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Medicaid Therapy Services in Texas Must Comply With HHSC Rules.

Medicaid Therapy Services Audit(May 2, 2012): Recognizing that many Medicaid therapy services in the state are not in compliance with fraud, waste, and abuse laws, Tom Suehs, the Executive Commissioner for the Texas Health and Human Services Commission (HHSC), issued a reminder last week. Specifically, the Commissioner identified several violations of Texas law in recent months, most notably in South Texas, which prompted such a response.

The Commissioner primarily identified the fact that Medicaid therapy services providers in South Texas were providing services to children without the presence or consent of the child’s parent or legal guardian. This practice violates a Texas law, which prohibits services provided to a child under the age of 15 unless a parent, legal guardian or other properly authorized adult accompanies the child.  The intent of the law is to make sure that an adult can verify that the services were, in fact, provided, and to ensure the safety of the child from medically unnecessary, or even dangerous, procedures.

In addition, transportation of children to and from medical procedures paid through Medicare or Medicaid by providers or those with which they have a business relationship may raise serious concerns, and may possibly implicate the Federal Anti-Kickback Statute, among other laws. Notably, this is a criminal statute. Because of the severity of punishments for non-compliance, it is imperative that Medicaid therapy services providers in Texas, especially South Texas, ensure that their practices fully comply with all applicable rule, regulations, and other guidance.

Implementing an effective compliance plan means more than simply downloading a model plan off of the Internet – instead, an effective compliance plan is one that is individualized to your practice, recognized by your employees, and followed on a daily basis. This may include the use of a gap analysis to assess your documentation practices and evaluate your business relationships for any signs of impropriety. Remember, the government is looking for these things, and they will most likely find them. You need to make sure that your practice can undergo and withstand an audit or other scrutiny.

Robert LilesLiles Parker is a full-service health law firm focusing on regulatory compliance and representing providers in health law and business matters. Our attorneys are highly skilled in designing and implementing effective Compliance Plans for all types of health care providers, including providers of Medicaid therapy services. Moreover, our attorneys are experienced in handling an array of complex health law matters, including the appeal of alleged overpayments to Medicaid. For more information on how we can assist your practice in developing an effective dental compliance plan, call Robert W. Liles, Esq. Robert is a Managing Partner at the Firm and can be reached at 1 (800) 475-1906. Call him today for a free consultation.

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