OIG Originally Demanded $3.2 Million, Now Owes Medicaid Dentist $380,000.

xerox -hhsc

The front-page of the Austin American Statesman Sunday morning carried the full story of the unprecedented ruling by the State Office of Administrative Hearings (SOAH) to award a Medicaid dentist back some $380,000 in legal fees from the Health and Human Service Commission Office of Inspector General (OIG) on a Medicaid payment hold case. TDMR has obtained a copy of the SOAH proposal for … [Read more...]

Texas Medicaid News Video Show Now Online

medicaid news

TDMR has started a regular video news segment that will be carrying Texas Medicaid news plus relevant stories from around the country. Over the next few weeks, we will be starting to include interviews with key players in Texas. Our first installment: Austin: Per the Houston Chronicle, Texas legislators don’t know how to stop agency officials from violating state regulations. At the … [Read more...]

New HHSC Webpage to Comment on Medicaid Medical and Dental Policies

THHSC building

Today, the Health and Human Services Commission announced that it has put up a new page on its website for Medicaid providers to comment and stay abreast of policy changes relating to Medicaid covered medical and dental treatments. The new page states: "HHSC continually reviews its policies to ensure they remain medically appropriate and responsive to the latest evidence. Through this website, … [Read more...]

SOAH Finds DENTIST Innocent of Medicaid Fraud, Orders OIG to Pay Back $360,000 in Legal Fees

human services

UPDATE: After publishing this article, TDMR was alerted that it is a DENTIST, not a medical doctor that is involved in this case. It involves the Rhoden Group from Corpus Christi with Dr. Cheryl Rhoden, DDS as the principal. This is the third SOAH decision in favor of Medicaid dentists. On Monday evening, during the House Human Services Committee hearing on Senate Bill 207, which is to reform … [Read more...]

OIG Advises Texas Dentist to “File Bankruptcy and Save Us Time and Money”

Dr. Paul Dunn testifying before a legislative committee

Dr. Paul Dunn, a small town general dentist who practices orthodontics out of Levelland, has had a case outstanding with the Health and Human Services Commission Office of Inspector General since 2011.  He has been under severe financial strain since that time from a 51% “credible allegation of fraud” payment hold although he was told by OIG that he had not committed any fraud. Overpayment rose … [Read more...]

Analysis of Legislative Changes to HHSC-OIG in SB 207

sunset commission2

Senate Bill 207 which details legislative reforms to be made to the structure and function of the Health and Human Services Commission Office of Inspector General as recommended by the Sunset Advisory Commission has cleared the Texas Senate and is set to be reviewed by the House. A report on the bill and its implications has been published by the Senate Research Center to aid legislators on the … [Read more...]

Medicaid Providers Must Re-Enroll by March, 2016

HIPAA compliance

HHSC sent out an email notice today that all Medicaid providers must re-enroll for Medicaid if they were approved prior to January 1, 2013.  This is due to a new federal mandate that all providers must be periodically revalidated.  All providers that must re-enroll must do so by March 24, 2016. The following is the HHSC notice: Due to a new federal mandate, all Texas Medicaid providers must … [Read more...]

Deputy Executive Commissioner Retiring from Health and Human Services Commission

THHSC building

This past week, the Texas Health and Human Services Commission in its monthly In Touch newsletter announced that Deputy Executive Commissioner Chris Traylor is retiring as of May 31st. Traylor has been in the Texas public service for 25 years and intimately involved with HHSC for many years. He was the Texas Medicaid director from 2007 to 2010, per In Touch, and was one of the staff that … [Read more...]

Time for Agency Officials to “Take Seriously” State Regulations

capitol

Two articles from the Houston Chronicle this last week should send shivers down the spine of every Texan about what kind of government his or her tax dollars are buying. The whole contracting fiasco in the Texas Health and Human Services Commission, the state's largest agency which spends over $34.5 billion annually, is apparently just a symptom of a much deeper problem within this immense … [Read more...]

Senate Passes Needed Reforms for HHSC Office of Inspector General

Sen. Juan "Chuy" Hinojosa

Yesterday, the Texas Senate passed and sent down to the House of Representatives Senate Bill 207, the bill setting out much needed reforms to the Health and Human Services Commission Office of Inspector General that came out of the Sunset Advisory Commission hearings last December.  The bill had ten amendments on the Senate floor and then was passed 30-0.  The bill will provide more due process … [Read more...]

National Dental Medicaid Fraud, Waste and Abuse $12 Million out of $2.2 Billion Total in 2014

hhs-oig

The U.S. Department of Health and Human Services Office of Inspector General issued a report today detailing the cumulative efforts of state Medicaid Fraud Control Units in dealing with Medicaid fraud, waste and abuse in 2014. Pharmaceutical settlements are largest recoveries - $1.26 billion Cumulatively, $1.961 billion was recovered civilly from 889 providers and $293 million recovered from … [Read more...]

Is That Pile of Straw on Kyle Janek’s Camel About to Break Its Back?

janek

Yesterday both the Austin American Statesman and Texas Tribune published new scathing exposes on contract handling at the Texas Health and Human Services Commission. Close personal relations with lobbyist of successful contractor This time however the stories did not involve either Jack Stick or the 21 CT contract but instead revolved around HHSC Executive Commissioner Kyle Janek and the … [Read more...]

Medicaid Compliance Seminars

Texas Dentists for Medicaid Reform

and Star Compliance Services

now have healthcare compliance

seminars scheduled in:

Houston, Friday, June 12

San Antonio, Friday June 26

Dallas, Friday, July 17