TDMR has received a missive from a concerned dentist, which we are publishing. It sums up the frustration and intense concern about DentaQuest’s recent actions in limiting its network, including a threat to remove over 100 urban providers. This prodigious threat has raised hackles and fears and we have been asked to spread the word.
Creating animosity in other states
DentaQuest, now foreign-owned with its parent company not making its profit targets, appears to no longer have the interests of its Medicaid clients or providers at heart. We have recently highlighted the company’s disturbing performance in Louisiana, which has earned it the ire of the legislature there, and Massachusett’s gave the company the boot earlier this year.
Texas DentaQuest troubles
But there is more here in Texas. Let’s recap what we have previously reported.
DentaQuest Dinged $1.5 Million by OIG – In 2020 an OIG audit found that DentaQuest had billed Texas $1.53 million in “unallowable, unsupported, and overstated expenses on its Administrative Expenses FSR [Financial Statistical Report]” which allowed DentaQuest to reduce the initial experience rebate amount paid to HHSC.
Seniors & Patients with Disabilities Lose Out as DentaQuest Takes Over Medicaid Waiver Coverage in Webb County – In 2021, almost three hundred seniors and patients with disabilities were stranded mid-treatment plan in Laredo thanks to a change to DentaQuest.
DentaQuest-led 3-Year Rule Outrages Medicaid Dentists – In late 2021, early 2022, controversy erupted over DentaQuest no longer paying for replacing a failing or broken restoration/filling in a child that was done at the same office within the last 36 months. Such failures are not unusual for children in low-income families due to a higher rate of tooth decay and the failure rate of such restorations.
Why Do Almost All DentaQuest Audits End with $20,000 Recoupments? – In early 2022, there were rumors of DentaQuest at that time culling its network and that the company was doing a money grab for harmless paperwork errors found in audits. In one instance, the audit alleged that because the doctor’s notes weren’t signed a $25,000 recoupment was owed.
DentaQuest Stops Paying for Some Two Surface Fillings in Texas – This is recent and HHSC stepped in to get the company to relent on this tactic.
Letter outlines the problems for Texans
With all that being said, as an introduction, here is the correspondence we received:
“I am writing to you about the alarming instability that DentaQuest (under the new ownership of Sun Life) is displaying by making a series of rash, ill-timed, and ill-planned moves that threaten the health and livelihood of thousands of Texans. DentaQuest’s business is clearly under duress in several states across the country.
“Since DentaQuest under Sun Life appears to be struggling both in Texas and nationally, it believes it has the right to try anything it pleases to turn a profit without any reservations about the thousands it will hurt. Recently, they have tried to erroneously rewrite dental codes, alter the way claims can be interpreted, and perform audits and recoupments that are inconsistent with acceptable norms of dentistry.
“But now they are rumored to be doing something so drastic that if they are allowed to move forward, it will insnare DQ, the State, and the affected patients and providers for years to come in legal proceedings. DentaQuest has already previously tried to purge offices as providers in other states. It has been taken to court and lost.
“They seem too stupid to understand the ramifications of the moves they want to make.
“Whether it is stupidity or hubris, the “new” Dentaquest/ Sun Life is trying to throw a Hail Mary to somehow magically fix the fundamentals of a business they acquired.
“Ruining the life work of many dentists, very possibly driving dozens of offices into bankruptcy, and causing more than a 1,000 Texan dental staff to lose their jobs is not as insignificant as a multi-billion dollar foreign company may think.
“But perhaps the most egregious is forcefully removing hundreds of thousands of patients from the only dental homes they have known, offices some have served them loyally for years. YES, DENTAQUEST IS ATTEMPTING TO FORCEFULLY REMOVE HUNDREDS OF THOUSANDS OF PATIENTS FROM OFFICES THAT THEY CHOSE AS THEIR DENTAL HOME. The ability of patients to choose their dental home is a legal right afforded to them by Medicaid Guidelines. It is our hope that HHSC and the State of Texas protect us from this greedy company.
