Texas Dentists for Medicaid Reform

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Latest TDMR Research and Articles

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 under the Medicaid program in compliance with Government Code, Chapter 537; and achieving other programmatic and administrative efficiencies." Additionally, the rider states "that HHSC shall achieve savings without adjusting amount, scope, or duration of … [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...]

Former IG Stuart Bowen Now In Austin Helping Medicaid Providers

You might remember the horrendous mess that plagued Texas' Office of Inspector General at the Health and Human Services Commission back in the day. Then-IG Doug Wilson and his sidekick Jack Stick alleged that there were hundreds of millions of dollars of Medicaid fraud committed by dental providers. These outlandish claims along with the cozy … [Read More...]

Controversy over DMO Not Paying for Work on Same Tooth

Back in February, MCNA issued a Provider Bulletin that effective March 15 it would start reviewing restorations being redone within 36 months. The company would also start requiring prior authorizations for identical restorations and similar restorations on the same tooth. Prior authorizations needed with evidence for work on same tooth According … [Read More...]