Texas Medicaid Fraud
Editor’s Note: I find it most interesting that the prosecution of these crimes was “hindered”.
Computer crash hinders Texas Attorney General’s Medicaid fraud case
07:00 AM CDT on Thursday, October 23, 2008
By EMILY RAMSHAW and ROBERT T. GARRETT / The Dallas Morning News
AUSTIN – A massive computer crash that destroyed hundreds of the state attorney general’s confidential documents may prevent scores of Medicaid fraud prosecutions and has revealed serious problems with a newly expanded state outsourcing of computer services.
As much as 50 percent of the Tyler Medicaid fraud division’s files were destroyed in July when a server being repaired by a state vendor wouldn’t restart. The scope of the damage is in dispute.
In an apparent oversight, the documents lost were not backed up – meaning that evidence crucial to convicting dishonest health-care providers who ripped off the state’s health insurance program for the poor may never be recovered. E-mails and other records obtained byThe Dallas Morning News indicate some Tyler investigators lost up to 90 percent of their open case files.
“In spite of earlier assurances, the destruction of critical data has, in fact, occurred,” First Assistant Attorney General Kent Sullivan wrote Monday in an e-mail to Brian Rawson, chief of the Department of Information Resources. Attorney General Greg Abbott’s office “cannot afford to risk a reoccurrence of this event.”
In all, 81 criminal cases and eight months of work in the attorney general’s 13-person Tyler Medicaid fraud office were completely lost, according to an attorney general’s report on the security breach – records that are being painstakingly recovered by the vendor.
IBM, which leads a vendor group selected by the information resources department in the $863 million, seven-year outsourcing deal, said it still is investigating the matter.
“We do take this incident seriously, and we’re taking appropriate steps to ensure that it doesn’t occur again,” company spokesman Jeff Tieszen said.
Mr. Tieszen said IBM-hired data recovery specialists have reassembled 24 of 27 lost gigabytes of information – 88 percent of the lost data.
State officials said that they couldn’t confirm that figure and that their latest estimates remain at 50 percent.
The Medicaid fraud data loss is the worst problem to surface in the first 18 months of the state’s deal with the IBM-led group – and further blemishes a privatization push throughout state government that grew rapidly after Republicans gained control of the Legislature six years ago.
In April 2007, Mr. Abbott’s office was forced to switch to the outsourced system. It gave “Team for Texas,” the vendor group, lead responsibility for the attorney general’s information technology system, including its servers and backup tapes.
The change was supposed to provide better service and save money. But early this year, the attorney general’s office and the IBM-led group had a series of communications breakdowns over whether data was actually being backed up.
In a May e-mail, Sean Peterson, Mr. Abbott’s director of network operations, appeared to have a premonition, raising doubts about whether remote office servers were being properly maintained. He also asked for a list of all the backups that had failed in the last three weeks.
“I am concerned that these are not being backed up properly,” he wrote.
On July 21, the Tyler server wouldn’t restart. Alarms weren’t raised immediately; memos in the attorney general’s office say the vendor didn’t notify Mr. Abbott’s office of the problem until 10 p.m. on July 22.
But as initial efforts to retrieve the records failed – and attorney general’s office employees realized that IBM had “not routinely backed up the server as required by contract” – memos show that both the state and the contractor realized the gravity of the situation.
By late July, IBM had to call in a special forensics team from California to try to recover documents. And the data losses were so severe that employees in Mr. Abbott’s office questioned in e-mails to each other whether they should resign for failing to properly oversee IBM, according to records obtained by The News.
Shortly after the Tyler office’s data loss, documents indicate the attorney general’s office determined that servers for three other field offices were not being backed up, either.
In Monday’s e-mail, Mr. Sullivan wrote that he needed a guarantee “that no state agency will again be faced with the situation of having data destroyed and functionally irretrievable.”
There have been other highly publicized problems with big outsourcing pushes by the Health and Human Services Commission – one that created privately run call centers and maintained software to support eligibility screening for public assistance, and another that privatized payroll and hiring at 12 social services agencies.
In 2005, the Legislature and Gov. Rick Perry, building on an earlier outsourcing of state computer services and data backups, approved a measure forcing at least 15 state agencies to join a dozen that already were using an earlier vendor, Northrop Grumman Corp.
