LATEST NEWS!

HHSC “Judge” Denies Disqualification of HHSC “Judge”…

justice for texas medicaid providers

HHSC appeals "judge" Keith Grantham has denied a motion to disqualify HHSC appeals "judge" Rick Gilpin from presiding over the overpayment "hearing" of M&M Orthodontics of San Antonio.  The ruling came out April 4th. "Court," not court TDMR is now placing quotes around judicial terms relating to the HHSC appeals process because the Attorney General of Texas has given the opinion that these courts are not judicial in nature and do not carry the protection of the Texas Constitution nor are subject to the Texas Rules of Civil Procedure. In fact, OAG, in their odd defense of Gilpin against disqualification, stated HHSC courts are not real courts and Gilpin and the rest of HHSC judges are not real judges. Gilpin had a 38-year history with the OAG before retiring and moving on to be … Read More...

THHSC building

Texas Did Not Report Excess Contractor Profits In Accordance With…

In an unheralded August 2012 audit report that is available online, the federal Health and Human Services Office of Inspector General found that the Texas Health and Human Services Commission had not returned  $2.6 million in Medicaid funding back to the federal government. Made a calculation mistake The money was owed because the state's private Medicaid contractor, TMHP/ACS, had returned … [Read More...]

Court of Law

The Other Side of the Texas Medicaid Orthodontic Fraud Debate…

The following is an opinion piece written by Jason Ray, attorney for a number dentists who are being prosecuted by HHSC-OIG for their Medicaid orthodontic billings.  Mr. Ray is with the firm of Riggs Aleshire & Ray, P.C.   I am familiar with the salacious allegations that many Texas dentists got rich on the back of Medicaid by committing fraud. I represent several dentists who have … [Read More...]

ortho

American Association of Orthodontists Updates Definition of…

The American Association of Orthodontists have updated their definition of "medically necessary" care to include "emotional well-being." They have done so because they state that recent studies have linked a "patient’s dental appearance and the incidence of bullying." Will such a change in definition by the AAO  have any effect on Texas Medicaid or cause HHSC or its OIG to reconsider  what is … [Read More...]

ortho case

Medicaid Ortho Case Photos with HLD Scores by…

A recent review of our website content revealed to us that … Read More...

Dental care for kids who need it

HHS releases security risk assessment tool to help…

A new security risk assessment (SRA) tool to help guide … Read More...

NY Times

Settlement in Medicaid Fraud Case Worries Health…

The NY Times, in conjunction with the Texas Tribune, has … Read More...

court of law

Attorney General: HHSC courts are not “trial…

This week the Texas Attorney General filed a remarkable … Read More...

texas constitution

Attorney for Dentists Moves to Disqualify HHSC…

A motion has been filed with the Texas Health and Human … Read More...

justice for texas medicaid providers

HHSC Judge Denies SOAH Hearing for Medicaid…

The same HHSC judge that overturned a favorable SOAH (State … Read More...

Justice for Medicaid providers

OIG Reaches $3.75 Million Settlement with Carousel…

The Health and Human Services Commission issued a press … Read More...

Kyle Janek

Powers OK With Janek as Chancellor | The Texas…

The Big Conversation If the University of Texas System … Read More...

Medicaid providers

HHSC-OIG Starts Provider Education!…

TDMR has received notification that HHSC-OIG has begun a … Read More...

HIPAA compliance

Recent HIPAA Enforcement Activities Hit Small…

TDMR presents the second in a series of articles on health … Read More...