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Rep. Guerra, Bobby

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Representative Guerra Files First House Bill  print page

by: Rep. Guerra, Bobby
02/20/2013

AUSTIN - State Representative R.D. "Bobby" Guerra filed his first House Bill today relating to a Medicaid provider's access to an administrative hearing on an action taken by the Office of Inspector General to recover overpayments under the Medicaid program. This legislation addresses a procedural issue that has resulted in undue hardship in the daily operation of many low-income health care providers, particularly in the South Texas area.

The Office of Inspector General of the Health and Human Services Commission has a duty to investigate suspicion of fraudulent Medicaid payments. However, recently the investigations have been targeted at clinics largely based upon a status as having the highest volume of Medicaid claims.

The current procedures have resulted in freezing payments for services provided for long periods of time without a final determination on the merit of the claims against low-income providers, many of which are forced to close their clinic doors and turn away patients that would otherwise qualify for Medicaid. This bill will provide for a final appeal on allegations of fraudulent Medicaid overpayment with an order by the State District Court so that a fair and impartial determination is rendered for both the state and low-income Medicaid providers.

"The fact is we live in an area where many indigent individuals need help, and we have providers that give back to the community and help impoverished children and families," said Representative Guerra. "We don't want to punish them for providing health care services to many by freezing their funding based on unsubstantiated allegations of fraud -- this is a due process bill that will protect the upstanding citizens wanting to do the right thing."





Contact: Bernardo Aldape

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McAllen, Texas 78504


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