A new, expanded outsourcing deal with Team for Texas – the current provider – was struck in November 2006 and took effect in April 2007.
The deal, expected to save the state $153 million by 2013, has attracted little public attention because even though more than 500 state employees lost their jobs, about 40 percent found other state positions and the rest were guaranteed spots with IBM or its subcontractors Unisys, Xerox and Pitney Bowes.
In July, though, state Auditor John Keel criticized the information department for not riding herd on major state agencies. Though agencies were supposed to hand over to IBM their most knowledgeable and experienced computer technicians, many kept those workers by using them to fill other vacancies, Mr. Keel’s audit said.
For Immediate Release:
Friday, June 23, 2006
Comptroller Strayhorn Statement
On Foster Care Abuse
Friday, June 23, 2006
(Austin)– “In April 2004 I said I would give our forgotten children in foster care something they need – a voice.
“I have been and I will continue to be their voice. This Governor’s Health and Human Services Commission continues to stonewall my investigation and this governor continues to hide the truth.
“In October 2004, I urged Gov. Perry to immediately create a Family and Protective Services Crisis Management Team by executive order to finally take serious steps to save children’s lives. Now it is June 2006.
“Gov. Perry’s failure to act is unconscionable.
“In November 2004, I launched an investigation into possible Medicaid prescription drug fraud and abuse in our state’s foster care system.
“I am here today to release disturbing information found during my investigation about the deaths, poisonings, rapes and pregnancies of children in our state’s foster care system.
“I found, from information provided by the Texas Department of Family and Protective Services, in Fiscal 2003, 30 foster children died in our state’s care; in Fiscal 2004, 38 foster children died; and in Fiscal 2005, 48 foster children died.
“Data shows that while the number of foster children in our state’s care increased 24 percent from 26,133 in Fiscal 2003 to 32,474 in Fiscal 2005, the number of deaths increased 60 percent.
“If you compare the number of deaths of children in our state’s population to the number of deaths in our state’s foster care system, a child is four times more likely to die in our state’s foster care system.
“Based on Fiscal 2004 data provided by the Health and Human Services Commission, about 100 children received treatment for poisoning from medications; 63 foster children received medical treatment for rape that occurred while in the foster care system; and 142 children gave birth while in the state foster care system.
“As alarming as these cases are, we can only imagine how much worse the Fiscal 2005 data is because Gov. Perry’s Health and Human Services Commission has refused to provide the data needed to complete my investigation.
“When I called on Gov. Perry in October 2004 to create a Crisis Management Team, I said the crisis was minute-by-minute and child-by-child.
“In Fiscal 2004, four-year old twin boys living in the same foster home received medical treatment in the hospital for rape.
A five-year old boy in the same foster home received medical treatment in the hospital for rape two days later.
A 15-year old girl who was not pregnant when she entered our state’s foster care system in May 2002 gave birth in February 2004.
The state is supposed to be protecting our forgotten children, but in all too many cases these children are taken from one abusive situation and placed in another abusive situation. Many children are in more abusive situations now than they were before the state intervened.
Children are being neglected and abused and are dying.
“As reported by the media, a 12-year-old boy died in December 2005, while in our state’s care at a facility that treats children with learning disabilities and emotional problems. The boy suffocated while being restrained from behind by an employee of the facility.
“Another boy in our state’s care at the same facility died May 30, after drowning in a creek during a May 6 bicycle outing.
A three-year old was treated for poisoning from an atypical, mind-altering antipsychotic drug. These drugs are not approved by the Food and Drug Administration for children under the age of 18 years old.
“Gov. Perry’s failure to create a Crisis Management Team is unconscionable. The crisis is minute-by-minute and child-by-child. I renew my call. He must act now to save children’s lives.
“I discovered the alarming number of deaths, poisonings, rapes and pregnancies while conducting my investigation into potential prescription drug fraud and abuse in the state’s foster care system.
“I launched my investigation in November 2004, after my report, Forgotten Children, uncovered the fact that large numbers of psychotropic drugs are being prescribed to children in the foster care system, even though, according to the FDA, many of these drugs are not approved for children and have serious side effects such as suicidal tendencies, diabetes, and cardiac arrhythmia.
