Texas Dentists for Medicaid Reform

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Latest TDMR Research and Articles

Why States Aren’t Really Interested in Reducing Medicaid Fraud

The following is an article from Jeff Leston of Castlestone LLC .  Castlestone provides fraud prevention solutions to governments and others. ------------- Since the passage of the Affordable Care Act, Medicaid expansion has been literally force-fed to states. Federal monies dished out Some, like California, Illinois, and Louisiana, took second helpings by enrolling ineligible beneficiaries.  Only a few have declined the free lunch.  And it has been a free lunch with the federal taxpayer funding 100% of new beneficiaries from 2012-2018.  It’s hard to pass up the buffet,  particularly when it’s … [Read More...]

UPDATE: Texas HHS: No DMOs Chosen Yet for New Medicaid Contract

UPDATE, August 30: The tentative start date for this contract is September 2, three days away.  The RFP number didn't come up when we searched for it on the Electronic State Business Daily (ESBD) website this morning. So we phoned Texas HHS Contracting to find out what was up.  We were told the state online contracting system won't show any … [Read More...]

Xerox/Conduent Relators to Get Zip, Nada, Nothing; State Now Says

Back in February, the Texas Office of Attorney General and Xerox/Conduent settled the state's longstanding lawsuit against the company for $235.9 million. The original lawsuit under the Texas Medicaid Fraud Prevention Act alleged that Xerox/Conduent had committed Medicaid fraud for its lax orthodontic prior authorization process which used … [Read More...]

Texas HHS OIG August 2019 Update

This came in from OIG. ----------------------------------------------------------- Welcome to the August 2019 edition of OIG Update. This monthly newsletter from the Texas Health and Human Services Office of Inspector General (OIG) provides an update about some of the agency's recent efforts in detecting, preventing and deterring fraud, waste … [Read More...]

HHS Looking To Save $350 Million On Medicaid

HHS sent out this notice today. The 86th Legislature included a cost containment rider in the FY 2020-21 General Appropriations Act directing the Health and Human Services Commission to achieve $350 million in savings by focusing efforts on "increasing fraud, waste, and abuse prevention and detection; seeking to maximize federal flexibility … [Read More...]

What Happened at the Medicaid Managed Care Advisory Committee Meeting

On August 13, the Medicaid Managed Care Advisory Committee met with Dr. Henry Chu attending. Legislation for medical review of denials doesn't include dental Dr. Chu told us that a new bill passed by the legislature, SB 1207, requires independent medical review related to an appeal for denial of treatment.  He found out that, unfortunately, … [Read More...]

80-Year Old Orthodontist Under OAG Hammer Declares Bankruptcy 

You may have thought the great HHSC/Xerox/Conduent Orthodontic Medicaid Fraud Debacle of 2007 to 2012 was over when the state settled with Xerox/Conduent back in February. Nope. Several dentists still under the gun There are still a few dentists and their practices under the hammer from the Office of the Attorney General (OAG) on allegations of … [Read More...]