In March TDMR reported on the federal HHS-OIG report about the 2021 cumulative activities of state Medicaid Fraud Control Units around the country. As there were no state breakdowns, we filed an access to information request with the Office of the Attorney General under which the Texas MFCU operates to get the breakdown for Texas. We were sent a spreadsheet, a PDF copy of which is below.
17 convictions of individual practitioners
According to the report, there were no dentists convicted of Medicaid fraud in 2021. There were only 17 convictions of individual practitioners in the state including five physicians, five nurses and four personal care service attendants.
However, dentists have a significantly high number of open investigations, some 83 for 2021. Only personal care services attendants with 230 open investigations have more. Family physicians have 45, Internal Medicine has 31, and Nurses have 67.
While there are no convictions listed for dentists, there is an $800,000.recovery indicated.
Third of a billion recovered?
When one totals up the seven different categories of fraud recovery - Facility Based Medicaid Providers and Programs - Inpatient/Residential, Facility Based Medicaid Providers and Programs - Outpatient/Day Services, Physicians (MD/DO) by Medical Specialty, Licensed Practitioners, Other Individual Practitioners, Medical Services, Program Related - total recoveries come to an astronomical $374,097,486.71, more than 1/3 of a billion dollars. As we did not get a total fraud figure with our spreadsheet, this is our conclusion based on the totals.
It seems odd, however, that recovery from nurse practitioners was over $52 million. Do nurses make that kind of money to pay off million-dollar recoupments?
If there’s any further evidence needed that fraud is a significant issue, I don’t know what could possibly exist. Now it is time to prevent many of them in addition to pay and chase
It’s important to make a clear distinction between actual dollar amounts received by the government in violator financial restitutions, versus dollar amounts agreed to in financial settlements between alleged violators and the government.
The first situation is real money. In the second situation, the government may never be fully compensated to the agreed terms.