“Since that time, repeated and continuing roadblocks and stonewalling have been encountered by me and my staff in attempting to secure basic and necessary data from the Health and Human Services Commission to complete my investigation.
“It has been 19 months and 25 letters, emails, meetings and phone calls since I first requested foster care and corresponding Medicaid data from HHSC.
“The Commission finally provided Fiscal 2004 data. But, 10 months into Fiscal 2006, we have yet to receive the Fiscal 2005 data, which we know has been available for months and months.
“In March 2006, I requested all of the same data for Fiscal 2005.
“The Governor’s commission has repeatedly thrown up roadblocks and stonewalled my investigation.
“We have had a signed Memorandum of Understanding, drafted by HHSC, at its offices since May 2005, agreeing in the Commission’s own language to the confidentiality of this information.
“Claiming confidentiality, HHSC to this day refuses to cooperate and provide the Fiscal 2005 data needed to complete my investigation, despite that the statute requires that they cooperate and the Court of Appeals ruled on June 16 that HHSC’s view about the confidentiality of its records is clearly wrong.
“What I have found from the information that was made available should be and is of grave concern, but the picture painted by Gov. Perry’s Health and Human Services Commission’s secret 2005 data must paint an even grimmer picture on all fronts.
“The people of Texas can handle the truth. What they will not tolerate is Gov. Perry’s callous indifference in hiding the truth and placing our forgotten children at high risk.
“On Thursday, June 29, my findings will be reported to the Medicaid and Public Assistance Fraud Oversight Task Force so there will be a public record of this neglect and abuse.
“With every breath of air in Carole Keeton Strayhorn’s lungs, I will continue to be the voice for these forgotten, neglected, abused, and dead children.
“There should have been a Crisis Management Team put into action in October 2004.
It must be put in action now to prevent any more neglect, abuse and deaths of our more than 32,000 children in our state’s foster care system.
“Gov. Perry is hiding the truth. And in hiding the truth he is jeopardizing our forgotten children’s lives. That makes me one heartbroken Grandma.”
Letter From Comptroller Carole Keeton Strayhorn
to Texas Medicaid and Public Assistance Fraud Oversight Task Force
June 23, 2006
Texas Medicaid and Public Assistance Fraud Oversight Task Force
Dear Task Force Members:
On December 16, 2004, I informed each of you that as Texas Comptroller and under my statutory authority to study Medicaid fraud and abuse, I had launched an investigation into possible Medicaid prescription drug fraud and abuse in our State’s foster care system. I promised to provide this Task Force the results of my investigation as soon as possible, so that appropriate remedial action could be taken at the earliest possible time.
What I have found thus far in conducting this investigation is shocking and alarming, and requires immediate attention at the upcoming Task Force meeting on June 29. The crisis is minute by minute and child by child. It is time to put Texas’ children first.
From information provided by the Texas Department of Family and Protective Services, in Fiscal 2003, 30 foster children died in our State’s care; in Fiscal 2004, 38 foster children died; and in Fiscal 2005, 48 foster children died. The number of foster children in our State’s care increased 24 percent from 2003 to 2005, but the number of deaths increased 60 percent. If you compare the number of deaths of children in our state’s population to the number of deaths in our state’s foster care system, a child is four times more likely to die in our state’s foster care system.
Further, based on Fiscal 2004 data provided after unconscionable delays and stonewalling by the Health and Human Services Commission (HHSC), in just one year, about 100 foster children suffered from poisoning from medications, including anti-convulsants, stimulants, anti-depressants, anti-psychotics and tranquilizers; 63 foster children received medical care for rape that occurred while in the State’s foster care system; and 142 foster children gave birth while in our State’s foster care system.
Since I announced my investigation, repeated and continuing roadblocks and stonewalling have been encountered by me and my staff in attempting to secure basic and necessary data from HHSC to complete my report to the Task Force. It has been 19 months and 25 letters, emails, meetings and phone calls since I first requested foster care and corresponding Medicaid data from HHSC.
