This past Friday, the Texas Supreme Court dismissed a petition from the Texas Office of Attorney General to review a 3rd Court of Appeal decision preventing the Health and Human Services Commission Office of Inspector General from placing payment holds on Medicaid providers for only allegations of program violations. State and federal law only provide for payment holds on Medicaid providers when there are "credible allegations" of fraud. Another legal victory for dentists The decision to dismiss the petition by the Supreme Court marks another victory for Medicaid dentists over the state in the now four-year running dispute over payments for Medicaid orthodontic services between 2007 and 2011. The Harlingen Family Dentistry dental practice initially brought the action against the … Read More...
As TDMR reported back at the end of September, the new Health and Human Services Commission Inspector General Stuart Bowen had started settling outstanding investigations and cases against Medicaid dentists and providers. Senator Charles Perry was quoted in the media as saying "“There were so many problems that there comes a point where you just have to clear the deck and start over. There comes a point where you have to draw a line in the sand and say that going forward, we are going to do … [Read More...]
Earlier this month, the Attorney Generals of Illinois and Arkansas announced the arrest and/or conviction of three individuals in different cases for Medicaid fraud. Going to jail for $1,000 The amounts of the fraud involved were around $1,000 per party (Illinois woman faces up to 10-year sentence, Texas man arrested in Arkansas, Arkansas Attorney General Announces Arrest). The fraudsters, generally low-paid home care workers who padded their hours on the job, (looks like they made … [Read More...]
Last Friday, the Health and Human Services Commission sent out a notice that it had "updated its Medicaid Medical and Dental Policy web page by posting stakeholder comments and HHSC responses for the THSteps Diagnostic Dental Services policy in development." TDMR had earlier promoted that providers should respond to the invitation to comment. The agency wrote it had received comments from MCNA Insurance Company, DentaQuest, and the Texas Dental Association The odd thing about the update … [Read More...]
Texas Attorney General Civil Medicaid Fraud Unit Spent Over $6 Million And Used Up To 21 Lawyers Per Case On Questionable Medicaid Dental Cases
A document received from an open records request filed in early September shows that the Civil Medicaid Fraud division of the Office of Attorney General (OAG) has expended some 20,953 staff legal hours against 16 dentists and dental practices accused of Medicaid fraud from as far back as early 2012. TDMR filed the request because the Civil Medicaid Fraud unit is at odds with the current initiative of the new Inspector General of the Health and Human Services Commission (HHSC) Stuart Bowen to … [Read More...]