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 … [Read more...]

Texas Did Not Report Excess Contractor Profits In Accordance With Federal Regulations

THHSC building

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...]

The Other Side of the Texas Medicaid Orthodontic Fraud Debate

Court of Law

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...]

American Association of Orthodontists Updates Definition of “Medically Necessary” Care to Include “Emotional Well-being”


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...]

Medicaid Ortho Case Photos with HLD Scores by Provider and Experts

ortho case

A recent review of our website content revealed to us that while PDF files containing these photos have always been on the site, perhaps they have not been as prominently displayed as they should be. Medicaid after all is about benefiting indigent children and the controversy is whether or not children such as these should have been treated under Texas Medicaid as the regulations were prior to … [Read more...]

HHS releases security risk assessment tool to help providers with HIPAA compliance

Dental care for kids who need it

A new security risk assessment (SRA) tool to help guide health care providers in small to medium sized offices conduct risk assessments of their organizations is now available from HHS. The SRA tool is the result of a collaborative effort by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR). The tool is designed to help … [Read more...]

Settlement in Medicaid Fraud Case Worries Health Providers – NYTimes.com

NY Times

The NY Times, in conjunction with the Texas Tribune, has published an article on the recent $3.75 million settlement between Carousel Pediatrics and the Texas Health and Human Services Commission Office of the Inspector General and its affect on the health care community in Texas. A major legal settlement with a children’s health provider in hand, a Texas agency investigating health care … [Read more...]

Attorney General: HHSC courts are not “trial courts” and HHSC judges are not “judges”

court of law

This week the Texas Attorney General filed a remarkable brief to oppose the motion to disqualify HHSC judge Rick Gilpin from a Medicaid payment hold case because he was a senior lawyer in the Attorney General’s office for some 38 years before becoming an administrative law judge with HHSC.  The motion to disqualify was brought by lawyers for M&M Ortho of San Antonio.  It relied on the Texas … [Read more...]