After our article about the need for a review of Medicaid dental fees was published in May, we received a number of comments from dentists about how the lack of a fee increase is impeding service to their clients and … Read More

TDMR has learned that a number of Medicaid dentists around the state have been receiving informal letters from the Office of Inspector General about their billings. Avoid formal process Apparently, OIG is looking to resolve billing situations informally rather than … Read More

PRESS RELEASE  BY Sun Life Financial Inc.  Jun 01, 2022, 08:27 ET BOSTON and WELLESLEY, Mass., TORONTO, June 1, 2022 /PRNewswire/ – Sun Life Financial Inc. (TSX: SLF) (NYSE: SLF), through its U.S. business, announced today the completion of its acquisition of DentaQuest, the second-largest dental benefits provider … Read More

It is with some irony that a company that has been found guilty of insurance fraud by a jury in Delaware (and apparently colluding with the Texas Office of the Attorney General to do so) is still a major player in … Read More

Everyone remembers the Frew case back in 2004 when the Supreme Court forced Texas to provide basic healthcare services including dental care for Medicaid-eligible children. Reason for fee increase in 2007 For those that don’t remember, let’s recap. Linda Frew, … Read More

In March TDMR reported on the federal HHS-OIG report about the 2021 cumulative activities of state Medicaid Fraud Control Units around the country.  As there were no state breakdowns, we filed an access to information request with the Office of … Read More

This was posted on the Texas HHS-OIG website yesterday.  Thought we would republish.. ————————— Ensuring Texas Medicaid dollars are spent for their intended purpose requires the OIG to work with health care professionals to prevent fraud, waste and abuse. Accurate … Read More

The list of complaints about DentaQuest from Medicaid providers keeps growing. It seems that new Canadian ownership hasn’t changed any business practices so far, but we hear they like their money too. While some problems have been reported about MCNA … Read More

The following article was supplied by Texas HHS-OIG. Keeping accurate and complete patient records is part of providing quality patient care. Good record keeping can also help protect a practice against allegations of wrongdoing. The patient record is a legal … Read More

TDMR received an email notification today that Texas HHS is looking for a Dental Policy Analyst to assist in advanced complex dental and medical benefits policy analysis, development and consultation. No necessary dental requirements The odd about the advertisement for … Read More

The Department of Health and Human Services Office of Inspector General recently released its 2021 Medicaid Fraud Control Units (MFCU) Fiscal Year 2021 Annual Report. Investigates criminal fraud Medicaid Fraud Control Units have the job of investigating criminal fraud by … Read More

Just received this notification today. NOTICE OF STAKEHOLDER MEETING March 11, 2022 The Texas State Board of Dental Examiners will host a Stakeholder Meeting  Friday, March 11, 2022 at 1:00 PM The meeting will be in person and broadcast via Zoom … Read More

The Houston Chronicle broke a bombshell story today (paywall, unfortunately). This ortho story still has legs. OAG assisted company they were suing to defraud insurer The Chronicle reported that the Office of the Attorney General had secretly made last-minute modifications … Read More

TDMR has done a review of the Texas Medicaid dental maintenance organization contract available publicly on the Texas HHS website and found a requirement that all medical necessity determinations be based on “valid and reliable clinical evidence or a consensus … Read More

We found an article recently published on the OIG website that we thought should be republished here. Providers encouraged to self-report errors More providers are participating in the OIG self-audit process so they can determine if they need to self-disclose … Read More