2013-05-30 / Community News

Texas House Takes Strike at Medicaid Fraud

Senate Bill 8 Brings Needed Reforms to the State Medicaid Program -

AUSTIN, TEXAS (May 21, 2013) . . . Monday evening, the Texas House of Representatives passed Senate Bill 8, an omnibus bill that seeks to address the rampant problem of Medicaid fraud, waste, and abuse. The bill is carried in the House by Rep. Lois W. Kolkhorst (R – Brenham), Chair of the Public Health Committee in the Texas House of Representatives, and is authored by Sen. Jane Nelson (R – Flower Mound), Chairman of the Senate Committee on Health and Human Services.

The legislation contains a host of measures designed to proactively ensure that Medicaid dollars are spent only on appropriate services. Among other provisions, Senate Bill 8 will create a special team to look for spending anomalies in the Medicaid program and the Children’s Health Insurance Program (CHIP), which will help the state stay aware of new trends in fraud and abuse.

Currently, the state can only seek recovery from Medicaid providers after the crime is committed, sometimes months or years after the offense, in what is commonly known as the “pay and chase” model. Under Senate Bill 8, new teams will use sophisticated software to monitor unusual Medicaid billing patterns as they are reported, thus starting investigations earlier in the process.

Kolkhorst said, “Every penny that is fraudulently taken out of the Medicaid system isn’t just a theft of taxpayer dollars, it means less care for those who are truly needy. This bill is a response to the fraud we continue to see in our public state health services. We’re creating new ways to make sure that our precious state tax dollars are truly going to those who need them most.”

Senate Bill 8 also gives new tools to the Inspector General of the Health and Human Services Commission to pursue fraud, waste, and abuse in nearly every health and human services program that is offered in Texas. From 2004 to 2011, the Office of Inspector General identified more than $6 billion in fraud, waste, and abuse in Texas public health programs. Medicaid billers cannot continue to defraud the system.

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