The Commission finally provided Fiscal 2004 data. But, 10 months into Fiscal 2006, we have yet to receive the Fiscal 2005 data, which we know has been available for months and months. In March 2006, I requested all of the data for Fiscal 2005. We have had a signed Memorandum of Understanding, drafted by HHSC, at its offices since May 2005, agreeing in HHSC’s own language to the confidentiality of this information.
Now, still claiming confidentiality as an issue, HHSC to this day refuses to cooperate and provide the Fiscal 2005 data needed to complete the study, despite that the statute requires that they cooperate and the Court of Appeals ruled on June 16 that HHSC’s view about the confidentiality of its records is clearly wrong.
What I have found from the information that was made available should be and is of grave concern, but the picture painted by HHSC’s secret 2005 data must paint an even grimmer picture on all fronts.
Since October 2004, I have repeatedly urged the Governor to issue an executive order to immediately create a Crisis Management Team. The agency charged with caring for our most precious resource – our children – continues to fail to protect our most vulnerable foster children. Two years later he still refuses to create this crisis management team. Tragically, Governor Perry’s callous indifference is placing our children at high risk. That makes me one heartbroken Grandma.
For these reasons, these matters must be brought to the full Task Force on June 29, and be made public record. They must be addressed by the Task Force to ensure that the Task Force leaves no stone unturned in fulfilling its lawful duty to assist in improving our State’s efforts to investigate and to prevent fraud, but most importantly they must be addressed because the lives of our most vulnerable foster children remain at high risk.
The child welfare system should be a safety net, which ensures the health, safety, and well being of all children. “Government in the sunshine” is the best way to ensure accountability. As Chairman of the Medicaid and Public Assistance Fraud Oversight Task Force, but more importantly as a mama and a grandma, it is my duty to advise Governor Perry and the Health and Human Service Commission of any problems or concerns regarding possible abuse and neglect that I become aware of that occur in this administration.
If you have additional questions or need additional assistance, please feel free to contact Will Counihan, of my staff, by e-mail at email@example.com or by phone at 1-800- 531-5441, extension 6-0758, or contact me directly at 512/463-4444.
Please know that I welcome your good advice at any time. Thanks for all that you do for Texas.
Carole Keeton Strayhorn,
Chairman, Texas Medicaid and Public Assistance Fraud Oversight Task Force
Texas Foster Care Investigation – Children as young as 3 are drugged with antipsychotics
Sat, 13 Nov 2004
The Dallas Morning News reports that Texas comptroller, Carole Keeton Strayhorn, who hade conducted an investigation of the foster care system, concluded that up to $4 million a year might be wasted on drugs given to foster children for mental illnesses such as schizophrenia, bipolar disorder and depression.
Her investigation shows that 60% of children in the Texas foster care system are being drugged with powerful psychotropic drugs that have not been approved for children. Yet, “Children as young as 3 are receiving powerful, mind-altering drugs.”
She suspects foster children are being given psychiatric drugs “so they’re more docile, or so doctors and drug companies can make a buck.”
A mother reported her son’s experience with the antipsychotic drug, Zyprexa: “He put on a tremendous amount of weight, 85 pounds to be exact,” she said, adding that as doctors continued to increase his medications starting at age 5, he experienced troubles in school and with the law and was hospitalized repeatedly.”
The Houston Chronicle reports that Risperdal and Zyprexa – made up half of the drugs prescribed to foster children in Texas. These drugs are among the most dangerous of psychotropic drugs. They carry new FDA-required warnings about diabetes, blood clots and strokes.
Dr. Tony Appel, a neuropsychologist from Florida who examined the Texas records agrees
: “We’re taking away their future. We’re taking away their ability to relate to people; trust, love caring, ability to put yourself in the other person’s shoes and see how they see you. We take all that away from these children. We blunt their emotion.”
Ever protective of the drug industry, the Texas Medical Association expressed skepticism about Comptroller Strayhorn’s concerns. It is appalling that the Texas Medical Association sees nothing wrong in violating medicine’s first principle, “do no harm” – if doing harm increases profits for psychotropic drug manufacturers.
