Friday, September 9, 2011


MEDICAID FRAUD, A VALLEY TRADITION

A family has asked that I file a medicaid fraud claim against the South Texas Behavial Health Center. Some 20 years ago I testified at Texas Senate Hearings regarding the illegal harvesting of children from schools and doctors for commitment in mental health facilities. As a result of both federal and state investigations hospitals were shut down and doctors and administrators went to prison.

I believe the entire thing started after the son of a State Senator was picked up and committed without the knowledge or consent of the parents.

I am certain this facility has helped people. But, I have worked with families at facilities all over Texas. With the exception of the state hospital in Witchita Falls it is the single worst facility I have ever seen.

They have opened a facility in Brownsville for harvesting patients. The child who they tried to force into the facility has been seen by a Board Certified Pediatric Psychiatrist and he saw no basis for their actions.  The child's therapist was taken aback to learn they were trying to force her client into the facility.

This is how it works - for months the family doctor failed to prescribe the medicine the child needed for ADHA. The child's therapist was concerned the child simply could not focus and it was impacting her behavior. The mother took the child back to the PCP and he sent her next door to see Hector Leal, an employee of the South Texas Behavioral Health Center.  According to the mother he interviewed the child in her presence while taking handwritten notes.  According to the mother at no time did he call anyone.  When the interview was done he gave the mother the number for medicaid and told her to call so they would give her $200.00 to get to the facility in Edinburg.

The mother called me and we discuss the situation.  The child's therapist was taken aback by the claim the child needed to be committed.  Hector Leal repeatedly called the mother to demand she call medicaid to get the money and then take her daughter to the facility.  In  fact he threatened to report her to Child Protective Services if she refused to call medicaid.  The child was already under the care of a therapist, but not one who works for South Texas Behavioral Health Center.

I called Hector Leal after learning I could find no evidence he is a licensed therapist in Texas.  He told me he works for South Texas Behavioral Health Center.  In fact his boss immediately called me based on caller ID after I hung up with Hector Leal.  Hector Leal told me he has no training in mental health.  He told me that after he interviews the children he calls Dr. Mosqueda and he is the one who orders the child admitted to the hospital.  The mother swears up and down that at no time Hector Leal called anyone before he told her her daughter had to be admitted to South Texas Behaviorial Health Center.

It will be for the investigators to decide who is lying.  But if Dr. Mosqueda did in  fact order the child admitted to the hospital based on never having  spoken with the child and on the opinion of a non-qualified 3rd party he is in  for a long ride over his medical license.

You should know this family has a history with Dr. Mosqueda.  They would seek a restraining order against Dr. Mosqueda before they ever allowed him near one of their children.  The son was seen by Dr. Mosqueda at this facility.  He released the child while the child was still suicidal and violent.  When the parents complained ot Dr. Mosqueda he blew them off.  It was the Board Certified Pediatric Psychiatrist in San Antonio who saved this child.  Dr. Mosqueda was not even close as to the proper dosage of medicine needed by this child.  When the family refused to continue to work with South Texas Behavioral Health Center by having their son see a therapist of their choosing they threatened to report the parents to child protective services. 

Fast forward in the case of their daughter with full knowledge that the child had a licensed therapist seeing her and that the child was going to be seen  by a Board Certified Pediatric Psychiatrist in San Antonio they called in Child Protective Services on the claim of neglect.  They had no interest in checking to verify the child was under the care of real experts.  Dr. Mosqueda is not a pediatric psychiatrist - he is a family pactice psychiastrist.   There is a big difference.

The mother called when CPS showed up at her home.  I ran over there right away.  I ordered the interviewed of the child stopped.  We provided the CPS worker the name of the child's therapist and psychiatrist.  We made it clear we wanted CPS to open a criminal investigation against whomever made the complaint.  It was a black and white case of fraud for the purpose of intimidating parents into putting their children into South Texas Behavioral Health Center.  The CPS worker made clear CPS does not enforce the law concerning false claims even when it is done to commit medicaid fraud.  I will be handling this  case worker and CPS in Austin.

The family is pursuing a medicaid fraud claim against the family doctor, Dr. Mosqueda and South Texas Behavioral Health Center.  If Hector Leal is lying a bout Dr. Mosqueda ordering the child put in the hospital that will be for Dr. Mosqueda to prove to the authorities.

It will be for federal investigators to decide if their was medicaid fraud.  When a hospital uses someone with no training in mental health to interview children, and tell the parents to call medicaid for money it is fair to say it appears they are harvesting children to fill their beds.  This is the same pattern of abuse we saw 20 years ago.  Federal investigators will decide if this is medicaid fraud.  It is not for me to make the  decision.

13 comments:

Anonymous said...

I'm curious as to how many families, who did not have the resources available to defend themselves against this injustice, have fallen victim to this type of medicaid scam? What a travesty! You don't see these type of reports printed on the local newspapers. Thanks for being there and serving as an advocate for this child.

Anonymous said...

Thanks for the story and for helping this family! Just another case of people in healthcare exploiting the medicaid programs and the Child Protective Services. Hopefully once this case is resolved it will also help other victims that do not have the resources to defend themselves.

Anonymous said...

Well done, Mr.

Anonymous said...

