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McAllen Problem Persists?

The reason for the so called “McAllen Problem” is that McAllen, on average, spends about $15,000 on healthcare for every patient enrolled in Medicare, which is almost double the national average of $8,300. This was researched by Harvard doctor Atul Gawande for a 2009 New Yorker article. His research found that critically-ill elderly patients in McAllen received 50% more specialist visits than in El Paso, a town with similar demographics, but 800 miles away. It was also found that doctors in McAllen ordered 20% more abdominal ultrasounds, 30% more bone density studies and 550% more urine-flow studies to look for prostate problems. The primary cause of McAllen’s extreme costs were the alleged across-the-board overuse of medicine.

Due to these perceived overuses and abuses, the U.S. Dept. of Health and Human Services Office of Inspector General opened an office in McAllen in 2010, because the area was No. 2 in the nation for healthcare fraud; and they enlisted Special Agent Michael Garcia to investigate. Agent Garcia recently stated that fraud happens in various ways. This includes: billing for medically unnecessary services; billing for services not rendered; forging doctor’s signatures on 485s; paying kickbacks to doctors for referrals; paying kickbacks to beneficiaries; billing for a higher level of ambulance transport than was actually provided; by ghost transports; by medically unnecessary transports; and by double loading. He also listed some of the OIG’s accomplishments in fiscal year 2012. OIG investigations resulted in approximately 723 criminal convictions; resulted in over 382 civil actions; resulted in the banning of 2,662 individuals and entities from Medicare, Medicaid, and other federal health care programs; and returned $4.6 billion back to health care programs.