See also, Foster Kids on Mind-Altering Drugs? Posted By: Mandi Bishop 11/11/2004, http://www.woai.com/troubleshooters/story.aspx?content_id=168321B6-DF50-4A2F-83D1-1789D8F2A18A
See also: Texas Keye News broadcasts 7/23/2004 and 9/30/ 2004 at: http://keyetv.com/investigativevideo/
The Dallas Morning News
Drug fraud alleged in foster care
Strayhorn believes kids are getting unnecessary psychiatric medication
November 12, 2004
By ROBERT T. GARRETT /
AUSTIN � Comptroller Carole Keeton Strayhorn suspects foster children are being given psychiatric drugs so they’re more docile, or so doctors and drug companies can make a buck.
Mrs. Strayhorn on Friday demanded a year’s worth of records on drugs given to foster children, and she vowed to investigate and share evidence of fraud with the Legislature and the Health and Human Services Commission.
The comptroller cited her authority as the head of a Medicaid fraud task force that advises the commission.
She immediately drew skepticism from the Texas Medical Association and political rival Gov. Rick Perry that her investigation will be either helpful or necessary.
But two mothers of children placed by the state into foster care praised Mrs. Strayhorn’s effort, saying her year-old crusade against misuse of mental health drugs among the state’s 17,000 foster children had helped save the lives of their children.
“If it wouldn’t have been for the care and concern of the comptroller, Mrs. Strayhorn, my daughter would not be alive today,” said Elain Philpott of Port Neches.
Ms. Philpott said an unnecessary antipsychotic drug dulled her 15-year-old daughter’s senses and caused other problems during the six years she was in foster care.
Mrs. Strayhorn said up to $4 million a year might be wasted on drugs given to foster children for mental illnesses such as schizophrenia, bipolar disorder and depression.
“Children as young as 3 are receiving powerful, mind-altering drugs,” she said.
Commission spokeswoman Jennifer Harris said it has launched a two-track review of whether poor children on Medicaid – including foster children – receive proper medicine for mental illness.
One is an ongoing review of drug claims by its beefed-up anti-fraud unit. The other is a review of “clinical data” on mentally disturbed children who receive Medicaid to see if policies need to be changed or if doctors need continuing education about mental health drugs.
Dr. John Holcomb of the Texas Medical Association said Mrs. Strayhorn has “a serious misunderstanding” of whether off-label use of drugs is appropriate.
“Hogwash,” retorted the comptroller, whose son, Mark McClellan, runs the Food and Drug Administration. “I understand the use of off-label drugs, and I understand that most of these drugs are not approved for use in children.”
She questioned actions by two Texas doctors who aren’t psychiatrists but have prescribed mental health medications to foster children. A third, she said, co-owns a pharmacy that dispenses the drugs.
“It is not uncommon for some [foster] children to have up to 14 different prescriptions,” she said.
Mrs. Strayhorn began reviewing foster care last year after stories in The Dallas Morning News found problems with the state’s financial oversight of some foster care operators.
Ms. Harris said Mrs. Strayhorn will get the requested data “as long as it doesn’t violate federal law protecting a patient’s confidentiality.”
Nov. 12, 2004, 11:39PM
Houston Chronicle Austin Bureau
Strayhorn will probe drug use on children
Comptroller asks for medical data on children
in foster care
By POLLY ROSS HUGHES
AUSTIN – Comptroller Carole Keeton Strayhorn launched an investigation Friday into potential fraud and abuse in a foster care system that spends $4 million a year on mind-altering “Physicians are prescribing these drugs for children as young as 3 years old,” Strayhorn said.
“I can’t imagine prescribing mind-altering drugs for a 3-year-old baby.”
Strayhorn said she’s asking the Health and Human Services Commission to hand over detailed Medicaid records so she can track which drugs are prescribed for individual foster care children and whether fraudulent patterns exist.
“I am requesting prescription drug and claims data for foster children for an entire year to determine whether these medications are being prescribed to make the children more submissive,” she said, “or to line the pockets of unscrupulous and uncaring doctors and pharmaceutical companies, or both.”
The Texas Medical Association issued a statement saying Strayhorn has “serious misunderstanding” about the use of such drugs in children and said her examination so far does not put the drug data in a clinical context to tell whether the drugs were prescribed appropriately.
