Dentist Tells His Story – “Medicaid for Braces is Over”

ortho case

TDMR received the following from a Texas Medicaid dentist who wishes to tell his story about his history with the HLD scoring system and the current state of Medicaid for orthodontia. He asked to remain anonymous. When I began working with the Medicaid program about 22 years ago, National Heritage Insurance Company (NHIC) was employed by HHSC to administer it for the dentists in Texas. Since … [Read more...]

There Needs to be a Difference Between Fraud and an Error


On September 3rd, Rachel Hammond of the Texas Association for Homecare and Hospice testified before the House Human Services Committee on SB 1803 and due process rights for Medicaid providers. Hammond gave examples of difficulties that their members were having with OIG investigations.  One point she made was that there needs to be a differentiation made between fraud and an error.  For … [Read more...]

$500,000 Spent on Hearings Worthless if HHSC Can Just Overturn the Decision


Dr. Behzad Nazari of Houston testified before the House Human Services Committee on September 3rd on SB 1803 and due process rights for Medicaid providers. Nazari's Antoine Dental clinics was put under a 100% payment hold for their Medicaid orthodontic billings and went to a payment hold hearing at the State Office of Administrative Hearings in 2013. The hearing lasted four days before two … [Read more...]

$4 Million Mistake – Dentist Didn’t Record Toothbrush Instructions to Medicaid Patients


Dr. Chad Evans of Smile Magic Dentistry in Dallas testified before the House Committee on Human Services last week regarding his experience with due process rights for Medicaid providers under SB 1803 and the HHSC Office of the Inspector General. 117 staff lost their jobs Evans testified that his practice was placed under a 100% Medicaid payment hold by OIG .  Due to the payment hold, 117 … [Read more...]

Dentist Says Armed Agent Came to His Office After Senate Testimony


Dr. Paul Dunn testified before the House Human Services Committee last week about his experiences with the Health and Human Services Commission Office of the Inspector General and SB 1803.  Dunn testified last year before the same committee and more recently this past August before the Senate Health and Human Services Committee. Going bankrupt despite being told didn't commit fraud Dunn had … [Read more...]

Rep. Raymond Tells Medicaid Dentist “We Got to do Something to Change the System”

House Committee on Human Services

This past Wednesday, the Texas House Human Services Committee held public testimony on the effectiveness of SB 1803 passed last session to put into legislation due process rights for Medicaid providers under investigation by the Health and Human Services Commission Office of Inspector General. A number of dentists who have been put under payment holds and accused of "credible allegations of fraud" … [Read more...]

OIG Video Flawed on Educating Medicaid Providers on Due Process Rights

THHSC building

This past Wednesday, the same day as the House Committee on Human Services hearing on SB 1803, HHSC sent out a notice that it had placed online a video for Medicaid providers about Office of the Inspector General investigations. This video was a requirement for OIG to produce under the SB 1803 legislation to inform and educate Medicaid providers about the OIG investigation process for fraud, waste … [Read more...]

Xerox Agrees to Temporarily Turn Over Medicaid Records

ACS Xerox

The following excerpt is from the Houston Chronicle about Xerox and the State coming to an agreement on the disputed files. AUSTIN - Lawyers for the Xerox Corp. agreed Thursday to temporarily turn over private health information about millions of Texas Medicaid recipients, setting up at least a small compromise in a high-stakes legal fight over who is responsible for years of waste in the … [Read more...]

Full Testimony of Inspector General Doug Wilson Before Senate Committee Now Online


On August 14th, the Senate Committee on Health and Human Services heard testimony regarding Medicaid fraud, waste and abuse. The full presentation given by Chris Traylor, Chief Deputy Commissioner, Douglas Wilson, Inspector General, Kay Ghahremani, Texas Medicaid/CHIP Director, and Joseph Schmider, State EMS Director, is now presented here. This is the full testimony which is also on YouTube … [Read more...]

House Human Services Committee to Hear Testimony on SB 1803 Next Week

Austin Texas Capitol

The Texas House of Representatives Committee on Human Services has announced that it will be holding a public hearing on Wednesday, September 3rd, which will include hearing testimony regarding the effectiveness of SB 1803 and changes that should be made to the legislation to improve it.  TDMR had requested such a hearing. The Committee is chaired by Rep. Richard Peña Raymond. The official … [Read more...]


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