Recent news on Medicaid fraud has been overflowing with egregious abuses of the system. Yet despite scandalous tales of government funds paying for fraudsters’ Tiffany&Co jewelry, luxury cars, and cleaning robots, we must be wary that innocents do not become entangled in the reactionary backlash of a charitable program done wrong. As the government attempts to recover the money it spent too freely on Meidcaid claims, it is accusing recipients at random and indicting community leaders who seek to bring affordable healthcare to those in need.
One medical martyr whose story gained national publicity in September 2013 is Dr. Juan Villarreal, a family dentist in Harlingen, Texas. In 2011, Dr. Villarreal was accused of Medicaid fraud; via a credible allegation of fraud payment hold, he was ordered to repay the state of Texas $7.8 million or face immediate suspension of funding at the clinic he founded. For close to two years, Dr. Villarreal was unable to provide treatment to many of his patients, most of whom rely on Medicaid to cover their medical expenses.
Dr. Villarreal was known as one of the area’s top providers for low-income patients up until the accusations, after which his thirty years of service were forgotten and he found himself being treated like a criminal by an impersonal entity. In the new frontier of Medicaid fraud investigations, there is no innocent before proven guilty. The accused are persecuted and punished prematurely, before any verdict is reached, in an effort by the government to
save money.
save money.
Legal proceedings which often take years to resolve are obstructing time-sensitive medical treatments with frightening frequency. Even after the charges are dropped, doctors who were acquitted must suffer routine visits from Meidcaid investigators to ensure that their operations run legally. While this may sound fine in theory, doctors report that the interviewers are hostile and will harangue patients, going so far as to question children about the purpose of their visit.
Across the nation, justice is being obstructed out of an overzealous attempt to correct a system with deep structural problems. The clincher in Dr. Villarreal’s case is that he was first suspected of fraud not because there was any allegation of fraud, but on account of his high case load. Dr. Villarreal did not learn this until much later, by which point he was treating his patients out of pocket to the tune of $1.5 million.
While cases of Medicaid fraud in which the accused have overindulged themselves to the point of laughable excess may be entertaining to read, we must remember that hardworking professionals are being prosecuted simultaneously. With changes in healthcare slated to take effect in the upcoming months we must stop the madness and arrive at a peaceable middle ground. We must prosecute the selfish and protect the dedicated.
As always, tune in to my blog for more stories from both sides of the field.
(Article Information from San Antonio Express News)