THE ATTORNEY GENERAL OF TEXAS
Ken Paxton

Health Care

The Office of the Attorney General protects Texans as consumers of health care. The agency has investigative and/or enforcement authority in a number of areas. These areas include:

  • Long-term care - Abuse and neglect of residents in nursing homes and other long-term care facilities;
  • Health-care products - Deceptive or misleading advertising of drugs, procedures, treatments and health-related equipment;
  • Access to health care> - Free emergency health care available regardless of ability to pay and some free health care to indigent consumers;
  • Medicaid fraud - Investigation and prosecution of Medicaid provider fraud; and
  • Health insurance - Unfair or deceptive practices of health insurance companies.

 

Long-Term Care

Long-term care providers include nursing homes, intermediate care facilities for the mentally retarded (ICF/MRs), and assisted living facilities (f/k/a personal care homes).In 2007, the Texas legislature authorized the establishment of a pilot program for the regulation of group homes for the elderly and mentally disabled in certain counties and municipalities.

The Attorney General protects residents of long-term care facilities in a number of ways. The agency can investigate and prosecute criminal abuse or neglect of residents in long-term care facilities that receive Medicaid funding.

We can also take civil enforcement action upon referral from the Texas Department of Aging and Disability Services (DADS). DADS regulates long-term care facilities and has authority to inspect them and investigate possible abuse and neglect. Upon referral, the Attorney General may sue for civil penalties and/or injunctive relief, which may include appointment of a trustee to temporarily manage a facility or to shutdown the facility.

 

Health-Care Products

The Attorney General can take action when makers or distributors of health-care products make unfounded or exaggerated claims about the effectiveness and/or safety of their products, or fail to disclose risks. Consumer protection lawsuits of this kind may involve drugs (prescription or otherwise), medical equipment, medical procedures, dietary supplements, products that claim to treat, cure or prevent diseases. In these cases, the Attorney General acts under the authority granted by the Texas Deceptive Trade Practices Act (DTPA). In addition, the Office of the Texas Attorney General wirks with the Texas Department of State Health Services and takes referrals from this department. As a result of a lawsuit, a company may be required to disclose risks, cease making unfounded claims, or in some cases, stop selling a product altogether. In some cases, a company may be required to pay restitution.

 

Access to Health Care

By law, all hospitals with emergency rooms must treat people who have emergency medical conditions, regardless of their ability to pay. In addition, non-profit hospitals are required to provide a certain amount of free health care to people who have no health insurance or cannot afford to pay for hospital care. More information >>>

Information about a non-profit hospital's charity care program must be posted in the emergency room and general waiting areas, the business office, and other visible areas. If you are unsure whether a hospital offers charity care, ask an admissions clerk.

Non-profit hospitals are also required to prepare community benefit plans based on community needs. Their plans must state how identified community needs will be addressed and must be reported to the Texas Department of State Health Services (DSHS).

Medicaid Fraud

The Attorney General's Medicaid Fraud Control Unit (MFCU) and Civil Medicaid Fraud Section investigate and prosecute Medicaid providers and entities suspected of cheating the Medicaid Program.

The MFCU investigates and prosecutes Medicaid providers who are suspected of cheating the Medicaid program. By prosecuting Medicaid fraud, the Attorney General saves both the state and federal governments millions of dollars each year -- dollars that can be used to provide badly needed health care services.

The providers may be health care professional like doctors, therapists, dentists, technicians and substance sabuse counselors. They can also be facilities (clinics, hospitals, long-term care) or manufacturers of medical supplies or equipment.

The fraud committed can include billing for services not provided, billing for a more expensive treatment or drugs than those actually provided, or billing for unnecessary treatment (which may or may not actually be performed).

The MFCU investigates and prosecutes criminal fraud. In addition, the Attorney General files civil Medicaid fraud lawsuits to recover damages from companies such as pharmaceutical manufacturers who profit from deceptive or unfair marketing practices affecting the Medicaid program.

 

Health Insurance

The Attorney General reviews the broad practices of insurance companies as they market their products and pay benefits. This agency has authority to sue under article 21.21 of the Texas Insurance Code, as well as the Texas Deceptive Trade Practices Act, to prevent those in the "business of insurance," including insurance companies, from taking advantage of Texas consumers through unfair or deceptive practices.

The Texas Department of Insurance (TDI) is the state agency charged with regulating the state's insurance industry under the provisions of the Texas Insurance Code. The Consumer Protection Program of TDI provides a toll-free hotline number to help consumers with insurance questions and problems. In addition, TDI can refer cases against insurance providers to the Office of the Attorney General for legal action.

The Office of Public Insurance Counsel (OPIC) represents the interests of Texas consumers in matters such as insurance rates and rules. OPIC is required by law to represent all consumers as a group. Individual complaints that suggest a widespread pattern of practices, or which indicate that a large number of consumers are affected, may lead to action by the agency.