists, licensed professional counselors, hospitals, adult day care centers, nursing homes, clinics, pharmacies, ambulance companies, case management centers and others.
The Texas Medicaid program costs about $30 Billion each year and is expected to continue to increase in the future.  Of this cost, it is estimated that Medicaid fraud costs are between Two Billion Dollars ($2,000,000,000.00) to Four Billion Dollars ($4,000,000,000.00) each year. 
There are many types of Medicaid fraud including:
  • billing Medicaid for X-rays, blood tests and other procedures that were never performed
  • falsifying a patient’s diagnosis to justify unnecessary tests;
  • giving a patient a generic drug and billing for the name-brand version of the medication;
  • giving a recipient a motorized scooter and billing for an electric wheelchair, which can cost three times more;
  • billing Medicaid for care not given;
  • billing Medicaid for patients who have died or who are no longer eligible for Medicaid;
  • billing Medicaid for care given to patients who have transferred to another facility;
  • transporting Medicaid patients by ambulance when it is not medically necessary;
  • requiring vendors to “kick back” part of the money they receive for rendering services to Medicaid patients (kickbacks may also include vacations, merchandise, etc.);
  • billing patients for services already paid for by Medicaid;
  • billing Medicaid for phantom patients;
  • double billing Medicaid for services;
  • upcoding services for increased Medicaid payments.
Medicaid fraud violates federal and state criminal laws and can result in significant fines and/or incarceration. Those convicted of fraud may also lose their status as Medicaid providers.  To prevent Medicaid fraud, Texas has enacted the Texas False Claims Act and Medicaid Fraud Prevention Act.

Being the First to File on as well as Having Original and Specialized Information of Medicaid Billing Fraud, CHIP Fraud, or Medicare Billing Fraud is Essential for a Texas Medicaid Fraud Whistleblower Recovery Lawsuit

It is necessary for a Texas health care professional whistleblower, Texas health care executive whistleblower, Texas health care administrator whistleblower, or other Texas Medicaid fraud whistleblower to have original and specialized knowledge of Medicare fraud to be eligible for Medicare whistleblower reward. It is also essential to not delay in coming forward with a Texas Medicaid fraud whistleblower claim as the first whistleblower to file is the only one eligible to be a relator and make a large recovery for exposing the fraud.  

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