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Substitute Dentist Billing for Medicaid Providers To Take Longer

Dental care for kids who need it

In the past legislative session, House Bill 1661 introduced by Rep. Bobby Guerra was passed unanimously by both the House and Senate and signed into law by Gov. Abbott. The purpose of the bill is to grant dental Medicaid providers the right to bill for services provided by a substitute dentist. This is the same privilege that physicians currently have under the Social Security Act. Need waiver from CMS It appears that dental Medicaid providers will have to wait a few more months for this privilege as Texas must seek a waiver to allow the practice from the Centers for Medicaid and Medicare Services. The following is a summary of the situation TDMR received: House Bill (HB) 1661, 84th Legislature, Regular Session, 2015, directs the Health and Human Services Commission (HHSC) to … Read More...

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 … [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...]

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...

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...

greg abbott2

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...

hhs-oig

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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