“If DentaQuest’s solution is to eliminate more than 100 offices, then the patients in those offices should be assigned to the other DMOs and be allowed to stay in their SELECTED dental home. The process of changing patients from one MCO to another must also become fast and painless, just like a provider change.
“There is enough anger towards DENTAQUEST that I believe if they continue to operate the way they have been, providers will begin to direct their patients to move away from DentaQuest. This is something that will be organized and will take place if DentaQuest does not correct its course.
“Please help us spread the word.”
Time for a boot?
So is it time to give DentaQuest a Texas-sized boot out of the state?
MCNA and UnitedHealth Dental appear to be doing a good job.
Who will miss this company? The answer is yes.
Very few dentists can afford the costs to fight the $20k-plus audit recoupments conducted by Dentaquest.
Can the ADA (or a federal agency) get involved, and represent the dentists who had recoupments taken from them for for “harmless paperwork errors” via audits that are “inconsistent with acceptable norms of dentistry”? Dentists who lost recoupment monies via audits should be reimbursed the audit recoupment amounts plus damages.
I also have the same problem with DentaQuest audit, recouping for “harmless paperwork errors” and downgrading to single surface because the X-rays does not clearly shows the bucccal or lingual on “OB” or “OL” fillings, but cannot afford to fight them in court. I didn’t realize that this audit had affected so many other dental offices as well. Please let me know how I can join a group to fight the recoupment since I can not afford to do so on my own.
As for filling frequency limit, I agree that a 3 year frequency limit is too long to expect for a Medicaid population. I believe a compromise to a 2 year frequency limit is more reasonable.
Agree. The business model of DentaQuest is replicated in several states.
It’s not only in Texas.
Its in New Mexico, Colorado, Louisiana and Virginia, among others.
What to do.
Needs to form a committee of lawyers and dentists to structure a response to this issue.
Nice Article. DentaQuest should be given the Boot in every state Medicaid program they administer – because they violate the Medicaid act everywhere I have looked. We just booted them in Massachusetts! Good Riddance DentaQuest!
Thank you for your guidance and input.
we are not only dealing with issues of dental clinical care but also, the rules and regulations created by CMS.
DentaQuest possibly has 95% lawyers/Admin and very few Healthcare professionals managing the company.
Suggest a group of lawyers and Dental Professionals to discuss this issue on a state and national level.
Absolutely…in fact the American Alliance on Dental Insurance Quality (AADIQ) – which I am the President of – has made it our mission to force states to pursue compliance with Medicaid Laws. Check out this article.
https://dentalinsurancequality.org/access-to-care-under-medicaid-means-time-to-obtain-treatment-not-distance-to-the-provider/
If they think they can destroy my business and hurt my family without paying for it, I think they are delusional. Greedy corporations can be brought down by the ordinary people they hurt. Sun life and DentaQuest need to pay for fear and insecurity they are causing for thousands of patients, staff, and providers. This has to stop now, and it needs to stop going forward. We are done paying for sun life and dentaquests greed.
What DQ is doing is outrageous. They hurt the patients that have established dental homes for their families. Many will not have care or delayed care. DQ is setting the example for how not do things and they need to be stopped. HHSC and the ADA need to step in. This is gone too far and it will many office, their staff, and mainly a Medicaid population in need of help.
I also agree with changing the requirements for patients to be able to change their MCO with more ease.
Dentaquest has clearly gone rogue and it is up to the state to reel them in. Every two weeks there seems to be some sort of news about their incompetence and greediness. From changing the rules of dentistry with the 2 surface rule, to the brash determination that they will not accept new providers. They make it increasingly difficult for patients and providers. If there is a lawsuit against SunLife/Dentaquest in Texas count me in. With slim margins anyway providing a service for a high risk population, I amongst many other practitioners cannot afford to have SunLife make decisions for patients who CHOSE my office have to go elsewhere, and who knows how far that may be for them. Complete disregard of patients, practitioners, and staff who will all ultimately suffer. I hope HHSC sees their greed and steps in.
