HHSC Dismisses Suggestions from Stakeholders on Changes to THSteps Caries Risk Assessment

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 … [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 … [Read more...]

State Board of Dental Examiners Under Sunset Review

The Texas State Board of Dental Examiners is under review by the Sunset Advisory Commission this year. The Board has published a 154-page self-evaluation report that can be downloaded from the Commission website. TDMR has not yet reviewed it.  The Sunset Commission is compiling a staff report on the Board and it is anticipated that it will have public hearings in the near future. Looking for … [Read more...]

OIG Settling Old Dental Medicaid Cases, But the OAG Retooling Some of Them

As reported in the press this week, there has been a tremendous effort on the part of the new Health and Human Services Commission Inspector General Stuart Bowen to settle old, outstanding investigations against Medicaid providers—including dentists.  Per the Chronicle, Bowen has offered settlements to nearly 100 Medicaid dental providers “to clear the decks” as previous methods used by OIG were … [Read more...]

UPDATED: Former HHSC Chief Counsel Jack Stick Hits Bottom with Long Avoided DWI Conviction

UPDATE:  Stick has been sentenced to six days in jail. The man who famously carried a toy stuffed wolf into informal resolution meetings with Medicaid providers and quipped that he could "find a program violation on Jesus Christ" if Jesus were a Medicaid provider met a further comeuppance Monday. A Travis County jury found he was guilty of driving while impaired back in September 2012 when an … [Read more...]

First Inspector General Report to Governor Available

As reported last week by the Austin American Statesman, Stuart Bowen, the new Inspector General for the Texas Health and Human Services Commission, is sending his first report to the Governor today. TDMR has obtained a copy of the full report which is available for download - OIG Quarterly Report Final. Report very comprehensive The report has not been examined in full but contains … [Read more...]

Antoine Dental Center District Court Victory Appealed – Are Taxpayers Being Served?

The recent decision by a Travis County District Court judge that again vindicated Antoine Dental Center of Houston on allegations of Medicaid fraud and vacated a three-year "credible allegation of fraud" payment hold has been appealed by the Civil Medicaid Fraud division of the Office of Attorney General. A copy can be downloaded here - Notice of Appeal. The Civil Medicaid Fraud division … [Read more...]

State Lawsuit Against Xerox for Medicaid Ortho Billings Moving Forward

Back in May of 2014, the State of Texas terminated Xerox as the state's Medicaid claims administrator and filed suit against the company.  The state is seeking recompense for hundreds of millions of taxpayer dollars paid out by the company for Medicaid orthodontic treatment for which it gave prior authorization. To recap, the lawsuit alleges that the company simply "rubber stamped" almost all … [Read more...]

WFAA’s Byron Harris is Leaving the Building

Dallas TV station WFAA is losing its long-time, award-winning investigative reporter Byron Harris to retirement.  Harris announced a few weeks ago that he would be leaving the station in October, after spending 40 years with WFAA.  It goes without saying he made some enemies during that time. Broke the Medicaid ortho story It was WFAA and Harris that broke, in May of 2011, the original story … [Read more...]

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

  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 … [Read more...]

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

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 … [Read more...]

UPDATE: Substitute Dentist Billing for Medicaid Providers To Take Longer

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. … [Read more...]


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