Medicaid fraud comes in many forms, from financial exploitation to fraudulent reimbursement claims for services or products not provided to physical abuse and neglect. The Medicaid Fraud Control Unit (MFCU) within my office has jurisdiction to investigate when these crimes occur in Medicaid-funded nursing homes and facilities and works together with local law enforcement to protect senior Texans. In this case, our MFCU investigators subpoenaed billing records and a voice recording that implicated the former activity director, and the case was successfully prosecuted by the Hill County District Attorney's Office.
Identity theft like this is a very common type of financial fraud in nursing homes. Seniors typically have clean credit histories, making it easy for a thief to open fraudulent accounts in the name of a resident. But falsifying identities and documents can be dangerous to the health and safety of residents and patients as well. Last month, the Williamson County Sheriff's Office arrested a woman who was posing as a registered nurse at an Obstetrical and Gynecological physicians' office in Round Rock. The woman gained employment using a fraudulent license and worked nearly a year as a registered nurse though she was not educated, trained, licensed or qualified. The criminal investigation by MFCU and the sheriff's office found that this was not the first occurrence of this woman fraudulently posing as a registered nurse, but it will be her last as the Williamson County District Attorney's Office prepares to prosecute the case with the ongoing help of our MFCU staff.
Many drug diversion scams also occur within nursing homes and healthcare facilities. Last year, a licensed vocational nurse (LVN) at a healthcare center in Brownwood appeared to be "under the influence" while she was working, raising the suspicions of another nurse on duty. A drug count revealed that 90 doses of the painkiller Oxycodone were missing. The joint criminal investigation conducted by the Brownwood Police Department and our MFCU investigators found evidence that the LVN had obtained the drug by fraud, a felony in Texas. She had injected herself with it and then destroyed the resident's narcotic count sheet.
In another case, missing morphine and the subsequent death of an elderly resident led the MFCU and the White Settlement Police Department to investigate the resident's prescribed use of the pain medication. The hospice LVN charged with monitoring the patient's dosage had left the medication unsecured in the room several times and later discovered multiple doses of the medication missing. The resident's granddaughter was eventually charged and received five years deferred probation and community supervision and was ordered to a substance abuse felony punishment facility.
Drug diversion scams and financial fraud against senior Texans is despicable, but physical abuse and neglect are even more heinous crimes. Our MFCU works closely with local law enforcement and the Texas Department of Aging and Disability Services to bring to justice those whose actions have inflicted injury or death.
On January 17, 2006, an LVN in Wharton County pled guilty to charges of injury to an elderly individual by reckless omission after she disregarded multiple reports from certified nurse aides of a resident's deteriorating condition. The symptoms progressively worsened over the next few hours without proper assessment, until the resident passed away. The Wharton County Sheriff's Office requested assistance from our MFCU investigators, and subpoenaed cell phone records showed that the LVN spent a significant amount of time on her personal phone during times she was supposed to be caring for the resident.
In Bell County, an 87-year-old nursing home resident died after a healthcare worker transported the resident from her doctor's appointment, parked the vehicle and then left the parking lot, leaving the resident in an unventilated and non air-conditioned van for over four hours. The case was investigated by the Temple Police Department as well as the MFCU, and the healthcare worker eventually pled guilty to criminally negligent homicide.
When I took office in 2002, one of my top priorities was to expand the work done by our MFCU as part of my commitment to seniors. Funding from the Texas Legislature in 2003 made that goal a reality, and today our MFCU has field offices in Corpus Christi, Dallas, El Paso, Houston, Lubbock, McAllen, San Antonio and Tyler. The staff of 196 personnel is comprised of criminal investigators, both commissioned and non-commissioned peace officers, attorneys, auditors and support staff.
Some police departments have also created specialized task forces within their department, such as the Special Victims Unit in El Paso, which conducts training in domestic violence and elderly abuse prevention issues. These types of initiatives offer valuable resources and services to victims and families.
Abuse against senior Texans will not be tolerated. While the majority of healthcare providers and caretakers are dedicated professionals, we will crack down on the few whose actions cause untold pain, damage and waste. Continued cooperation from you is an important key to the efforts of our MFCU, and I commend local law enforcement for your continued diligence in protecting and serving our senior Texans.