Friday, July 20, 2012

In Medicaid Fraud Investigations, a Controversial Tool

Good story in Texas Tribune:

When it comes to finding cost savings in the state’s unwieldy Medicaid program, the Health and Human Services Commission’s Office of Inspector General gets high marks.

The division, charged with investigating fraud among health providers paid to treat poor children and the disabled, has dramatically increased both its caseload and the potential monetary returns associated with it over the last fiscal year, a spike that has won rave reviews from budget-weary state lawmakers and has cast Texas’ innovative enforcement team into the national spotlight.
Together, they have redirected the office’s resources to put a greater focus on investigations with the biggest potential monetary returns, and on Medicaid providers, not recipients. They cut the time it took to work a case down from three or four years to eight weeks with just a slight increase in budget. In the last fiscal year, the dollars identified for possible recovery have increased by more than 1,200 percent.
“It’s like having an atom bomb dropped on my business. I could lose everything,” said one doctor who asked not to be named pending the outcome of his Medicaid fraud investigation, which has lasted months. “I’ve had to cut wages. People are worried about their jobs. We’re pariahs at this point. It’s been real hell.” 
 Full story: