“Abuse by Xerox” Echoed at Legislative Hearing on Medicaid Reimbursement Rates

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On August 9, the House Committee on Human Services held a public hearing. Part of the agenda was to hear testimony relating to the proposed dental Medicaid reimbursement rate cuts for many necessary codes that have been called “devastating” by the Texas Dental Association.

Testifying on the subject were Dr. Paul Kennedy, Dr. Adam Lalonde and Dr. Chad Evans. The three basically told the committee that the providers should have been consulted beforehand to work out the best way to save money for the program, not just drastically cutting rates on necessary codes that will reduce prevention and cost the state more in the long run.  They offered to work with HHS now to still do so.

Dentists should be consulted

Committee chair Rep. Richard Peña Raymond told the dentists, committee members and Charles Smith, Executive Commissioner of Texas Health and Human Services that the dentists should be consulted with now to help provide the greatest benefit to the program. Smith basically agreed.

“Abuse by Xerox” caused program costs to soar

An expected hearing highlight occurred when vice-chair Rep. James Frank mentioned that program excesses such as in the case of the previously failed Medicaid orthodontic program needed to be avoided. Chair Raymond took pains to explain that the excesses were not caused by dentists but by “abuse by Xerox” which was still the subject of a lawsuit by the state.

TDMR has compiled a number of short videos showing the relevant testimony for those interested.





9 Responses

  • These fellows really know how to present the facts. Still think MCO Or HMO are taking advantage of we dentist no acting as one whole entity . All the changes come from one end and with one purpose milking the cow with the benefits to the MCO pocket, reducing Medicaid payments to providers and utilizing the providers by taking away the right of practice..
    Shame on some colleagues that play the same roll as corporate business people opening practices with only purpose to take the practice right autonomy form their colleagues using no qualify staff ,DA in the must , to hire and manage dentist providers services autonomy with the only purpose of having abuses to the good practice of dentistry and all for profit instead of a true professional dental services.
    Really do not know when this is going to end or if someday soon it would change for good toward the wrong path . It is a call to each individual new generation colleague which needs to stand up for the good, honest dental practice other wise we will continue losing our respect and being denigrated to the worst by under educated personnel or third parties estrangers to our profession . ( Fact Xerox and Dental office staff communicating to each other and taking decision on approving treatments and payments).

  • Xerox story is BS. Why would we not give guidelines for them to follow. They are not orthodontists. Texas HHS are dummies. I remember seeing “free braces “ signs in the metro plex. Many of our colleagues became crooks doing More than a million per month in just ortho. How could we not supervise this program. Sorry but I am so tired of Medicaid fraud. We are short on ethics

    • The ortho spending issue came into being because Xerox was not doing its job in determining medical necessity on the ortho prior authorizations as it had apparently secretly hired high school graduates and janitors to rubber stamp the requests. Many of those dentists you complain about questioned HHSC about the legitimacy of the approvals and were told that a “board certified orthodontist” was doing the reviews. Do a search of our articles. In interviews done with several dentists, they were even encouraged by HHSC to take on more ortho patients during those years.

      • Daniel Drefke is correct and I give him credit as a dentist for recognizing that some of his peers do not have ethics. Xerox is certainly to blame, but you (TDMR) have failed to see that they left the bank vault wide open with their absentee prior authorization process and the providers just walked in an took the money. Dentist take ethics courses in dental school and they know what is acceptable and what is not. They are taught what an ectopic eruption is and they know how to properly score a Handicapping Labio Lingual Deviation scoring sheet. If someone told you it’s o.k. to fudge a little on your IRS return because no one is really paying attention….what would you do. If you have scruples, you stay honest, if you don’t, you take advantage of the situation. Jack Stick gravely and strategically erred in trying to call this fraud in his investigations of the providers and the SOAH judges ultimately thought the State was just picking on the poor providers who were “trying to help poor children”. This was still massive waste and abuse of the system even if it was not fraud. The SOAH judges said it was not fraud, but that does not address the waste and abuse. No one ever died of simple crooked teeth. These dentists and Xerox were only supposed to submit and/or approve braces for situations that were “severly handicapping”. Look at the pictures of some of the exhibits in the SOAH cases…do you believe for a second those teeth qualified as severely handicapping???? You need to remove the wool from your eyes and stop letting these unethical dentists blow smoke up your skirt. Both Xerox and the dentist are culpable. Be objective and fair and for God’s sake open your eyes.

        • These are the same old tired arguments used by shills of personal injury and qui tam attorneys who seek to denigrate the entire dental profession so they can make their own tidy little profits on the backs of Texas taxpayers. “Joe Knows,” disgustingly hides behind anonymity to sling their muck and pretend great knowledge of the “facts.” The facts are simply every case taken by the state before judges of the State Office of Administrative Hearings accusing dentists of fraud or waste on this ortho debacle, found that not to be the case. The last hearing actually awarded court costs to the dental practice in question. We have written numerous stories and articles detailing the “facts” and “Joe Knows Nothing” should read them.

    • Replying to Daniel Drefke DDS
      You say
      \” Not a chance that will happen. The new dentist as a whole are money driven. Just an observation\”
      – I\’ve seen plenty of old heads that are money driven too. Tell me, how are you paying your employees, rent, supplies, and utilities? Charity work? If you are accepting payment for your fillings, crowns, and root canals, are you not \”money driven\”? Can I come to your office to get my fillings done? Will you do my braces for free since you are not money driven? \”Money driven\” could mean many different things for example, if the new dentist wants to work from 7am to 10pm, do you consider that money driven or hard working? Just because someone is WILLING to work more doesn\’t mean they are money driven. Maybe the new dentist likes working, maybe he has loans (we all have been there before), or maybe he wants to really buy a nice car for his mom. Is that so much to ask? are you ok with that?
      – This is my observation, a dentist\’s worst enemy is the not the insurance companies or the corporate dentistry but the other single practitioners. Let that sink in for a minute. Our own worst enemy is our colleagues. And it is quite unfortunate. I know I\’ve been there before so I try to lend a hand to anyone who needs advice or guidance, never point fingers or place blame on a fellow. Let\’s start by supporting each other and not breaking each other down Daniel. No one is perfect.
      – Side note – I\’m not a new dentist (practicing for 10 successful years)

      • The great Medicaid orthodontic debacle would never have occurred if there was the same mutual respect in the dental profession as in the medical profession. Doctors do not allow their whole profession to be maligned and thrown under the bus when there is a controversy.

        • Yes I see that all the time in our industry. Sad and unfortunate. There is always someone who is riding high on their horse. There are also dentists who would testify as an “expert witness” to throw their fellow colleague under the bus but of course with PAY perhaps for $30k, $50k, $90k. Would you take 50k to be an expert witness against your colleague? I’d say that is almost equal to being a fraud. In the end you didn’t EARN 50k. The attorneys tossed you crumbs and they walked away with millions. I have also met dentists who were too proud to take Medicaid and say that they are only a “cash” office. Is that possibly your office?
          – To each their own but everything in life is money driven whether you like it or not. Go to your barber and ask him for a free haircut and he will tell you to take a hike!
          – I have 2 close friends that are practicing law for 8 years and they absolutely love the disconnect in our industry because it’s easy to for them to pierce through our wooden shield.
          – Good luck to all my fellow colleagues around the world especially Texas. I love and support all dentists trying to do the right thing. Go out and be the best you can be and get paid for it.
          – Let this be a learned lesson, there is strength in numbers. There is no honor in being a cash office only compared to a medicaid office. And there is definitely no honor is bad mouthing other dentists.
          🙂 Merry Christmas everyone. Keep up the good work TDMR!

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