Lawsuit Alleges Xerox Wrote Misleading Documents on Ortho Prior Authorizations

justice for texas medicaid providers

As part of the lawsuit against Xerox, the former lead contractor for the Texas Medicaid and Healthcare Partnership, the Texas Office of the Attorney General alleges that Xerox, from the beginning of its contract with Texas, wrote misleading documents that indicated each request for Medicaid orthodontic treatment was submitted to and reviewed by its dental director when this was not the … [Read more...]

State Alleges Xerox Instructed Dental Staff to Approve HLD Scores of 26 or More Automatically Starting in 2004

ACS Xerox

In the lawsuit against Xerox filed by the Texas Attorney General, there is one more startling revelation. The State is alleging that Xerox as early as 2004, when the company took over the contract as the state's Medicaid claims administrator, the lead contractor in the Texas Medicaid and Healthcare Partnership, immediately changed the Medicaid orthodontic prior authorization process. Xerox … [Read more...]

Dentists Told in 2009 to “Assume” Medicaid Ortho PAs Are Reviewed by Board-Certified Orthodontist

THHSC building

Back in January 2009, a Medicaid Orthodontic Stakeholder meeting was held in Austin at the offices of the Texas Dental Association. Dr. Linda Altenhoff presided at the meeting. Dr. Altenhoff is currently the Dental Director for the Texas Health and Human Services Commission Office of Inspector General, a position that was created under SB 1803. Back in 2009, Dr. Altenhoff held the position of … [Read more...]

Xerox/TMHP “Dental Specialists” Trained Only to Add Up HLD Score

fraud

Apparently TMHP/Xerox "dental specialists" were only trained to add up HLD scores on Medicaid orthodontic pre-approval requests and determine whether the total was 26 points or more, per allegations contained in the  lawsuit filed against Xerox by the Attorney General of Texas. Approved $700 Million in Orthodontic Pre-approvals These Xerox staff approved some $700 million in Medicaid … [Read more...]

Xerox Ortho Staff Worked from Home, Didn’t Review Material and HHSC Knew in 2008

Texas Medicaid fraud

As reported in May, the Office of the Attorney General of Texas filed suit against Xerox as the state's lead contractor in the Texas Medicaid and Healthcare Partnership.  The state is seeking to recover fraudulent Medicaid payments for orthodontic and dental services that were improperly approved by Xerox from 2003 forward. The Texas Health and Human Services Commission also terminated Xerox's … [Read more...]

Former HHSC OIG Deputy Counsel Reported Internal Wrongdoing and Was Dismissed Per Lawsuit

whistleblower wrongful dismissal

Michael McMillen, former Deputy Chief Counsel, Texas Health and Human Services Commission Office of Inspector General, is suing the HHSC for wrongful dismissal after reporting alleged violations of law within the agency.  The nature of the alleged violations are not known.  The pleading is available online or since the connection is slow, now on the TDMR website. The suit, filed July 2012, is … [Read more...]

Kyle Janek Rules – “Dentists Found Innocent by SOAH, Are Guilty”

THHSC building

On May 7th,  Dr. Kyle Janek, the Executive Commissioner of the Texas Health and Human Services Commission, issued his final order in the case of Antoine Dental Center of Houston. Upheld reversal of favorable SOAH ruling on Antoine Dental As expected, Janek overturned SOAH’s payment hold ruling, which was favorable for Antoine Dental. That SOAH ruling found no prima facie evidence of fraud … [Read more...]

HHSC Collecting SOAH Medicaid Provider Hearing Costs Because SOAH Worried About Funding

budget

As was reported in the Austin American Statesman back on May 25th, the Texas Health and Human Services Commission is seeking tens of thousands of dollars in advance from dentists who wish to go before the State Office of Administrative Hearings for either a Medicaid payment hold or overpayment hearing. "Abusive" Attorney Tony Canales portrayed the large amounts of the advance payments as … [Read more...]

Xerox Awarded $500 Million Medicaid Deal in NY Despite Texas AG Law Suit and HHSC Contract Cancellation

ACS Xerox

Xerox Corp at the end of May was awarded a $500 million contract to revamp New York's Medicaid system despite Texas suing the company and discontinuing their contract as chief Medicaid claims administrator in the state. The Rochester Democrat and Chronicle published the following: Xerox Corp. has been awarded a major contract to revamp the state's massive Medicaid management system, according … [Read more...]

HHSC Releases Deloitte Report “State of Texas Medicaid Payment Reform”

consulting report

Wednesday, TDMR received a notice that HHSC had put online a report from Deloitte Consulting LLP entitled, "State of Texas Medicaid Payment Reform – Market Assessment and Recommendation Analysis." The report is dated March 31st, 2014 and is 51 pages long.  It is available online here. The term "dental" only comes up ten times in the document. As a Medicaid provider, the report might be of … [Read more...]