Sen. Joan Huffman authored Senate Bill 1803 after hearing concerns from many Texas physicians about insufficient due process when the Office of Inspector General suspects or accuses a physician of Medicaid fraud or abuse.


accused of fraud, waste, or abuse. Noth- ing like that had been done before,” said John Holcomb, MD, chair of TMA’s Se- lect Committee on Medicaid, CHIP, and the Uninsured.


TMA opposes health care fraud and supports a fair process to prevent and detect actual fraud. TMA’s work on the issue began last


John Holcomb, MD


October when physicians complained the OIG’s new rules essentially cast every Medicaid billing er- ror as a possible tar- get for fraud-and- abuse prosecution. They also worried they’d be incorrect- ly accused of fraud, waste, or abuse, or denied meaningful recourse during an investigation.


36 TEXAS MEDICINE August 2013


After OIG adopted the rules, TMA be- gan evaluating its options for asking the legislature to make sure the state con- ducts fair investigations and gives physi- cians and other health care profession- als appropriate due process if accused of fraud, waste, or abuse. Additionally, TMA convened a Physi- cians Medicaid Congress in October to discuss ways to attract more physicians to participate in the program, such as alleviating physicians’ fears of OIG. Ac- cording to TMA’s 2012 physician survey, Texas physicians available to treat all new Medicaid patients plummeted from 42 percent in 2010 to 31 percent — an all-time low. TMA worked with lawmakers this


year to craft legislation that improves due process when a physician faces Med- icaid fraud or overpayment accusations. The hard work paid off in passage of


Senate Bill 1803 by Sen. Joan Huffman (R-Houston) and Rep. Lois Kolkhorst (R- Brenham). SB 1803, which takes effect Sept. 1, clarifies the definition of “cred- ible allegation of fraud” and establishes timelines for when OIG must notify doc- tors of an investigation or can withhold payments in the process.


Senator Huffman says she felt com-


pelled to file SB 1803 because lawmak- ers “have an obligation to spend tax- payer dollars efficiently and effectively” while ensuring that truly needy Texans receive assistance in obtaining medical care.


“Many physicians and other medical


providers around the state expressed concern that there is insufficient due process when OIG suspects or accuses a physician of Medicaid fraud or abuse. Certainly, those guilty of Medicaid fraud or abuse must be caught and prosecuted.


MARJORIE KOTERA / BOB DAEMMRICH PHOTOGRAPHY


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