The future for dental providers in Texas is nothing short of a nightmare, thanks to DentaQuest and their so-called guardians at Sun Life who couldn’t care less. DentaQuest, in their blind chase for profit, is tearing apart the dental care network with all the grace of a bull in a china shop. The new ownership? Absolutely clueless, pushing through decisions that are nothing short of an assault on our livelihoods. They’re playing with fire, on the verge of legal nightmares, and who’s going to clean up the mess? Us, the providers, watching our life’s work crumble.
Decades of dedication down the drain because some corporate bigwigs decided to play roulette with our practices. Practices that will now face bankruptcy, staff thrown into unemployment with no warning. Patients? They’re being ripped away from their dental homes like it’s no big deal, leaving us powerless. It’s pure corporate greed at its worst, a complete disregard for the very people who keep their business running. We’re left here, fuming, watching helplessly as our future is dismantled by the very people who should be supporting us. It’s a betrayal of the worst kind, and we’re all just supposed to stand by and watch it happen? Utterly infuriating.
That is exactly how we felt in Massachusetts- violations and dismantling of the program – by the very people who should be supporting us. That is why we ousted them.
This is absolutely ridiculous. How do they expect people to run their office and pay staff and associates if they have the power to kick them off whenever they feel. Dentaquest needs to be removed from Texas Medicaid
Dentaquest greed has no end. They take every opportunity to hurt doctors, patients, practices for the sake of profit. Unilaterally deciding to drop offices across the state cannot and will not be done without a fight. It seems like it’s one thing after another with this company and Medicaid dentists all over Texas are frankly fed up.
Agree.
An issue is that the DentaQuest business model and unfair business practices are replicated in other states as well.
New Mexico, Virginia, Colorado, Louisiana and Massachusetts.
We practice in New Mexico and many providers got terminated for unfair reasons.
We as Dentists have a moral/ethical responsibility to make things right for our patients.
How can one company affect so many patients and providers and nobody can do anything about it ??
How can one company affect so many patients you ask? BECAUSE very few stand up to them. I have sued the state of Massachusetts 6 times….I always win. BUT they have hurt me badly for it. I like to think that my attacks on DQ are not just for me…I am fighting for a nation. And I think we need to unite NATIONALLY – to say No More to Dentaquest….just like my state of Massachusetts just did. My favorite was when DQ senior counsel sent me a CEASE & DESIST LETTER that said that they spend more time on my cases…than the rest of the country combined. GOOD…… 🙂
Thank you for devoting all this time to making things right.
I agree with your statement: “I think we need to unite NATIONALLY – to say No More to Dentaquest….just like my state of Massachusetts just did.”
Where do we start?
We hardly have any Medicaid providers in my state because of DentaQuest
Read this article in the AADIQ.
https://dentalinsurancequality.org/how-a-child-medicaid-law-affects-all-dentists-and-patients/
This past month, the ADA did indeed adopt my resolution – and now we need to make sure the HPI does this audit properly.
Also….are you a member of “Dentistry in General” Facebook page? If not…join….we can discuss this in that form and bring attention to what is happening in Texas.
It’s absolutely infuriating to see DentaQuest continue with such reckless actions that directly harm the most vulnerable people relying on Medicaid for essential dental care. How can they justify kicking hundreds of providers out of their network, disrupting care for countless patients who have built long-standing relationships with their chosen dental providers? This isn’t just about paperwork or profit margins; it’s about real people being stripped of their only access to reliable dental care. Texas Medicaid deserves better than this disregard for patients’ rights and well-being. DentaQuest’s approach is nothing short of callous, and it’s high time Texas stands up to this corporate indifference. If they can’t support our communities with the care and respect they deserve, they shouldn’t be here.