AG's Medicaid Control Unit Steps Up Enforcement Efforts
Over the summer the Attorney General Office hired 40 new lawyers as part of its ongoing initiative to redouble its efforts against Medicaid fraud. Besides investigating and prosecuting Medicaid fraud, the AG’s Medicaid Fraud Control Unit (MFCU) also zealously roots out cases of patient neglect, drug diversion, and ordinary fraud and theft connected with the institutions and seniors who benefit from the program.
In regards to Medicaid fraud, the AG has recently indicted the office manager of a Waxahachie nursing home for theft. The MCFU claims that in addition to writing out checks to herself from a resident’s personal checkbook, the defendant also diverted more than $350,000 into a trust fund account which she then withdrew for her own purposes.
The primary hunting ground for the MFCU has always been nursing homes and the medical personnel who serve their elderly patients. For example, in a 2006 press release the Attorney General lauded the recent uncovering by the Unit and local law enforcement of drug diversion in a nursing home. In response to a nurse’s complaint that another LVN was arriving to work while apparently under the influence, the AG determined that the suspect nurse was fraudulently diverting Oxycodone for her own use. Another case from last year involved an LVN’s guilty plea to charges of injury to an elderly person by reckless omission. The Unit’s prosecutor claimed that the nurse disregarded multiple reports of an elderly patient’s failing condition while she engaged in personal conversations on her cell-phone.
The AG’s hiring binge represents the culmination of several years of increased appropriations by the State Legislature and mirrors the increased pressure placed on the Texas Nursing and Medical Boards to weed out offenders. The addition of 40 new attorneys can only augur additional prosecutions of medical personnel and an increase in the licensing actions that inevitably follow such criminal proceedings.
Recently Adopted Rules: The Texas Board of Nursing
Effective May 2, 2007, the Texas Board of Nurse Examiners (recently renamed to the Texas Board of Nursing) adopted new language regarding rules §§ 214 and 215 governing Professional and Vocational Nursing Education. First published in the Texas Register on March 9, 2007, the rule change was designed to eliminate any misunderstanding as to the necessary student-to-faculty ratio required for an approved nursing school. The rule makes clear that by using preceptors, the maximum student-to-faculty ratio can be increased to 1:24 and for teaching assistants with a faculty member in a clinical setting, a ratio of 1:15.
More recently on June 22, 2007, the Board adopted numerous changes regarding Continuing Education requirements. Rule § 216 was modified so that a contact hour for continuing education requirements purposes was extended from 50 to 60 minutes. The Rule was also changed such that it is no longer mandatory for RNs to take a CE course on Hepatitis C.
More significantly, the Board has changed its policy on auditing and investigating nurses for compliance with CE requirements. Previously Board rules provided for a random audit of licensees for fulfillment of CE provisions. If no evidence of compliance was provided by the nurse an investigation was initiated which could lead to possible disciplinary action. Under the rule change, all licensees are required to submit evidence of CE compliance when seeking license renewal and if insufficient proof is provided the Board will simply deny their renewal application. This new rule is found at § 216.11.
In March, the Board adopted several amendments to §§ 213.28 and 213.33, two rules related to practice and procedure in disciplinary matters. Language was added to § 213.33 outlining the specific qualifications required of a Board appointed psychologist or psychiatrist who is charged with evaluating a licensee’s present fitness to practice nursing (§ 213.33(e)). The new provisions also permit the Board to request that the licensee be examined by a forensic psychologist or psychiatrist to determine the likelihood of future violations by the nurse and the level of danger they pose to the public (§ 213.33(f)).
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