Medicaid and Medicare fraud has made headlines recently after Texas Governor Rick Perry signed a series of bills to step up state enforcement and investigations into bad practices in the healthcare field.
The legislation is also intended to set up procedural safeguards for health providers accused of wrongdoing.
The new laws broaden the definition of unlawful acts. These will now include receiving unauthorized Medicaid funds and failing to pay the state what it’s owed. They are likely to mean an increasing number of prosecutions in the healthcare fraud field.
In April news organizations reported on how an Office of Inspector General investigation identified $6 billion in fraud and waste within Medicaid from 2004 to 2011.
“This bill will make it tougher for fraudulent providers to take advantage of the system, while easing the process for the majority of providers that are operating honestly and in accordance with the law,” said Sen. Jane Nelson, who introduced the bill.
Her bill proposed the establishment of a unit at the Health and Human Services Commission with a responsibility for identifying possible Medicaid fraud or abuse, and giving the state Inspector General the authority to investigate those claims.
Medicaid and Medicare fraud are the hot law enforcement issues of the moment. Last year, 12 defendants were arrested in Texas on a variety of charges outlined in five federal indictments.
Federal authorities alleged they made $100 million in fraudulent billings to Medicare, according to U.S. Attorney Sarah Saldaña of the Northern District of Texas.
“Over the last 18 months the Medicare Fraud Strike Force in Northern District of Texas has charged defendants with close to one half billion dollars of fraud and have sent a clear message that we will protect taxpayers’ dollars and the Medicare program,” Saldaña, said in a statement.
But healthcare fraud remains a rapidly evolving area and in some cases there is a danger of gray areas appearing between what constitutes fraud versus poor accountability.
Broden & Mickelsen have represented numerous healthcare professionals charged with Medicare and Medicaid fraud in federal courts throughout the United States. Clint Broden recently won an appeal in a Medicare/Medicaid fraud case in the United States Court of Appeals for the Fifth Circuit and Mick Mickelsen recently persuaded prosecutors in the Southern District of Mississippi to dismiss all charges in a federal Medicare/Medicaid fraud case after taking over the case from another attorney.
While healthcare fraud is a top priority area of law enforcement carrying stiff penalties, the pressure being put on federal agents to get results in this area carries potential dangers for those who are accused of crimes.
When federal agents and other investigators are asked to prioritize an area of law enforcement, the pressure to get results can lead to miscarriages of justice.