Tags: Healthcare Reform | sheila jackson lee | medicare | payments | overbilling | probe | democrats

WSJ: Political Pressure Hits Medicare Overbilling Probes

By    |   Friday, 12 Dec 2014 08:56 PM

When Texas Democratic Rep. Sheila Jackson Lee learned that federal officials had moved to block Medicare payments to Riverside General Hospital in Houston, she sprung into action.

Investigators had acted after learning that the hospital may have filed claims for patients who were not treated. But in a June 2012 letter to Marilyn Tavenner, the federal official who oversees Medicare, Jackson Lee contended that blocking payments had "jeopardized" the well-being of patients needing Medicare and put Riverside at financial risk, The Wall Street Journal reported.

In a follow-up meeting with Medicare anti-fraud officials that July, Jackson Lee claimed that Riverside was the area’s only provider of certain mental-health services. Medicare anti-fraud investigators countered that there were six other providers within 10 miles of the hospital offering the same services.

But shortly afterwards, Tavenner ordered the restoration of 70 percent of the payments to the hospital even as her agency, the Centers for Medicare and Medicaid Services, was cooperating with a criminal investigation of the facility.

Two months after Tavenner’s order releasing the payments , federal agents arrested Riverside CEO Earnest Gibson III at the hospital and charged him with federal health care fraud. Medicare officials resumed blocking payments to Riverside.

On Oct. 20, 2014, Gibson, his son and two other people affiliated with the hospital were convicted in federal court for their roles in a Medicare scheme to steal $158 million from the federal government, the Houston Chronicle reported.

In a recent interview, Gibson said he had initially been unaware of fraudulent billing and that he subsequently learned that an employee and some contractors had engaged in fraud.

Gibson claimed that he sought Jackson Lee’s help in order to "make sure we got a fair shot," the Journal reported. He says he is innocent and is seeking a new trial.

The same WSJ piece also pointed to clashes involving Medicare officials and two Republicans: Rep. Kevin Brady of Texas and Florida Gov. Rick Scott – over the program’s anti-fraud measures.

Scott’s administration blocked Medicare from stopping payments to Florida skilled-nursing facilities after investigators found what they considered "suspicious" billing patterns at 33 facilities owned by Plaza Health Network, according to the Journal.

The newspaper also reported that Brady – who received more than $218,000 in contributions from nursing homes and hospitals during the current election cycle and is chairman of the House Ways and Means Subcommittee on Health – has clashed with Medicare officials over fraud-related issues in the wake of complaints by the hospital industry over the way program audits are being conducted.

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When Texas Democratic Rep. Sheila Jackson Lee learned that federal officials had moved to block Medicare payments to Riverside General Hospital in Houston, she sprung into action.
sheila jackson lee, medicare, payments, overbilling, probe, democrats
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2014-56-12
Friday, 12 Dec 2014 08:56 PM
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