"Ezekiel 25:17 - The path of the righteous man is beset on all sides by the inequities of the selfish and the tyranny of evil men. Blessed is he that shepherds the weak from the valley of darkness for he is truly his brother's keeper, and the finder of lost children. And I will strike down upon thee with great vengeance and furious anger those who attempt to poison and destroy my brothers, and you will know my name is the Lord when I lay my vengeance upon thee."

Ambulance firms raided in Medicaid fraud inquiry

Companies in Dallas, 11 other cities searched in billing investigation

12:00 AM CST on Thursday, December 7, 2006

By TANYA EISERER / The Dallas Morning News

Fraud investigators served 19 search warrants in Dallas and 11 other cities in a wide-ranging inquiry into allegations of fraudulent billing practices by ambulance companies, the Texas attorney general said Wednesday.

"This is a statewide fleecing of millions of dollars from Texas taxpayers of the Medicaid system," said Attorney General Greg Abbott. "There were billings that were either for more than the amount of services provided, or even billings for services that were not provided. [The] bottom line is we have a statewide operation cracking down on Medicaid fraud."

The investigation centers on ambulance companies suspected of submitting false claims to Medicare, Medicaid, private insurers and the Federal Employees Health Benefits Plan, said Jerry Strickland, a spokesman for the attorney general's office.

The inquiry, Operation Easy Rider, began at least six months ago after the Texas Health and Human Services Commission reported discrepancies in billing practices, Mr. Strickland said. The agency oversees the disbursement of Medicaid funds.

"The fraud that we're dealing with really doesn't have anything to do with any kind of complexities that may exist in the system," Mr. Abbott said. "We're dealing with people who are just out and out cheating and lying to the state of Texas, stealing money from the taxpayers of the state of Texas.

"They thought, gosh, that [they] could take money by overcharging the state of Texas, overcharging the Medicaid system, maybe no one would see."

Officials declined to release further details, citing the continuing investigation.

The attorney general's Medicaid Fraud Control Unit was involved in the operation, along with federal agents from the inspector general's office at the U.S. Department of Health and Human Services, the FBI, the inspector general's office for the U.S. Office of Personnel Management, the U.S. Postal Inspection Service and the U.S. Department of Homeland Security.

North Texas ambulance companies that were searched included Carefirst EMS on Centre Street and Judd Court in Dallas; Greater Dallas EMS on South Hall Street in Dallas; All State Ambulance Service in Rowlett; Advicare Ambulance Transfer Service in DeSoto; and Visions EMS in Cedar Hill.

Officials with the ambulance companies either declined to comment or could not be reached for comment.

Mr. Strickland also confirmed that law officers arrested the owners of an ambulance service in McAllen, Texas, as part of the raids.

Chris Heinbaugh of WFAA-TV (Channel 8) contributed to this report.

E-mail teiserer@dallasnews.com

MEDICAID "LIEN" RESOLUTION

Medicaid has only a right of Subrogation

All the money recovered in most personal injury actions should go to the injured Plaintiff.
Avoid the conflict of interests in representing two competing parties, the injured Plaintiff and the State.
Attorneys are mistakenly creating "equitible liens" by suing for medical expenses in personal injury actions to the detriment of the client.

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Medicaid, nationwide, has been considered to have a "lien" on any personal injury recovery such as motor vehicle accidents and "slip and falls" since its inception. That all changed with the United States Supreme Court decision in ADHHS v Ahlborn, 547 US 268 (2006). From that point forward, it should have been recognized that the Medicaid claim is actually one of subrogation. Unfortunately, to the significant and totally unnecessary financial loss of injured plaintiffs, the full impact of this decision has not been understood by personal injury attorneys.

