Wednesday, October 4, 2023
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Texas Agencies Blocked Over Medicare Fraud

DALLAS (CN) - Federal officials will block new home-health agencies in Dallas and Houston in response to years of widespread billing fraud that cost taxpayers millions.

The Centers for Medicare & Medicaid Services announced Thursday a temporary moratorium on the enrollment of such agencies for at least six months, meaning they will be unable to bill Medicare or Medicaid.

CMS administrator Marilyn Tavenner said the action aims to move the agency beyond the simple "pay and chase" methods used in the past to prevent fraud.

This is the "second wave" of bans after three fraud "hot spots" metropolitan areas were identified in July 2013, Tavenner added. Bans against home-health agencies in Chicago and Miami, as well as against ground ambulance suppliers in Houston, are in place and were extended Thursday.

"Our first use of the moratoria put fraudsters on notice that we are using all available tools, including these moratoria, to combat fraud, waste and abuse in our health care programs, while maintaining patients' access to care," Tavenner said. "Today's announcement shows we are continuing our intense fight against fraud, waste and abuse in these vital health care programs."

Dallas and Houston were singled out for having a "disproportionate number of home-health providers."

A steady stream of Medicare fraud indictments have plagued the state in recent years, led by accusations that Rockwall physician Jacques Roy ran the largest home health care billing fraud in history.

"The evidence of Dr. Roy's guilt is strong and he faces a life sentence if convicted," prosecutors said after his indictment in February 2012. "He has shown a brazen disregard for legal and administrative process by reconstituting his fraud scheme under the guise of another company after being places on suspension from the Medicare program in 2011. And perhaps most importantly, Dr. Roy has created a false identity and squirreled away millions of dollars of assets that likely would be available to him should he choose to flee."

Identical six-month bans were also announced Thursday for home-health agencies in Fort Lauderdale and Detroit, and for new ground ambulance suppliers in Philadelphia.

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