Texas Dentists for Medicaid Reform - Fighting for Due Process Rights for Medicaid Providers

Texas HHS 2020 Inaugural Business Plan Available

December 12, 2019

HHS Executive Director Courtney Phillips Texas HHS has published a business plan for 2020 outlining its goals. This came out a few months ago but we just became aware of it. The plan is contained in a 64-page PDF document which is available below. There is no mention of dental services but the document is a useful window into HHS and its priorities, one of which is Medicaid Managed Care which starts on page 22. HHS is focussing on four goals for MCOs: Ensure Access to Providers Ensure Members Receive Services Strengthen Oversight of MCOs Strengthen Fair Hearings Process There is … [Read More...]

UPDATED with Survey- Medicaid Dentists: Lack of Use of D1352 Is Causing Audits and Recoupments

December 2, 2019

MEDICAID DENTISTS: Please take our confidential and anonymous five-question survey about D1352. It is basically a simple Yes-No questionnaire. It takes less than a minute. SURVEY IS NOW CLOSED. Back in late 2011, the ADA added several new codes to the CDT (Current Dental Terminology) manual. One of these codes was D1352 which is defined as a … [Read More...]

Texas HHS-OIG Fraud and Abuse Prevention Advisory on Dental Services

November 21, 2019

Last month, TDMR reported on the Texas Health and Human Services Office of Inspector General Quarterly Report for the fourth quarter of 2019. A highlighted topic in the report was the Illegal solicitation of patients by dental providers. Didn't know about advisory We just discovered that OIG issued a Fraud and Abuse Prevention Advisory back … [Read More...]

Texas HHS-OIG Audit Finds MCNA billed Medicaid $766,000 in unsupported consulting expenses and more

November 18, 2019

A recent audit done by Texas Health and Human Services Office of Inspector General found that dental maintenance organization MCNA had paid out $766,000 in consulting expenses that are unallowable under their Medicaid contract. The expenses were reported in their 2017 Administrative Expenses financial statistical report that MCNA had filed … [Read More...]

Who Lobbied for UnitedHealthcare, MCNA and DentaQuest

October 31, 2019

For the sake of public disclosure, TDMR is providing the lists of lobbyists registered with the Texas Ethics Commission who lobbied in 2019 on behalf of the three dental insurance companies that were recently announced as the awardees of the contracts for dental services for Texas Medicaid. The reports are in PDF format and are downloadable.. … [Read More...]

OIG Update & Quarterly Report – Dental Fraud Highlighted

October 25, 2019

TDMR received an email newsletter this week from HHS-OIG. They promoted their quarterly report and also a special downloadable publication for dentists on illegal dental solicitation. We have these below for you to download. Here some other items of interest from the email. OIG releases second part of audit series The OIG is conducting a series … [Read More...]

Who is UnitedHealthcare?

October 24, 2019

Part of UnitedHealthcare complex in Minnetonka, MN We thought Medicaid dentists might like to know something about UnitedHealthcare, the company that is going to be awarded the third DMO contract for Texas Medicaid, based on the recent announcement by Texas Health and Human Services. We had hoped to have the company supply us with information … [Read More...]

HHS Finally Announces DMO Contract Awardees

October 15, 2019

Texas Health and Human Services has finally made an announcement about the award of DMO contracts for Texas Medicaid. The announcement was posted on the HHS website yesterday and the big winners are MCNA, DentaQuest and newcomer United Healthcare Insurance Company. HHS states: "HHSC intends to award three dental managed care contracts to DentaQuest … [Read More...]