The latest Texas HHS-OIG Quarterly Report issued last month, again for some reason, under provider integrity, focussed on findings made on investigations of Medicaid dental providers when these investigations only account for a tithe of full-scale investigations conducted by OIG. … Read More

Back in March, Rep. Mike Simpson, D.M.D., R-Idaho, introduced federal legislation to reduce administrative barriers for Medicaid dentists. Simplify credentialing According to an ADA release, “H.R. 1422, the Strengthening Medicaid Incentives for Licensees Enrolled in Dental Act [SMILED Act], would … Read More

TDMR has learned that Dr. Margaret Laccabue is no longer the Dental Director, Office of the Medical Director, Medicaid and CHIP Services for Texas HHS.  We have it on good authority that she was released from employment with HHS, but … Read More

We’re not exactly sure what happened, but Raymond C. Winter, who headed up the Civil Medicaid Fraud division of the Office of the Attorney General of Texas for the last 15 years, is no longer there. According to his LinkedIn … Read More

Texas needs to attract more dentists to help serve the ever-increasing number of Medicaid-eligible children in the state. Medicaid dental provider statistics Back at the end of 2013, there were roughly 3.2 million Medicaid-eligible children with 3,468 Medicaid dental providers … Read More

UPDATE:  The Texas HHS Open Records Office sent TDMR a further document that contains only the active number of dentists in the Texas Medicaid program from 1996 to 2022.  The previous document used contained both active and inactive combined.  This … Read More

More trouble for Texas’s latest Medicaid contractor, Conduent. Needless to say, insurance providers AIG and partner companies are appalled that the Delaware judge in their case against Conduent granted a retrial and dismissed the jury verdict that Conduent had committed … Read More

You just can’t make this stuff up. HHS just contracted with Conduent again Texas just rehired Conduent, the company it had fired in 2014 as its lead Medicaid contractor and then accused of $1.2 billion in Medicaid fraud which it … Read More

UPDATE:  Taxpayers to pay settlement which the Legislature must approve. Attorney General Ken Paxton and four of his former top deputies who said he improperly fired them after they accused him of crimes have reached a tentative agreement to end … Read More

Recently, an OIG audit of a managed care organization (MCO) found issues when determining the fair market value of outsourced services and behavioral health claims. The audit reviewed multiple financial statistical reports (FSR) for UnitedHealthcare Community Plan of Texas, L.L.C. including Medical … Read More

What happens if a company gets sued for $2 billion by the State of Texas for Medicaid fraud as its former Medicaid claims administrator, then tries to pay the settlement by committing insurance fraud? Texas gives them a new contract!  … Read More

TDMR received an email from a provider that a new problem had developed in credentialing a dentist that adds even more time to the process. No TPI in welcome letter Apparently, TMHP is no longer including the TPI (Texas Provider … Read More

This seems like a silly question because surely the agency that pays billions of dollars to DMOs and MCOs and keeps the Medicaid show on the road in Texas should know something—and perhaps should know everything– about the credentialing of their Medicaid dentists in Texas. You wouldn’t be … Read More

The American Dental Association’s Health Policy Institute last month published the results of an ongoing survey it has been conducting since January 2022, quizzing some 3,000 participating private practice dentists each month to measure the impact of COVID-19 and other … Read More

Over the last several months TDMR has been receiving an increasing number of complaints regarding credentialing for Texas Medicaid dental providers. There have been numerous fixes over the years such as PEMS, the Provider Enrollment & Management System, which is … Read More