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.
It is also important to realize that when a fraudulent Medicaid scheme is
exposed, the people that kept the fraud secret can
sometimes be found liable for criminal activity for not
exposing the Medicaid fraud that was being committed and further
be held liable for continuing criminal activity.
