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...]

Former Jack Stick Aide Cody Cazares Resigns

A name familiar to many Medicaid dentists who have felt the sting of Doug Wilson and Jack Stick's Office of Inspector General in the last few years has resigned, per the Texas Tribune. Cody Cazares, an aide to former Health and Human Services Commission chief counsel Jack Stick and who assisted Stick when he was with the Office of Inspector General, has left the building.  Cazares used to … [Read more...]

Dental Practice Victimized by OIG Actuary Should Have Settled Case for $41,000 not $323,000

The story about Dr. Rachel Trueblood settling in October 2014 with the Health and Human Services Commission Office of Inspector General for $39,000 after the agency was demanding $16 million in Medicaid overpayments is well-known. However, the story of another dental practice and how it got burned by OIG for several hundred thousand dollars after this settlement is not known. But today it is … [Read more...]

New Law Helps Tackle Health Agency Woes – Texas Tribune

In January, Stuart Bowen took charge of a state office rocked by accusations of corruption, incompetence and inefficiency. Responsible for ferreting out fraud amid the programs and procedures of the sprawling Health and Human Services Commission, the office of Inspector General itself remains under a cloud. He hopes a new law kicking in Sept. 1 will help revive the office's performance and … [Read more...]

New Inspector General Overhauling Agency Use of Statistical Extrapolation and Settling Cases

TDMR has learned that the new Health and Human Services Commission Inspector General Stuart Bowen, Jr. has been taking on and overhauling the agency’s use of statistical sampling and extrapolation. This is the most controversial tool that the agency had been using to demand multi-million dollar settlements from Medicaid providers under investigation. Statistical extrapolation - a few things … [Read more...]

Dentist’s Nightmare Over – Settles for $120,000 Withheld Medicaid Funds

The vicissitudes of Dr. Paul Dunn have been chronicled by TDMR over the last several years. Dunn first appeared on the scene when he came to Austin during the 2013 legislative session. "Credible allegation of fraud" payment hold, but told he hadn't committed fraud He had been placed earlier under a 100% “credible allegation of fraud” payment hold for his Medicaid orthodontic billings by then … [Read more...]

Janek’s “Capricious” Decision in Antoine Dental Case Challenged in District Court

Last Wednesday, July 16, lawyers for Antoine Dental Centers of Houston again went to court. Going Travis County District Court This time they appeared before Travis County District Court to appeal the Medicaid payment hold final decision by former Health and Human Services Commission Executive Commissioner Kyle Janek that was issued back on May 7, 2014. Janek decision "capricious," … [Read more...]

8 Components of an Effective Compliance Program

The eight steps you need to take to put together a program for yourself! Many people have asked what the process for establishing an effective compliance program is.  At one point, having a compliance program was optional.  As a result of the Patient Protection and Affordable Care Act, health care providers who participate in federal health programs must have an effective compliance program as a … [Read more...]

Texas Medicaid News Video – June/July 2015

Here is the June/July edition of the Texas Medicaid News! Hello and welcome to the Texas Medicaid news update, I'm Andy Zajac. Things have been hot and heavy over the last few weeks in Austin. 1) Our top story is that Texas Health and Human Services Executive Commissioner Kyle Janek finally resigned. Things couldn’t have been worse for Janek over the last seven months as scandal piled on … [Read more...]

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