“Hogwash,” she responded, adding that she understands the drugs have not been approved for use in children.
“I also understand that no child needs to be on 14 different drugs, and I severely question a 3-year-old being put on (the antipsychotic) Risperdal and a radiologist in San Antonio prescribing psychotropic drugs to children in El Paso.”
Health and Human Services Commission spokeswoman Jennifer Harris said that the commission’s inspector general and the Department of State indicated that Strayhorn’s request will be subject to federal privacy law.
“We’re willing to provide her with any information that she requests as long as it doesn’t violate federal law protecting a patient’s privacy,” she said, adding that the commission already is overseeing a similar study.
HHSC’s Inspector General Brian Flood and Health Commissioner Eduardo Sanchez are conducting a broad review into all children who receive Medicaid and are prescribed psychiatric drugs, but Strayhorn wishes to specifically examine medications prescribed to abused or neglected children in the state’s foster care custody.
The commission oversees four major social service agencies and reports directly to Strayhorn’s political rival Gov. Rick Perry.
Earlier report cited
Strayhorn spokesman Mark Sanders said Strayhorn, as chairman of a Medicaid fraud task force that reports to the Legislature every two years, already has access to confidential Medicaid information and has authorization to sign confidentiality agreements with the agency.
Widespread psychiatric drug use in foster children came under scrutiny earlier this year in Strayhorn’s major report, “Forgotten Children,” which also detailed physical and sexual abuse of foster care children and unsanitary living conditions.
“My report uncovered the fact that large numbers of psychotropic drugs are being prescribed to children in the foster care system, even though, according to the Food and Drug Administration, many of these drugs are not labeled for use in children and have serious side effects such as suicidal tendencies, diabetes and cardiac arrhythmia,” Strayhorn said.
She said she was alarmed that in her review of a single month of data, two antipsychotic drugs – Risperdal and Zyprexa – made up half of the drugs prescribed to foster children.
Federal warning issued
Last June, these two drugs, along with Clozaril, Seroquel, Geodon and Abilify, became subject to a Food and Drug Administration warning of dangerous side effects.
The warning states the drugs carry an increased risk for hyperglycemia and diabetes and that the safety and effectiveness of the drugs has not been established for children.
The FDA also issued a warning last spring that adults and children taking 10 commonly prescribed antidepressants must be closely monitored for worsening depression and increased risk of suicide.
The drugs include Paxil, Luvox, Celexa, Lexapro, Wellbutrin, Effexor, Serzone and Remeron. Parents who joined Strayhorn at a press conference credited her actions for helping save the lives of children.
Child heard ‘voices’
Lori Holland of Austin said her son experienced highly disturbing side effects when placed under powerful psychiatric drugs. On Zyprexa, he began hearing “voices in his head,” she said.
“He put on a tremendous amount of weight, 85 pounds to be exact,”
adding that as doctors continued to increase his medications starting at age 5, he experienced troubles in school and with the law and was hospitalized repeatedly.
Holland said she thinks her son’s problems were the result of post-traumatic stress after suspected sexual abuse around the age of 4 or 5 years old.
She said he was removed from his family’s home as a preteen when he committed a crime that victimized a younger child in the home. After being sent to a facility in Lockhart called Pegasus, she said, he has been weaned off the psychiatric drugs, is attending high school and playing baseball. Earlier, depending on the doctor in charge, he was variously diagnosed as suffering from attention deficit disorder, bipolar disorder, schizophrenia or sociopathy.
Strayhorn: Foster Children’s Health Care System A Failure
Last Update: 8/06/2007 11:32 am
There are concerns over the health care provided for Texas foster children. The Texas Comptroller Carole Keeton Strayhorn calls the system a failure. She detailed specific problems and made some recommendations.CBS 42 started reporting on the issue of psychotropic drugs prescribed to foster kids more than two years ago. The comptroller issued a report called Our Forgotten Children that detailed widespread use of powerful and often dangerous psychotropic, or psychiatric drugs among foster children.
Much of the report outlining the states care of foster children focuses on the use of psychotropic medications such as anti-depressants, anti-psychotics, stimulants and mood stabilizers.
