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DALLAS (AP) — Access to medical care has long been a dilemma for rural Americans. In some pockets of Texas, the problem has grown even worse after a doctor's Medicaid and Medicare fraud scheme decimated a chain of rural medical centers that provided health care not easily found for hundreds of miles.
The sentencing this week of Dr. Tariq Mahmood concludes a legal saga that included the closure of four rural hospitals he operated. But for the communities now facing a gaping void in medical care, the problems are far from over.
"These are small community hospitals in rural areas, which was why the impact of their closure was so large," said David Wright, deputy regional administrator for the Centers for Medicare and Medicaid Services.
He said occasionally other care facilities such as nursing homes will close because of mismanagement or fraud, but it's unusual to find a hospital system so broadly effected.
"It really was something we weren't expecting to see in this kind of arena," Wright said.
Mahmood, 63, was sentenced Tuesday to 11 years in federal prison after earlier being convicted of submitting more than $1 million in false reimbursement claims. The hospitals at the center of the case took a major financial hit when federal funding was withdrawn after inspectors found substandard patient care and deteriorating conditions at the facilities.
Hospitals in the North Texas communities of Terrell and Grand Saline have closed. In East Texas, the town of Center lost its hospital, as did Whitney, northwest of Waco. Two others were taken over by new owners.
The closures exacerbate the shortage of medical care in some areas of Texas, where 10 rural medical centers have ceased operations in the last two years alone, according to the Texas Organization of Rural and Community Hospitals. Many of these facilities were losing millions of dollars amid a decline in patients and lower federal and state reimbursement rates.
"Whenever something like that happens, and these hospitals close, you just don't have the access to care," said Dr. Doug Curran, a family physician in the East Texas town of Athens and board member of the Texas Medical Association. "Especially for people who are poor."
Some people must travel hundreds of miles to receive care, particularly if it's for specialized treatment, he said. People in East Texas seeking specialized pediatric care usually have to travel to Dallas or Houston, Curran said.
"Health care ought to be about how we take good care of our patients and when hospitals like these close down you see people who get hurt," he said.
David Pearson, president and CEO of the Texas Organization of Rural and Community Hospitals, said rural hospitals are "suffocating and there's no long-term remedy."
Numerous regulations combined with new technology to provide electronic medical records and other requirements place heavy costs on hospitals, Pearson said, but at the same time reimbursement rates keep getting slashed. Reimbursements from Medicare and Medicaid cover about 60 to 70 of the cost for treatment provided by rural hospitals, he said.
"When you add the Medicaid shortfall to the amount of self-pay and self-debt that each hospital has, there's a lot of uncompensated care at those hospitals and it's worse in rural areas," he said.
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