Latest TDMR Stories
Proposed changes to state Medicaid plans could shake up health coverage for 1.8 million low-income Texans
REPUBLISHED FROM THE TEXAS TRIBUNE By Karen Brooks Harper, The Texas Tribune April 18, 2024 “Proposed changes to state Medicaid plans could shake up health coverage for 1.8 million low-income Texans” was first published by The Texas Tribune, a nonprofit, … Read More
Louisiana Raised Medicaid Dental Fees, Now Significantly More Than Texas
Last July, Louisiana quietly and significantly increased its EPSDT Dental program fee schedule. According to online information, the increase came about because Louisiana Medicaid was using the Full Medicaid Pricing program to establish fees. Its creator, the Centers for Medicaid … Read More
National Dental Organization Wants to Reform Medicaid & Dental Insurance
TDMR has reported on a number of recent controversies regarding dental loss ratios and value-based care outside of Texas. Now, to address these issues nationally, a Massachusetts-based dental organization, the American Alliance for Dental Insurance Quality (AADIQ), has been formed … Read More
OIG Receiving Complaints Against Dentists Alleging Substandard and Unnecessary Procedures As Well As Case Management Irregularities
The latest OIG Quarterly report was released last month. It contains several important trends for dentists and trends in OIG investigations into dental practices. Firstly, OIG preliminary investigations into dentists and dental practices remain at their traditional level of 6%, … Read More
Texas Terminates Conduent Again After Delaware Supreme Court Announces Review of Insurance Fraud Claims on Texas Medicaid Fraud Settlement
HHSC announced this morning that Conduent’s recently awarded contract as TMHP’s claims vendor had been terminated for convenience. Termination for convenience means “a party to a contract to bring the contract to an end without the need to establish that … Read More
Dentists Suing Conduent for Orthodontic Prior Authorization Debacle Hits Third Court of Appeals
For the last decade flying under the radar, a couple of dentists and their attorneys have quietly and doggedly pursued the private contractor that approved their Medicaid orthodontic prior authorizations from 2004 to 2012. These dentists are seeking damages for … Read More
OIG Provides Guidance on Common Errors in Dental Sedation
Yesterday, we received an OIG update that is valuable for Medicaid dentists. OIG has found concerns “about inappropriate administration of sedation and local anesthesia, discharging the patient before they fully recovered from anesthesia, and billing for sedation levels the provider … Read More
ADA Under Fire for Dental Loss Ratio Compromise with National Association of Dental Plans
Since Massachusetts voters overwhelmingly voted in favor of Question 2, the “Patient Access to Affordable Dental Care Act” in November 2022, instituting the nation’s first dental loss ratio, there has been a push to get other states on board with … Read More
Dentists’ Antitrust Class Action Claims $13 Billion Scheme by Delta Dental
In a landmark case for antitrust law and the dental industry, roughly 240,000 dentists and dental practices have initiated a class action lawsuit against Delta Dental, the United States’ largest dental insurance system. The case, formally known as In Re … Read More
52% of Children Covered by Texas Medicaid During PHE Not Covered Now
TDMR received notification of a new report from Texas HHS on the End of Continuous Medicaid Coverage in Texas. The upshot for children who were under Medicaid coverage during the public health emergency (PHE) is that, at present, some 999,524 … Read More
Perfect Storm Hitting Medicaid Dentists in Texas
Over the last several months, TDMR has been receiving anecdotal comments from Medicaid dental providers that they have found themselves truly between a rock and a hard place at this time. Although we have reported on a number of negative … Read More
Nebraska Legislature Votes 35-0 to Increase Medicaid Dental Fees by 25%
On February 7, the Nebraska legislature passed the first reading on a bill to increase Medicaid dental reimbursement rates by a whopping 25%. In the only state with one state legislative body, that legislative body passed the bill 35-0. Recognizes … Read More
Dr. Richard Malouf May Get His Day In Court After All
UPDATE: YouTube video added of hearing 22-1046 Malouf v. State ex rel. Ellis Supreme Court Hearing, January 31, 2024 It might just be possible that more than a dozen years after the great WFAA expose on “Crooked Teeth,” a Medicaid … Read More
So This is Why New IG Raymond C. Winter Was Fired by the OAG Last Year
This week, Pro Publica and the Texas Tribune released the results of an investigation into the Texas Office of Attorney General Civil Medicaid Fraud unit and its recent tremendous loss of staff coinciding with the firing of its long-time head, … Read More
Dental Loss Ratio Gaining Momentum Nationwide
The movement to set a dental loss ratio (DLR) for the dental insurance industry is fast becoming a national issue and is now on the agenda of a number of state dental associations as well as the ADA thanks to … Read More
Inspector General Winter’s First Quarterly Report
Inspector General Raymond Winter who came to post last October released his first quarterly report at the end of December. It is also the report for the first quarter of fiscal year 2024. No cases involving dentists highlighted OIG settled … Read More