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CMS cracking down on health care fraud in Texas

On Behalf of | Jun 23, 2016 | White Collar Crimes

As a result of increasing concerns about fraud, home health care providers in Texas will soon be under even more scrutiny than ever before. The initiative hopes to cut down on Medicare and health care fraud, but some worry that the move could have unintended consequences. The extra scrutiny could jeopardize health care providers’ careers, as well as patient coverage.

Home health care costs hit $83.2 billion for patients in 2014, the vast majority of which was covered by Medicare and Medicaid plans. However, the Center for Medicare Services claims that approximately 60 percent of home health claims in 2015 were possibly filed improperly, which can sometimes be an indicator for fraud. The CMS plans to address this by reviewing every single claim for home health care rather than the 20 percent that has been standard in the past.

At face value, carefully reviewing each claim for possible indications of fraud might seem like a good idea, but it can have a profoundly negative impact on patients. A delay in processing due to reviews can leave patients unsure of their current statuses and even possibly delay some claims for extended time periods. Furthermore, increased scrutiny also raises the opportunity for home health providers to be wrongly accused of submitting false claims.

Almost 1,800 defendants have been convicted of committing felony health care fraud in the past 11 years. A conviction for this type of charge can result in years spent behind the bars of a federal prison, as well as hefty fines that can prove to be difficult to repay. Although handling a federal charge rather than one under the jurisdiction of a Texas state court can be complicated, taking the necessary time to review charges and formulate a strategic defense plan can be especially useful.

Source: The Dallas Morning News, “Texas home health care providers will soon face extra scrutiny to prevent fraud”, Sabriya Rice, June 17, 2016