My friend takes her son to Mosqueda. She says the doctor doesn't even talk to her son. Mosqueda just asks her questions about her son's behavior and then gives her a prescription. That's it. The valley needs other options for special needs children.

BobbyWC said...

Brownsville does not have a pediatrict psychiatrist - they are a dime a dozen in San Antonio.

the psychaitrict hospital is amazing - for children only - siblings may visit their sibling who is at the hospital.

It is an open campus with a lot of security. parents can just walk around outside with their child or play football or basketball with them during their free time.

All visitors can but a meal pass and eat with the children. The school district provides their education. many of the children are transitioned to the school next door

It is a remarkable place. The chief psychiatrist trains the future pediatric psychiatists at the medical school. He has students who would come to Brownsville if recruited

Other than a desire to do nothing - UTB, BISD and valley Baptist take no action to work together to make this happen. A board certified pediatrict psychiastrist is needed in Brownsville - they would be very busy teaching at UTB, helping at BISD, and treating patients.

About two years ago valley Baptist looked into a pediatrict facility - I have no idea what happened.

Bobby WC

Anonymous said...

Bobby, it is a pleasure to read BV. This site does a lot of good for Brownsville and shows genuine concern for this community.

Anonymous said...

Mr Bobby,

I too know someone who's child is sick and mentioned to me once that the Dr. she saw practically gave her the diagnosis as soon as she was seen inside his office. The Dr told her "Your child has ADHD" because of the observation of the child's behaviour IN THE LOBBY!! Why? Because the child wouldn't sit still.

I wonder if that is because many people apply for benefits such as Supplemental Security Income (SSI) from Social Security & if the Dr states that the child does have that disability (and the application is approved), the child will be entitled to monetary benefits and Medicaid. Therefore, the patient will continue to go to see the Dr at Medicaid's (or rather the taxpayer's) expense.

Granted I know there are many children who are sick, but what I found appalling is we've gotten into this "Lucy & Ethel at the chocolate factory" type of examinations that the true diagnosis is not being formed correctly. That is a huge disadvantage to all patients involved as well as the parents who go see a Dr because of their so called "expertise".

I really hope someone does look into this type of fraud because unfortunately with this type of fraud or any other type (Food Stamp & Medicare Fraud) the monster is so big there is no manpower to investigate.

Hopefully because of your "voice" someone will listen, do something & try to catch this monster we call fraud.

Til next time..

Anonymous said...

Bobby,
Thank you for sharing this.
Now I would like to share what happened to my sister who has cancer and is a senior citizen.
The home visitor was not even showing up when she was supposed to but still charging medicaid and or medicare. My sister was too ill to keep track of this but we reported this and many heads have rolled because of this
we did what she could not do for herself and proud of it.
RELATIVES----PLEASE-PLEASE REPORT THIS MISERABLE PEOPLE WHO HOLD OUR LOVED ONES HOSTAGE WHEN THEY ARE TOO SICK TO FIEND FOR THEMSELVES!!!!
This makes me so upset that there are people preying on our loved ones.


Thank you and GOD bless you all.

BobbyWC said...

Most children in the valley are on medicaid regardless of any mental health diagnosis - I do not know if you can get SSI for ADHD - if you can then I begin to understand why we are broke

Bobby WC

Anonymous said...

Abuses galore....One that I see all the time (besides Lonestar Card which irks me) is the use/sale of adult pampers. These are home delivered by the dozens. Then the so called clients turn right around and sell them for a profit at the flea market....dont believe me; check for yourself....They sell them for a buck or two....which multiplied is cash for them to keep......but the government/or us taxpayers are getting screwed buying those adult pamers for them at eight to ten bucks a pack....

BobbyWC said...

Oh, I believe you - what really angers me is the people who are honest who go without - I have a friend who sold his truck and now rides a bike to work - he decided he could not feed his kids and afford the repairs, insurance and gas. He feeds his kids and they have what they need for school. He now rides a bike to work every day and once a week borrows a car to do the groceries.

I think he did the right thing - apparently at $10.00 an hour that was too much income to qualify for assistance. While he does not have to through his work he has bought good health insurance and disability insurance so that his family is protected if he get sick. A lot of men would just take the money for beer

The honest and responsible always end up at the bottom. Oh, what he buys for his kids is above the child support he pays every month - he buys all of their clothes and school supplies. I know for a fact most parents would not spend an extra penny beyond the child support

Bobby WC

Anonymous said...

.....now Lone Star....that should be to feed the needy...the ones who have nothing.....yet we go to the gas station and see people using them to buy candy, sodas, chips....what the heck???? My children and I have to do without some of those things many a times....we are on a budget and dont get government help/////same applies at the grocery store....I have to budget, buy the generic stuff and make it last.....but the person infront of me is having a blast in their basket at my expense...fajitas, chicken, brand name groceries...blah blah blah ..Ugh!!!

BobbyWC said...

I appreciate your comment but I do not publish specific comments about doctors unless I have first knowledge of the event or personally know the source

Your friend needs to look for another doctor - also I find something suspect in the story - doctors do not prescribe ADHD medicines for 6 months without checking on the child - many of these medications have side effects on the liver which you cannot see.

There are other doctors - further she can go to SA where there are Pedaitrict Psychiatrists - if it were my child I would spare no expense

Bobby WC