Texas recently announced that they reached a $236 million health care fraud settlement to resolve Medicaid fraud claims.

According to Texas Attorney General Ken Paxton, a recent settlement between the State of Texas and Xerox Corporation will be a “the largest single resolution in a case filed by the attorney general’s office for Medicaid-related claims.”

The $236 million settlement is not a complete win for the Lone Star state, as the Office of the Attorney General originally sought $2 billion to compensate health care fraud damages. However, Paxton said in a written statement that his office is “proud of this recovery of taxpayer money”.

A 2015 audit of 2008 to 2011 conducted by the federal government reportedly revealed that Texas had paid out $191 million for unnecessary orthodontic work during a 2.5 year period. Considering that the state’s contract was longer than that, it is estimated that total losses due to Medicaid fraud may exceed the audit’s calculations.

Xerox managed the state’s dental preauthorization program until 2012 when it was replaced by Texas officials. The lawsuit against the company followed shortly afterwards.

Although the state has recovered over $200 million from their settlement with Xerox, it is still seeking money from dentists and orthodontists in connection with the Medicaid fraud claims. Texas officials argue that practitioners wrongfully billed procedures as medically necessary in order to allow Medicaid coverage when they were only cosmetic.

When fighting the state’s suit, Xerox attempted to lay the blame on dental providers who allegedly billed for their services incorrectly. However, the providers argue the opposite in their dealings with the state – claiming that Xerox was responsible. The providers have even filed a lawsuit against Xerox for negligently exposing them to regulatory action they say they do not deserve.

“Five years of expensive and time consuming litigation has proven that the blame should have always been on Xerox, not the providers,” said an attorney for many providers, according to the Houston Chronicle. “Continuing to blame the dental providers—who only did what Xerox told them to do under penalty of law—makes no sense.”

According to the National Anti-Healthcare Fraud Association, healthcare fraud occurs when  corporations or caregivers commit a variety of actions to maximize their profits while taking advantage of government programs. Actions that fall under the umbrella of healthcare fraud include:

• billing for services not performed;
• overbilling for performed services;
• performing medically unnecessary services;
• misrepresenting treatments as medically necessary;
• falsifying a diagnosis to justify tests;
• billing services as separate procedures despite only being one;
• accepting kickbacks;
• and more.

In cases of Medicaid fraud, the government is the victim of fraud and may be tricked into wrongfully paying fraudulent claims made by healthcare providers. According to the Federal Bureau of Investigation, a variety of state and federal agencies may involved in persecuting health care fraud including Health and Human Services-Office of Inspector General (HHS-OIG), Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), Defense Criminal Investigative Service (DCIS), Office of Personnel Management-Office of Inspector General (OPM-OIG), and Internal Revenue Service-Criminal Investigation (IRS-CI) and more.