Medicaid has only a right of subrogation as against a wrongdoer in a personal injury action. That is the fact. The statute [42 USC 1396(a)25 ] does not give the State a "lien". Why, therefore, do plaintiffs' attorneys across the nation continue to remit part of their client's settlement for their injuries back to the State? Why do they tell the injured client that there is a lien that must be repaid? Why, when they are possibly committing legal malpractice, should the attorneys be pleased that they have been able to get the State to reduce their claim to 50% from the standard two-thirds they normally claim? We all know that the attorneys take their full one-third off the top and then negotiations begin with the State. The attorneys are being fully compensated. Perhaps the injured client should have the same privilege.

The legal rationale of the bar generally and the flaw in their legal analysis is found in the form of the pleadings and in the scope of the General Release tendered at the conclusion of the personal injury law suit. The simple version is that if a claim by the injured plaintiff is made for medical expenses paid by another (Medicaid) and there is a release given by that injured plaintiff for all damages of any kind, including medical expenses, then the injured plaintiff has collected money that belongs to Medicaid. If Medicaid has paid an expense, if that expense is to be reimbursed, it must go to the one who actually incurred the loss, the payor, Medicaid. In a subrogation action, Medicaid is the "real party in interest" relative to recovery of medical expenses. If an injured plaintiff recovers another's medical expenditures, then he has created an "equitable lien". Since he has money that does not belong to him, he must pay it back to the State.

The error occurs in collecting the State's money in the first instance. Since the recovery of medical expenses is the State's right, let it bring about the collection. If the injured plaintiff in a fall down accident does not claim, prove nor release the State's rights, then all the money recovered in the personal injury action goes to the injured plaintiff. The methodology is straight forward: Do not claim medical expenses in the lawsuit. Specifically advise opposing counsel that Medicaid may have a right of subrogation for medical expenditures and that the client is not making a claim for any of those damages. This pleading should also be sent to the State representative in charge of Medicaid. That way, everyone is on notice that no claim is being made for medical expenses arising out of this accident. Finally, when the Release is exchanged, make certain that it is for "bodily injury, pain and suffering only" and that "any and all rights of subrogation by insurance companies and Medicaid are preserved and survive this settlement". Those statements, along with some other specific language, should make it crystal clear that the claim and resolution were for the bodily injuries, pain and suffering only.

Ahlborn held generally that were there was a "global" release for pain and suffering and medical expenses but the recovery was for less that full value and all parties stipulated to those conditions, then the recovery had to be allocated on a pro rata basis with the same percentage values going to the claimant and the State. Here, the recommendation is not to issue a "global" release but only a Release for "pain and suffering". Then there will have been no "equitable lien" created and, therefore, no obligation to share any of the proceeds with the State.

Attorneys will argue that insurance companies will not take such a release in a typical motor vehicle or "slip and fall" action. They must argue this because none have ever tired it. The fact is that carriers must accept such a release if the pleadings are proper and there is notice to all sides and parties that this is only a claim for injuries, pain and suffering. If the carrier refuses, then the injured plaintiff may need take his case to verdict. There he will obtain a judgment which can be enforced against the insurance company. The insurance company now must pay. And since the injured party did not claim nor prove medical expenses, those items still remain the property of the State to initiate a lawsuit or claim aganist the wrongdoer, not the plaintiff or the plaintiff's attorney. This form of practice works. This practice directs more of the recovery to the party injured in the automobile accident or in the "slip and fall". It also avoids any conflicts of interest as the attorneys are only working for one claimant, the injured party. The attorney is not obligated to represent the injured party and the State for two separate, competing claims arising out of the same personal injury accident and being paid from a single source of money. It is better for the injured plaintiff. It is ultimately better for the attorney as there can be no claim of conflict of interests.

WIA

Sunday, June 21, 2009

This is the mary cano type of business creates wit your tax money......isn't she worth the amount of services provided,????

Thursday, January 29, 2009

Why would Medicaid side with a wrongdoer? Federal medicaid and insurance inc sitting in a tree......

MEDICAID "LIEN" RESOLUTION

Medicaid has only a right of Subrogation

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