HHSC Updating THSteps Diagnostic Dental Services Policy and Wants Feedback from Dentists

children health insurance program

  The Health and Human Services Commission has just put online proposed changes to the THSteps Diagnostic Dental Services Policy and is requesting stakeholder feedback on the changes. The updated policy will require the use of a professionally developed and approved caries risk assessment (CRA) tool.  Per the document, "one of the CRA codes must be appended to dental oral examination codes for the dental oral examination to be considered for reimbursement. The client’s dental condition(s) that justifies the CRA classification submitted with the claim must be clearly documented and maintained by the provider in the client’s medical record." A copy of the discussion document can be downloaded here.  Proposed changes to the existing policy ARE IN RED. If you would like to … Read More...

Antoine Dental Vindicated! Court Overturns HHSC Ruling on Alleged Fraud and Payment Hold

justice for texas medicaid providers

Yesterday, Travis County District Court Judge Amy Clark Meachum issued her decision in the case of Antoine Dental Centers of Houston, vindicating the practice in its payment hold case.  The practice had been accused of "credible allegations of fraud" in its Medicaid orthodontic billings from 2008 to 2011. Appeal of Janek's decision Antoine was appealing the final decision issued last year by former Health and Human Services Commissioner Kyle Janek that totally negated a 2013 administrative … [Read More...]

UPDATE: Substitute Dentist Billing for Medicaid Providers To Take Longer

Dental care for kids who need it

UPDATE, August 11, 2015:  We have been informed by a very keen-eyed and interested observer that the definition of "physician" under the Social Security Act includes dentists. So we are not sure why the Texas Health and Human Services Commission has to get a waiver from CMS for something that is already in federal law. Here is an excerpt from the statute along with its link: Sec. 1861. [42 U.S.C. 1395x]  (r) The term “physician”, when used in connection with the performance of any … [Read More...]

Former Jack Stick Aide Cody Cazares Resigns

THHSC building

A name familiar to many Medicaid dentists who have felt the sting of Doug Wilson and Jack Stick's Office of Inspector General in the last few years has resigned, per the Texas Tribune. Cody Cazares, an aide to former Health and Human Services Commission chief counsel Jack Stick and who assisted Stick when he was with the Office of Inspector General, has left the building.  Cazares used to attend a lot of informal meetings with providers under OIG investigation, with and without Stick.  He is … [Read More...]

Dental Practice Victimized by OIG Actuary Should Have Settled Case for $41,000 not $323,000

Former HHSC Inspector General Doug Wilson

The story about Dr. Rachel Trueblood settling in October 2014 with the Health and Human Services Commission Office of Inspector General for $39,000 after the agency was demanding $16 million in Medicaid overpayments is well-known. However, the story of another dental practice and how it got burned by OIG for several hundred thousand dollars after this settlement is not known. But today it is going to be told. OIG actuary "cooking the books" in Trueblood case After the Trueblood … [Read More...]


New Law Helps Tackle Health Agency Woes – Texas Tribune

In January, Stuart Bowen took charge of a state … Read More...

Inspector General Stuart Bowen Jr.

New Inspector General Overhauling Agency Use of Statistical Extrapolation and Settling Cases

TDMR has learned that the new Health and Human Services … Read More...

Dr. Paul Dunn testifying before a legislative committee

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

The vicissitudes of Dr. Paul Dunn have been chronicled by … Read More...

Kyle Janek

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

Last Wednesday, July 16, lawyers for Antoine Dental Centers … Read More...

compliance program

8 Components of an Effective Compliance Program

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texas medicaid news

Texas Medicaid News Video – June/July 2015

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

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

Four firms provided “proof of concept” demonstrations of … Read More...

san antonio seminar 7 feature

San Antonio Seminar Helping Providers Understand Compliance and Enforcement Issues

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


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