(Flickr image by chrisjohnbeckett)

I love reading great health investigations, so last weekend was really satisfying.

Terri Langford at the Houston Chronicle had a wonderfully detailed piece on how private ambulances in Harris County, Tex., have taken Medicare and taxpayers for a ride. Here are her findings:

The unabated growth of this enormous EMS industry - 397 companies in Harris County alone - has allowed the nation’s largest insurance provider for the elderly and disabled to morph into a virtual ATM, the Chronicle’s examination of Medicare billings shows.

By the federal government’s own rules, many of these EMS transports should not qualify for federal dollars.

The financial consequence: Nearly $500 million in Medicare dollars have flown into the hands of private EMS operators in Harris County over a six-year period - $62 million in 2009.

Not even New York City came close to matching the cost. Its Medicare bill for private transports that year: $7 million.

But this isn’t about one ambulance, one psychiatric program or one mentally fragile Texan.

It’s about churning up money in America’s fourth largest city, using tax dollars to feed a ravenous machine.

It’s also worth reading the other Chronicle stories in the series, here and here.

Kelli Kennedy at the AP also has a terrific story about how Medicare yanks the licenses of providers but then gives them right back. She writes:

Regulators fighting an estimated $60 billion to $90 billion a year in Medicare fraud frequently suspend Medicare providers, then quickly reinstate them after appeals hearings that government employees don’t even attend, according to an Associated Press review.

Federal prosecutors say the speedy reinstatements — though helpful to legitimate suppliers who get snagged on technicalities or minor violations — amount to a missed chance to cut off the flow of taxpayer dollars to bogus companies that in many cases wind up under indictment. Some store owners have collected tens of thousands of dollars even after conviction, prosecutors told the AP.

Making matters worse, Medicare officials have failed to collect a single cent from the security bonds that were instituted two years ago specifically to discourage crooked providers from vanishing at the first sign of trouble from regulators. Millions of dollars sit unrecovered; officials blame the delay on personnel changes.

The gaps in the system grow out of poor communication between one set of contractors paid to inspect Medicare providers and alert officials to suspicious activity; a separate set of contractors that handles payments; and the agency that runs Medicare.

Finally, I wish you could read the Dallas Morning News’ look at quality-of-care problems at Parkland Hospital, the latest stories in a series about the troubled public hospital. But I regret to tell you that you can’t read them unless you subscribe to the paper, a real bummer. Here’s a snapshot of the findings, as written by Ryan McNeill and Daniel Lathrop:

Parkland Memorial Hospital , now under U.S. government monitoring because of systemic failures in patient care, has for years been one of the state’s worst-performing hospitals on a broad federal measure of patient safety, a Dallas Morning News analysis shows.

Several other Dallas-area hospitals also ranked among the 10 worst large hospitals in Texas, including UT Southwestern University Hospital-St. Paul, which shares physicians with Parkland. Others were John Peter Smith Hospital in Fort Worth , Methodist Charlton Medical Center in southwest Dallas and Baylor Medical Center-Garland.

Only 10 of the 27 large hospitals in Dallas, Collin, Denton and Tarrant counties ranked above average on the patient safety measure, which was designed to track problems such as surgical accidents and hospital-acquired infections. And only one — Texas Health Harris Methodist Southwest Fort Worth — scored among the state’s 10 best large general hospitals, those with 200 beds or more. Dallas County’s top performer was Texas Health Presbyterian Hospital Dallas.