The comptrollers report showed in 2004, 39.7-percent of 5-year-olds to 9-year-olds in the state’s care were prescribed psychotropic drugs. Sixty point nine percent of 10-year-olds to 14-year-olds were medicated and 57.6 percent of foster kids between 15-year-olds to 19-year-olds were prescribed a number of psychotropic medications.
The comptrollers report expressed concern that, in 2004, 686 kids–4 years old and under–received an average of seven psychotropic prescriptions.
The comptroller says new studies show many of the drugs are not effective for kids. On top of that they are expensive.
The comptroller says the report reveals shocking evidence of the poor health care provided to the states foster children. First Posted Dec 15, 2006
Four Points Media Group, LLC
in Foster Care
to Begin in April 2008
The Health and Human Services Commission (HHSC) is launching STAR Health, a new health-care program to improve services and better coordinate care for children in foster care. STAR Health will begin enrolling participants in March 2008, and children in foster care will begin receiving services through the program in April 2008. Services to children in foster care will be provided through a contract with Superior HealthPlan Network.
Learn more: STAR Health presentations are taking place across Texas. [Schedule]
Program components will include:
- The Health Passport will be available through the Internet and make it easier for doctors and caregivers to get accurate medical information on each child.
For more information about this benefit, read the Frequently Asked Questions about the Health Passport.
- Texas Department of Family and Protective Services
Benefits will include:
A Health Passport for each child in foster care, containing a summary of his or her medical information.
Expedited enrollment so children can begin receiving services as soon as they enter state conservatorship.
Improved access to services through a network of providers.
24-hour nurse hotline for caregivers and caseworkers.
Service coordination to help children, caregivers and caseworkers get services and information.
“We reject the notion that foster kids are not getting appropriate care…” said Patrick Crimmins, spokesman for the Department of Family and Child Protective Services.
Crimmins says the state addressed the issue of psychotropic drugs by appointing a group of experts to come up guidelines for prescribing drugs to foster care children.
“The number of prescriptions has decreased since the guidelines went into effect,” Crimmins said.In 2004, the cost to Texas taxpayers for providing psychotropic drugs to foster kids was $29,909,510. The comptrollers report recommended looking at alternative treatments, such as diet exercise and psychotherapy. The spokesman for the Department of Family and Child Protective Services disputes the report.
To become a provider: Providers interested in participating in this program should call Superior HealthPlan Network.
Vision Services: 866-642-9488
Behavioral Health Services: 866-218-8263
Dental Services: 866-708-8795
Report Medicaid Fraud Violations
If you believe an individual is fraudulently receiving Medicaid benefits, contact the Texas Health and Human Services Commission’s Office of Inspector General at:
Texas Health and Human Services Commission
Office of Inspector General
PO Box 85200
Austin, Texas 78708-5200
To report a medicaid provider for fraud or abuse, contact our
Medicaid Fraud Control Unit at:
Office of the Attorney General
Medicaid Fraud Control Unit
PO Box 12307
Austin, Texas 78711-2307
(800) 252-8011 (Main agency switchboard)
Medicaid Fraud Control Unit Regional Offices
Civil Medicaid Fraud
The Civil Medicaid Fraud Section (CMF) is nationally recognized as a leader in the recovery of funds wrongfully taken from the Medicaid program.
Attorney general columns:
The group protects taxpayers by enforcing the Texas Medicaid Fraud Prevention Act (TMFPA), chapter 36 of the Texas Human Resources Code. The TMFPA permits private citizens to file lawsuits on behalf of the state against those who violate the TMFPA. These private citizens are referred to as “relators” and they assist the state in identifying and pursuing fraudulent activity committed against the Medicaid program.
Relators in successful matters receive a portion of the recovery. The OAG may also pursue cases on its own on behalf of the Medicaid program.
In addition to actively litigating in state and federal courts, CMF works with relators, the criminal Medicaid Fraud Control Unit, the federal government, other state governments, and law enforcement to effectively conduct nationwide fraud recovery efforts. Through these efforts, the OAG has recovered over a quarter of a Billion dollars on behalf of the Texas Medicaid system.
A medical home through a primary care doctor who coordinates care and promotes better preventive health practices.
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