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Monday, January 12, 2015

SUNSET COMMISSION SAYS REDEFINE MEDICAID FRAUD


TMA and Texas physicians won a major victory in the fight against overzealous Medicaid “fraud and abuse” investigators. The Sunset Advisory Commission agreed with us in recommending that the legislature enact significant changes in the operation of the Texas Health and Human Services Commission (HHSC) Office of Inspector General. A workgroup chaired by Sen. Juan “Chuy” Hinojosa (D-McAllen) recommended — and the commission adopted — a change in the definition of Medicaid fraud “to clarify that the term does NOT include unintentional technical, clerical, or administrative errors. The amended definition would be read as follows: ‘Fraud’ means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to that person or some other person, but does not include unintentional technical, clerical, or administrative errors.” Additionally, the commission adopted the recommendation of Sen. Charles Schwertner, MD (R-Georgetown), directing HHSC to strengthen oversight for Medicaid HMO network adequacy, which TMA requested.

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