Dr. Anthony Valdez, a physician who rain pain management clinics in San Antonio and El Paso, Texas was sentenced January 6, 2012, to twenty-five years in prison for a 42 million dollar health care fraud scheme, as reported in the San Antonio Express News on January 7, 2012.

Dr. Valdez was found guilty of submitting false claims to Medicare, Medicaid, TRICARE and the Texas Worker’s Compensation Commission between January 2001 and December 2009 for work that was never done or not reimbursable.

The conviction stems from a whistleblower lawsuit filed in 2002 that claimed Valdez’s Institute of Pain Management clinics located in the two Texas cities fraudulently performed injection procedures that were not covered by the government health care programs, but were billing them as procedures that were reimbursable.

Valdez has lost his license to practice medicine, the government has seized most of his property and the court handed down a monetary judgement against Valdez for 9.7 million dollars.

Vermont, the second smallest state by population in the Union, signed into law one of the largest health care reform bills in the fifty states. On May 26, 2011, Democratic Governor Peter Shumlin signed House Bill 202 creating Vermont’s Green Mountain Care System, the first single payer health care plan for a state.  As section 1(a) of the bill sets out, Green Mountain Care will provide “….. comprehensive, affordable, high-quality, publicly financed health care coverage for all Vermont residents in a seamless manner regardless of income, assets, health status, or availability of health coverage.”

Although the legislative intent is for seamless coverage, creating the Green Mountain Care System and the financing thereof may be anything but seamless.  The enactment of this bill is a big step, the next steps before the legislature will be hurdles by comparison. The Vermont legislature wants the law to be operational by 2014.  The first hurdle Vermont faces in meeting that goal is receiving a waiver from the U.S. Department of  Health and Human Services under the recently passed Affordable Care Act.  The Affordable Care Act currently only allows states to implement their own alternative plans to the federal law in 2017.  Two pending bills before the 112th Congress, H.R. 844 and S. 248 will allow states to implement alternative plans in 2014.  So Vermont waits on Congress.

In the meantime, the legisltature has to establish the necessary financing for the Green Mountain Care System, recruit the necessary health care professionals to implement the system and create the actual health care coverage that will be available to all Vermont residents. In order to accomplish these objectives, the legislature will start by appointing the five members of the Green Mountain Care Board.  The Board members are responsible for the development and implementation of Green Mountain Care.  The Board will be creating the system with the input from all Vermonters — health care providers, small business owners, insurance companies and the general public.  The Board must also accomplish these monumental tasks with the rest of the nation looking on.