The measure's author, Sen. Jane Nelson (R-Flower Mound), said SB 8 will make it harder to bilk the system, while easing the process for the majority of providers who are operating in accordance with the law.
The commission would be tasked with identifying possible Medicaid fraud or abuse, and would give the state inspector general the authority to investigate those claims. The law strengthens statutes that forbid the solicitation of Medicaid patients by providers, and would exclude from the state Medicaid program any provider found guilty of fraud in another state. Besides prohibiting contact between Medicaid "recruiters" and patients and parents, it also prohibits payments to patients or parents.
Texas has been rocked by allegations of fraud by dentists and orthodontists accused of bilking the state Medicaid program out of tens of millions of dollars. A report released in 2012 by the state Health and Human Services Commission revealed that Texas orthodontists charged Medicaid as much for services as the rest of the U.S. combined in 2010, and that the Texas Medicaid and Healthcare Partnership, tasked with evaluating and approving claims, was rubber stamping them.
Last October, the Texas Office of Inspector General and the U.S. Department of Labor's Office of Inspector General formed a task force designed to target Medicaid dental fraud. The task force is working to improve investigations of fraudulent charges to the children's Medicaid program and recover losses more quickly.
Under the new law, which takes effect in September, the inspector general will have five law enforcement officers to police Medicaid fraud. Also, the health department will have to analyze Medicaid expenditures and report them on a quarterly basis. Over the next five years, these tools are projected to save the state $65 million, according to a story by WFAA.
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