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Whistleblowers May Be the Best Line of Defense In Fighting Texas Medicaid Fraud

Medicaid fraud costs taxpayers millions of dollars annually. Just one hospital operator was recently convicted of making fraudulent Medicaid claims in Texas that totaled more than $1 million according to KWTX. The government uses lots of tools to try to fight fraud, but some of those tools are more effective than others. medical stethoscope 2

One of the best ways to stop Medicaid fraud is for people who know about dishonest behavior to come forward. A Medicaid fraud attorney in Texas can help clients who learn about dishonest actions to take the necessary steps to bring the fraud to light. Not only can this save money so dollars can be spent on those who need medical care, but the whistleblower may also be able to receive a portion of the money recovered.

Considering Methods of Fighting Medicaid Fraud in Texas

According to Forbes, one approach that the government uses to try to identify Medicaid fraud is to rely on data mining. If irregularities in claims data can be identified, investigations can occur and people who are defrauding the system can be prosecuted.

Unfortunately, the data that is available to the government may not be accurate or complete. An HHS Regional Inspector General testified back in June of 2012 that a large amount of the data that is used to identify overpayments and fraud is not "current, available, accurate or complete." Predictive analysis designed to fight fraud and abuse cannot work effectively if the data is incomplete.

Since 2012, there has been plenty of time for the problems to be addressed so that more accurate data could be obtained. Unfortunately, as with most government IT projects, making improvements to data collection is a slow process that may take months or years. It is a process that has not been completed. Some improvements have been made, but "cracks in the system" reportedly continue to emerge.

Just days ago, for example, the Department of Heath and Human Service's Office of the Inspector General issued a report highlighting flaws in the "Medicaid Interstate Match" program. This program is intended to reduce the number of improper Medicaid payments that occur by identifying beneficiaries who may be enrolled in Medicaid in multiple states. It is part of a broader data collection program called the Public Assistnace Reporting Information System (PARIS). Unfortunately, the government has not issued clear guidelines for states to participate in the Match program and the majority of states are not doing enough to provide data the federal government needs.

When problems in data collection inevitably occur, the government loses a potential avenue for finding fraudulent payouts. Whistleblowers, on the other hand, are much more reliable than government IT systems.

A person who knows about Medicaid fraud can come forward and provide information about what is actually occurring. Swift action can be taken without the need for the government to try to master both data collection and the creation of a program to evaluate data, both of which tasks seem to be well beyond the grasp of the government if recent IT debacles are anything to go by.

Contact a Medicaid fraud attorney if you believe you have evidence of fraud. Call Brewer & Prichard P.C. today at 800-445-8710 to schedule a consultation.