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Texas Medicaid Fraud Costing Millions

Two brothers convicted of medicaid fraud in South Carolina were sentenced to prison recently and ordered to pay more than $3 million in restitution to Medicaid. The State reports Norman Lewis, of Georgetown, was sentenced to 7 years in prison while his 35-year-old brother, Truman Lewis, of Charlotte, was sentenced to 10 years.

Consulting an experienced Medicaid fraud attorney is the first step in helping prevent criminals from taking advantage of the system. In many cases, employees, providers or other whistleblowers who report fraud are eligible for substantial rewards based on the amount saved by the government.1380007_one_dollar

Medicaid is the government program that provides health care to low-income individuals and families. In this case, prosecutors say the defendants ran a youth mentoring service in South Carolina that billed Medicaid for almost $9 million in fraudulent charges over a two-year period. But there are many ways criminal and unscrupulous medical providers perpetrate fraud. Medicaid fraud is typically classified as provider fraud, patient fraud or insurer fraud.

Provider Fraud: Emphasis in recent years has been on combating provider fraud, as pain clinics, medical supply services and strip mall clinics are often established for the sole purpose of defrauding the government out of health care dollars. Provider fraud may include things like billing for services not performed, false diagnosis, duplicate billing, kickback and patient referral arrangements, false billing for covered services, excessive or inappropriate testing and providing prescription medications for unapproved uses or which aren't medically necessary.

Patient Fraud: Examples of patient fraud include false claims, forged or altered receipts, prescription drug fraud, doctor shopping or using another person's insurance coverage to obtain services.

Insurer Fraud: Most states transitioned to managed care Medicaid programs in the 1980s, which means recipients are enrolled in private health care plans and insurance companies are paid a set premium by the state. Instances of Medicaid fraud involving insurers may include overstating costs, misleading enrollees about benefits and denying valid claims.

A recent legal settlement in Texas illustrates the challenges of determining fraud from human error. According to the New York Times, Carousel Pediatrics, which provides health care to the poor in Texas, agreed to pay $3.75 million to the state for what the Texas Health and Human Services Commission's Office of Inspector General termed "a pattern of billing errors." The state had initially demanded $17.9 million plus a $4 million penalty. In the last two years the state has collected $14.7 million from 10 Medicaid providers it claims inappropriately billed for services.

Meanwhile, in Washington, D.C., agents arrested 25 people in February in a wide-ranging scheme to defraud the D.C. government out of millions of dollars in Medicaid payments in what is being described as the largest case of health care fraud in the city's history. The case involved fraudulent claims for home health-care services; the city blames the bogus claims for the majority of increased billings for home care -- which rose from $40 million in 2006 to more than $280 million last year.

Contact a Medicaid fraud attorney if you believe you have evidence of fraud. Call Brewer & Prichard P.C. today at 800-445-8710  or visit https://www.bplaw.com to schedule a consultation.