It is remarkable that in a state that cherishes free enterprise, it is okay for dental maintenance organizations to offer money and other inducements to encourage parents with Medicaid-eligible children to use their company yet it is a crime for Medicaid providers to approach those same parents for the same purpose.
If it is illegal for one, it should be for the other. Aren't DMOs spending taxpayer monies on those inducements?
Provider caught & punished
Regardless of the seeming hypocrisy, the last OIG Quarterly Report for 2021 highlighted the agency's efforts to stop this crime.
In fact, it is reported on page 5 that a dental provider was caught and punished for it.
"The OIG settled a case in September against a Richardson dental provider. The dentist billed Medicaid for services not rendered by altering treatment charts and illegally solicited Medicaid clients by using gift cards. The provider agreed to pay $4,066 in overpayment and $8,133 in penalty to resolve this case."
The report then publishes a full-page section on dental solicitation, which we republish here.
OIG expands illegal dental solicitation education effort
The Texas Health and Human Services Office of Inspector General proactively works with dental providers to prevent fraud, waste and abuse in Texas Medicaid delivery.
In its latest endeavor, the OIG is collaborating with the Texas Department of State Health Services (DSHS) to share information about illegal dental solicitation with dentists who participate in Texas Health Steps, which provides free dental and medical checkups to children with Medicaid.
The outreach effort with DSHS Regional and Local Health Operations is currently underway. OIG staff is training DSHS staff in public health regions across the state, giving them a solid understanding of illegal
dental solicitation and the OIG's role in detecting and preventing it. The OIG Communications Team produced educational material to remind Medicaid dentists and their staff of the prohibition against patient solicitation; the material outlines the prohibited behavior and the penalties involved. DSHS will share the information with providers across Texas through a variety of communication avenues.
The OIG enforces 1 Texas Administrative Code §371.1669, which prohibits a person from offering any cash, gifts or other items that may influence a potential client's selection of a Medicaid service provider.
Providers may not offer, and clients may not accept:
- Cash, cash equivalents or gift cards in any amount.
- Free or discounted services for a family member to influence their health care decisions.
- Transportation, unless it's properly arranged with the client's managed care organization or the Texas Health and Human Services Commission.
The OIG may investigate providers who advertise free transportation on their website or providers who hire people to canvass neighborhoods looking for Medicaid-eligible children and pay drivers to transport children for Medicaid services. Providing goods or services of any value could be considered a violation, but that would typically not be the case for non-cash, low-cost items such as a toothbrush valued less than $10.
If a provider solicits Medicaid clients, the provider may be found guilty of a Class A misdemeanor and a third-degree felony if the dentist was previously convicted of illegal dental solicitation or was employed
by the federal, state or local government at the time. The provider may be subject to disciplinary action by the Texas State Board of Dental Examiners, an injunction, civil penalties of up to $10,000 and possible
exclusion as a provider from the Medicaid and CHIP programs.
The OIG created a brochure to educate providers about the signs and consequences of illegal dental solicitation in Medicaid. Providers may download it from https://tinyurl.com/OIGsolicitation and share it
with their staff.
With this being said, it should be realized again that dental providers are less likely to receive a full OIG investigation than home health agencies, attendants, hospitals, nursing facilities, and even physicians. See page 5 of the report.
So think twice about giving that kid a toothbrush!quarterly_report_qtr1_fy2022