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OIG Originally Demanded $3.2 Million, Now Owes Medicaid Dentist $380,000.

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The front-page of the Austin American Statesman Sunday morning carried the full story of the unprecedented ruling by the State Office of Administrative Hearings (SOAH) to award a Medicaid dentist back some $380,000 in legal fees from the Health and Human Service Commission Office of Inspector General (OIG) on a Medicaid payment hold case. TDMR has obtained a copy of the SOAH proposal for decision. Facts of the case Here are the basics of the Rhoden Group case: From 2006 to 2011 (the years at issue), the Rhoden Group had three offices in Corpus Christi, but only one which was a pediatric dentistry office.  There was only one dentist there who was also a board-certified pediatric dentist.  Per the evidence, 70-75% of Medicaid patients were seen at that location and by that … Read More...

Texas Medicaid News Video Show Now Online

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TDMR has started a regular video news segment that will be carrying Texas Medicaid news plus relevant stories from around the country. Over the next few weeks, we will be starting to include interviews with key players in Texas. Our first installment: Austin: Per the Houston Chronicle, Texas legislators don’t know how to stop agency officials from violating state regulations. At the Texas Health and Human Services Commission, this led to the 21CT scandal over Medicaid fraud detection … [Read More...]

New HHSC Webpage to Comment on Medicaid Medical and Dental Policies

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Today, the Health and Human Services Commission announced that it has put up a new page on its website for Medicaid providers to comment and stay abreast of policy changes relating to Medicaid covered medical and dental treatments. The new page states: "HHSC continually reviews its policies to ensure they remain medically appropriate and responsive to the latest evidence. Through this website, medical practitioners, program clients, and the general public can give HHSC direct feedback … [Read More...]

SOAH Finds DENTIST Innocent of Medicaid Fraud, Orders OIG to Pay Back $360,000 in Legal Fees

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UPDATE: After publishing this article, TDMR was alerted that it is a DENTIST, not a medical doctor that is involved in this case. It involves the Rhoden Group from Corpus Christi with Dr. Cheryl Rhoden, DDS as the principal. This is the third SOAH decision in favor of Medicaid dentists. On Monday evening, during the House Human Services Committee hearing on Senate Bill 207, which is to reform the Health and Human Services Commission Office of Inspector General, Chair Richard Peña Raymond … [Read More...]

OIG Advises Texas Dentist to “File Bankruptcy and Save Us Time and Money”

Dr. Paul Dunn testifying before a legislative committee

Dr. Paul Dunn, a small town general dentist who practices orthodontics out of Levelland, has had a case outstanding with the Health and Human Services Commission Office of Inspector General since 2011.  He has been under severe financial strain since that time from a 51% “credible allegation of fraud” payment hold although he was told by OIG that he had not committed any fraud. Overpayment rose from $1.2 to $2.5 million including $500,000 interest despite no fraud Since that time, the … [Read More...]

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Analysis of Legislative Changes to HHSC-OIG in SB 207

Senate Bill 207 which details legislative reforms to be made … Read More...

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Medicaid Providers Must Re-Enroll by March, 2016

HHSC sent out an email notice today that all Medicaid … Read More...

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Deputy Executive Commissioner Retiring from Health and Human Services Commission

This past week, the Texas Health and Human Services … Read More...

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Time for Agency Officials to “Take Seriously” State Regulations

Two articles from the Houston Chronicle this last week … Read More...

Sen. Juan "Chuy" Hinojosa

Senate Passes Needed Reforms for HHSC Office of Inspector General

Yesterday, the Texas Senate passed and sent down to the … Read More...

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National Dental Medicaid Fraud, Waste and Abuse $12 Million out of $2.2 Billion Total in 2014

The U.S. Department of Health and Human Services Office of … Read More...

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Is That Pile of Straw on Kyle Janek’s Camel About to Break Its Back?

Yesterday both the Austin American Statesman and Texas … Read More...

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Texas Health and Human Services Commission Fact Book Available

The Texas Health and Human Services Commission has put … Read More...