Protecting Senior Texans: Attorney Generalís Medicaid Fraud Control Unit
Tuesday, May 1, 2012
With the arrival of Older Americans Month, all Texans have an opportunity to think about our senior citizens, the remarkable contributions they have made to our great state, and how we can all express our gratitude by working together to protect seniors in our communities.|
Unfortunately, all Texansí vigilance is necessary because a few unscrupulous actors will abuse, neglect and defraud senior citizens. By remaining alert and on the lookout for scams or abuse, family members, neighbors and concerned citizens can help protect seniors Ė and hold wrongdoers accountable by notifying law enforcement authorities.
At the Texas Attorney Generalís Office, the Medicaid Fraud Control Unit (MFCU) is on the front lines of a dedicated effort to protect seniors by investigating abuse and neglect at Medicaid-funded nursing homes and facilities based upon referrals from local law enforcement officials and the Texas Department of Aging and Disability Services. State police officers with the MFCU regularly investigate a wide variety of crimes against nursing home residents. These investigations range from embezzlement schemes Ė where drugs are stolen from patientsí rooms or money is withdrawn from their bank accounts Ė to identity theft, failure to deliver products or services and outright physical abuse or neglect.
In a recent case, hearing aid fitter and distributor Debra Spradlin pleaded guilty in federal court to conspiracy to commit health care fraud. Spradlin was indicted in August 2009 for submitting improper Medicaid claims for hearing aids and services that were not actually delivered to patients. Investigators with the MFCU and the FBIís Dallas office estimated the Spradlinsí scheme defrauded taxpayers of more than $1.5 million.
MFCU investigators and Dallas FBI agents opened the case against Spradlin in response to the MFCUís reviews of financial records during a separate investigation. After reviewing the more than $400,000 in Medicaid claims submitted by Spradlin, investigators noticed that although Spradlin was located in Waco, many of her claims involved patients residing in the Dallas/Ft. Worth area. In some instances, Spradlin submitted claims for patients who were no longer alive at the time she purported to have fit them for hearing aids.
As if defrauding the Medicaid program Ė and Texas taxpayers Ė was not bad enough, Spradlinís scheme prevented some economically challenged patients from obtaining hearing aids through the Medicaid program. In these instances, Medicaid recipients saw a legitimate audiologist who conducted hearing tests and prescribed a hearing aid. When the recipients submitted a Medicaid claim for their hearing aid, however, the claim was denied because the patient appeared to have exhausted Medicaidís hearing aid coverage. The MFCU and FBI team discovered that the patientsí claims were denied because Spradlin had submitted a fraudulent claim in the names and without their knowledge.
Keep in mind that the Medicaid program exists to provide health care coverage to the Stateís most financially disadvantaged citizens. Thus, Spradlinís scheme harmed both Medicaid recipients and the taxpayers who paid for the products and services Spradlin never provided. So when Spradlin submitted a false claim that prevented a Medicaid recipient from getting a hearing aid, what did she do with her stolen profits? When the MFCU officers executed a search warrant, the officers seized two homes, two vehicles, a motorcycle, a boat, two jet skis, trailers and cash in multiple bank accounts.
Fortunately, the MFCU and FBIís joint investigation paid off, and Spradlin pleaded guilty to conspiracy to commit health care fraud. She was sentenced to 120 months in federal prison and ordered to pay $1.6 million in restitution.