TMA: Medicaid Fraud Rules Too Much

Proposed new Medicaid fraud and abuse rules give the state too much power and presume that physicians are crooks.

That's the gist of a 35-page letter TMA sent the Texas Health and Human Services Commission (HHSC) to oppose its proposed new "program integrity" rules that cast every Medicaid billing error as a possible target for fraud-and-abuse prosecution.

"TMA strongly opposes the proposed rules because they expand [the Office of Inspector General's] authority, minimize the rights of physicians and other providers, and have a tenor that implies a presumption of wrongdoing," John Holcomb, MD, chair of TMA's Select Committee on Medicaid, CHIP and the Uninsured, wrote. Without due process protections and other important changes in the draft rules, he wrote, "the pervasive fear among physicians that they will be incorrectly accused of fraud, waste, or abuse, or denied meaningful recourse in a fraud investigation will continue to contribute to the decline in physician participation in Medicaid."

Dr. Holcomb objected to the proposed rules repealing current language that not all actions resulting in overpayment to a provider are necessarily fraudulent. He asked that HHSC officials retain that language and reiterate in new rules that some overpayments are the result of mistakes, not fraud.

TMA opposes health care fraud and supports fair processes designed to prevent and detect actual fraud.

 Action, Sept. 17, 2012