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While only two-thirds of Texas doctors treat Medicaid patients, a Texas government agency is using tactics that might turn more doctors away from the program, according to the Texas Medical Association (TMA).
In one recent example, Texas' Office of Inspector General (OIG), a Texas Health and Human Services Commission (HHSC) agency, told San Antonio physician Milissa Aldridge, MD, that she can treat Medicaid patients only if she pays the state nearly $1 million. The OIG monitors Texas Medicaid to prevent and reduce waste, abuse, and fraud. In dispute in Dr. Aldridge's case are a clerical error and a misplaced letter from years ago.
For nine years, Dr. Aldridge practiced pediatric radiology in San Antonio - one of only 36 such specialists in the state - and cared for young Medicaid patients. But the OIG made her stop seeing Medicaid patients earlier this year, and demanded she repay the state $834,434.83. The OIG cites an administrative sanction she received 13 years ago when she chose to end her career as a pharmacist and become a physician. Because she chose to let her pharmacy license lapse to inactive status during medical school, Medicaid excluded her from participating in the program as a pharmacist. But she was unaware they had excluded her, so she did not report that on a Medicaid provider application in 2000. Unknown to her, the 13-year-old action meant she should not have participated in Medicaid all these years.
After the OIG banned her from Medicaid, Dr. Aldridge appealed for permission to see Medicaid patients again. The OIG first denied the request, then offered her this deal to entitle her to care for Medicaid patients: She could pay back the $800,000+ that Medicaid paid her for treating all those patients, or it would keep half of all her future Medicaid earnings until she repaid the full amount. Only by paying back what she had earned caring for Medicaid patients could she treat more Medicaid patients.
One TMA physician leader calls this extortion.
"If the [OIG] inspector general truly believed that this was fraudulent billing, it's his responsibility and duty to turn this case over to the attorney general for criminal prosecution," says John R. Holcomb, MD, chair of TMA's Select Committee on Medicaid, CHIP, and the Uninsured. "Instead, the office has sent Dr. Aldridge a letter demanding more than $800,000 as the price of letting her back in the program," he said.
TMA's Patient-Physician Advocacy Committee recently reviewed Dr. Aldridge's case. "Based on the information we heard from Dr. Aldridge and her attorney, it raises the concern of whether the OIG is functioning to protect the integrity of the Medicaid program or acting as a revenue generation mechanism," says Chair Robert H. Emmick Jr., MD. He adds that it raises "a question of the lack of common sense and proportionality for the issues that the OIG is addressing."
Because of the sanction, Dr. Aldridge lost her job with her medical group, Radiology Associates of San Antonio PA. She also lost her faith in Texas' Medicaid system. "You think you're doing the right thing, and then someone tells you you're not doing the right thing and are a criminal," she says in the July issue of TMA's Texas Medicine magazine.
In one recent example, Texas' Office of Inspector General (OIG), a Texas Health and Human Services Commission (HHSC) agency, told San Antonio physician Milissa Aldridge, MD, that she can treat Medicaid patients only if she pays the state nearly $1 million. The OIG monitors Texas Medicaid to prevent and reduce waste, abuse, and fraud. In dispute in Dr. Aldridge's case are a clerical error and a misplaced letter from years ago.
For nine years, Dr. Aldridge practiced pediatric radiology in San Antonio - one of only 36 such specialists in the state - and cared for young Medicaid patients. But the OIG made her stop seeing Medicaid patients earlier this year, and demanded she repay the state $834,434.83. The OIG cites an administrative sanction she received 13 years ago when she chose to end her career as a pharmacist and become a physician. Because she chose to let her pharmacy license lapse to inactive status during medical school, Medicaid excluded her from participating in the program as a pharmacist. But she was unaware they had excluded her, so she did not report that on a Medicaid provider application in 2000. Unknown to her, the 13-year-old action meant she should not have participated in Medicaid all these years.
After the OIG banned her from Medicaid, Dr. Aldridge appealed for permission to see Medicaid patients again. The OIG first denied the request, then offered her this deal to entitle her to care for Medicaid patients: She could pay back the $800,000+ that Medicaid paid her for treating all those patients, or it would keep half of all her future Medicaid earnings until she repaid the full amount. Only by paying back what she had earned caring for Medicaid patients could she treat more Medicaid patients.
One TMA physician leader calls this extortion.
"If the [OIG] inspector general truly believed that this was fraudulent billing, it's his responsibility and duty to turn this case over to the attorney general for criminal prosecution," says John R. Holcomb, MD, chair of TMA's Select Committee on Medicaid, CHIP, and the Uninsured. "Instead, the office has sent Dr. Aldridge a letter demanding more than $800,000 as the price of letting her back in the program," he said.
TMA's Patient-Physician Advocacy Committee recently reviewed Dr. Aldridge's case. "Based on the information we heard from Dr. Aldridge and her attorney, it raises the concern of whether the OIG is functioning to protect the integrity of the Medicaid program or acting as a revenue generation mechanism," says Chair Robert H. Emmick Jr., MD. He adds that it raises "a question of the lack of common sense and proportionality for the issues that the OIG is addressing."
Because of the sanction, Dr. Aldridge lost her job with her medical group, Radiology Associates of San Antonio PA. She also lost her faith in Texas' Medicaid system. "You think you're doing the right thing, and then someone tells you you're not doing the right thing and are a criminal," she says in the July issue of TMA's Texas Medicine magazine.
