Dentist’s Nightmare Over – Settles for $120,000 Withheld Medicaid Funds

Dr. Paul Dunn testifying before a legislative committee

The vicissitudes of Dr. Paul Dunn have been chronicled by TDMR over the last several years. Dunn first appeared on the scene when he came to Austin during the 2013 legislative session. "Credible allegation of fraud" payment hold, but told he hadn't committed fraud He had been placed earlier under a 100% “credible allegation of fraud” payment hold for his Medicaid orthodontic billings by then deputy inspector general for enforcement Jack Stick. He had an informal resolution meeting with Stick who told him that Dunn apparently hadn’t committed any fraud but the agency still wanted its money back. As a result of the meeting, Stick eventually reduced Dunn’s payment hold to 51% which barely kept his doors open. Courageous in testifying before legislative committees In Austin, Dunn … Read More...

Janek’s “Capricious” Decision in Antoine Dental Case Challenged in District Court

Kyle Janek

Last Wednesday, July 16, lawyers for Antoine Dental Centers of Houston again went to court. Going Travis County District Court This time they appeared before Travis County District Court to appeal the Medicaid payment hold final decision by former Health and Human Services Commission Executive Commissioner Kyle Janek that was issued back on May 7, 2014. Janek decision "capricious," "arbitrary," "abuse of discretion" The lawyers, in the pleadings, deemed that Janek’s decision amounted … [Read More...]

8 Components of an Effective Compliance Program

compliance program

The eight steps you need to take to put together a program for yourself! Many people have asked what the process for establishing an effective compliance program is.  At one point, having a compliance program was optional.  As a result of the Patient Protection and Affordable Care Act, health care providers who participate in federal health programs must have an effective compliance program as a condition of participation. Even HMOs are beginning to require compliance programs for plan … [Read More...]

Texas Medicaid News Video – June/July 2015

texas medicaid news

Here is the June/July edition of the Texas Medicaid News! Hello and welcome to the Texas Medicaid news update, I'm Andy Zajac. Things have been hot and heavy over the last few weeks in Austin. 1) Our top story is that Texas Health and Human Services Executive Commissioner Kyle Janek finally resigned. Things couldn’t have been worse for Janek over the last seven months as scandal piled on top of scandal at HHSC. From Jack Stick and 21CT to Terrell State Hospital, to violating state … [Read More...]

HHSC Allegedly Paid Out $104 Million to 8,000 Medicaid Providers the Agency Suspected Of Fraud

Former HHSC Chief Counsel Jack Stick's $87 OIG Badges

Four firms provided “proof of concept” demonstrations of their Medicaid fraud detection software to the Texas Health and Human Services Commission and its Office of Inspector General back in 2011. These proof of concept projects allowed the firms to access Medicaid claims data to evaluate it for fund diversion to fraud. In the case of Reflective Medical (RMIS), as already reported in the press and by TDMR, they were able to look at three years of Texas Medicaid data and found inexplicable … [Read More...]

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San Antonio Seminar Helping Providers Understand Compliance and Enforcement Issues

This past Friday at the Leon Valley Conference Center in San … Read More...

THHSC building

Offer of Free Fraud Detection Software and Other Skeletons Still in the HHSC Medicaid Closet

The press has uncovered a lot of conduct unbecoming at the … Read More...

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SB 207 Signed by Governor Abbott on Heels of FBI Medicaid Fraud Arrests in RGV

This morning, TDMR was notified that Governor Greg Abbott … Read More...

Houston Seminar June 12

Houston Compliance Seminar Successful in Communicating Vast Amount of Information on Compliance Issues and Providing Tools for Application

Texas Dentists for Medicaid Reform assisted Star Compliance … Read More...

health care providers

HIPAA, Meaningful Use And The False Claims Act

The term “Meaningful Use” is the federal government’s way of … Read More...

Kyle Janek

HHSC Commissioner Kyle Janek to Resign

The Texas Tribune just reported the following this … Read More...


Breaking News: Texas Owes Feds $133 Million for Medicaid Ortho Debacle

Back last August, the Department of Health and Human … Read More...

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Want to Take Over Texas Medicaid Like Xerox? Here is Your Chance

On May 29th, the Texas Health and Human Services Commission … Read More...