Whistleblowers Help Texas In Medicaid Fraud Cases

"When I've spoken with a couple of other states, they definitely recognize Texas as a leader in enforcing pharmaceutical fraud," said Dr. Sammy Almashat, one of the report's authors.

Texas has recovered at least $354 million in Medicaid fraud settlements from pharmaceutical companies since 1991 with the help of private whistleblowers, according to the report. Almashat said that's because under Texas law, whistleblowers can receive between 15 to 25 percent of the financial penalties of a Medicaid fraud settlement for bringing the case forward.

Although 13 states have similar laws, "Texas is a unique case, because other states haven't been nearly as active as Texas in taking advantage of whistleblower revelations in prosecuting," civil Medicaid fraud, said Almashat.

"A whistleblower brings unique underlying knowledge about the fraud that was perpetrated by the defendant in the case," said Daniel Hodge, first assistant attorney general. In all civil Medicaid fraud cases -- including those against pharmaceutical companies and many others -- in the last 10 years, Texas has recovered $880 million, said Hodge, and $373 million of that went to the state treasury.

The whistleblower cases are entirely responsible for that $880 million, Hodge said, explaining that although the Inspector General at the Texas Health and Human Services Commission referred 12,000 criminal Medicaid fraud cases to the AG's office since 2002, during that same time, that agency only referred three civil Medicaid fraud cases.

Currently, a top priority at the AG's Office is to pursue orthodontic and dental fraud in the Medicaid Program, said Hodge. The office has assembled the Orthodontic and Dental Fraud Task Force to combine resources at various agencies, including the Office of Inspector General at the HHSC. At least one case being pursued by the task force was referred by a whistleblower.

Given the significant portion of the state budget that goes to Medicaid, "it's more critical than ever for the taxpayers that we aggressively pursue any actors that defraud the taxpayers and recover those dollars," Hodge said. "We're thrilled that Texas has been recognized for [Attorney] General Abbott's efforts to prioritize uncovering and recovering waste, fraud and abuse in the Medicaid program."

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This article originally appeared in The Texas Tribune at http://www.texastribune.org/texas-health-resources/medicaid/whistleblowers-help-texas-stop-medicaid-fraud/.