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

Dr. Paul Dunn testifying before a legislative committee

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

Kyle Janek

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

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

texas medicaid news

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...]

HHSC Allegedly Paid Out $104 Million to 8,000 Medicaid Providers the Agency Suspected Of Fraud

Former HHSC Chief Counsel Jack Stick's $87 OIG Badges

Four firms provided “proof of concept” demonstrations of their Medicaid fraud detection software to the Texas Health and Human Services Commission and its Office of Inspector General back in 2011. These proof of concept projects allowed the firms to access Medicaid claims data to evaluate it for fund diversion to fraud. In the case of Reflective Medical (RMIS), as already reported in the … [Read more...]

San Antonio Seminar Helping Providers Understand Compliance and Enforcement Issues

san antonio seminar 7 feature

This past Friday at the Leon Valley Conference Center in San Antonio, Star Compliance Services and TDMR held our third healthcare compliance seminar, following our recent successful seminar in Houston and the earlier one held in February at Weslaco. Gregory Ewing and Dr. Juan D. Villarreal were once again the presenters and provided attendees the benefits of their knowledge and personal … [Read more...]

Offer of Free Fraud Detection Software and Other Skeletons Still in the HHSC Medicaid Closet

THHSC building

The press has uncovered a lot of conduct unbecoming at the Texas Health and Human Services Commission and its Office of Inspector General in the last eight months. First there was the Sunset Advisory Commission with its damning report on OIG and its treatment of Medicaid providers, its poor handling of investigations and lack of due process.  Then, the 21CT scandal surfaced with former HHSC … [Read more...]

SB 207 Signed by Governor Abbott on Heels of FBI Medicaid Fraud Arrests in RGV

greg abbott2

This morning, TDMR was notified that Governor Greg Abbott has now signed into law SB 207, the legislation which makes major changes and improvements to the way the Texas Health and Human Services Commission Office of Inspector General will work. Agency meltdown The last half of 2014 and 2015 was a tumultuous period for the agency. It started with hearings before the House Human Services … [Read more...]

Houston Compliance Seminar Successful in Communicating Vast Amount of Information on Compliance Issues and Providing Tools for Application

Houston Seminar June 12

Texas Dentists for Medicaid Reform assisted Star Compliance Services this past Friday to hold a one-day healthcare compliance seminar in Houston at the Norris Conference Center – City Centre.  It is the first in a series of seminars that were demanded by dental Medicaid providers after TDMR’s first such seminar in Weslaco in February.  Further seminars are scheduled for San Antonio on June 26 and … [Read more...]

HIPAA, Meaningful Use And The False Claims Act

health care providers

The term “Meaningful Use” is the federal government’s way of describing the use of certified Electronic Health Record (EHR) technology, in a meaningful manner to achieve specific standards, namely: Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of … [Read more...]

HHSC Commissioner Kyle Janek to Resign

Kyle Janek

The Texas Tribune just reported the following this morning: Kyle Janek, the head of the state’s embattled Health and Human Services Commission, will step down and be replaced by his former deputy, sources with direct knowledge of the move said Friday. Gov. Greg Abbott is expected to announce Friday that Chris Traylor, who recently retired from the health agency, will take over for Janek. … [Read more...]

Breaking News: Texas Owes Feds $133 Million for Medicaid Ortho Debacle

hhs-oig

Back last August, the Department of Health and Human Services Office of Inspector General released an audit report that the Texas Health and Human Services Commission was responsible for the conduct of its Medicaid claims administrator for the hundreds of millions of dollars of increased spending on Medicaid orthodontia from 2008 to 2011. HHSC and Xerox found responsible for extent of Medicaid … [Read more...]