DentistryIQ recently published an important article examining how two Texas Medicaid fraud lawsuits are shining a spotlight on compliance risks facing pediatric dental practices. The title of the article is Is Pediatrics the Most Heavily Scrutinized Specialty in Dentistry? Ouch! The … Read More
The Texas Supreme Court has issued a significant decision that could reshape how Medicaid fraud cases are pursued in Texas, ruling that the State cannot simply point to an alleged regulatory violation. Instead, it must also prove that the alleged … Read More
HHSC has announced “that Stephanie Stephens will be the new Chief Medicaid and CHIP Officer, also known as Texas State Medicaid director, effective Aug. 15. Stephens will succeed Emily Zalkovsky and lead Medicaid and CHIP Services through the Sunset review … Read More
Delta Dental is again eyeing Texas Medicaid. TDMR has received recent reports from several Texas dentists indicating that Delta Dental is reaching out to recruit providers as part of a planned expansion into the Texas Medicaid market. According to information … Read More
Concerns are being raised about DentaQuest’s audit practices in the Texas Medicaid dental program, with some providers and attorneys questioning whether the process is fair, transparent, and functioning as intended. Austin administrative attorney Jason Ray, who represents healthcare providers in … Read More
Brident Dental & Orthodontics appears to be reducing its presence in Texas. TDMR has received several independent reports indicating that Brident locations in Texas are being offered to prospective buyers. One source familiar with the process described seeing a substantial … Read More
OIG recently published the following article on its website. Providers should know that AI is on the job at OIG now. New tech tools increase OIG productivity Teams within the OIG Data Operations Division recently launched new efficiency-focused tools … Read More
The Centers for Medicare & Medicaid Services has proposed a new rule to limit certain Medicaid payment arrangements used by states. According to CMS, the proposal is intended to “rein in misused Medicaid dollars” and place new limits on state-directed … Read More
We are republishing this article from the OIG website that was written for and published by Texas Dental Association (TDA). As the Texas Health and Human Services Office of Inspector General (OIG) works to prevent fraud, waste and abuse in … Read More
The ADA’s latest State of the U.S. Dental Economy (Q1 2026) has been released and paints an interesting picture. According to the report, on the surface, things look stable. Dentist confidence is holding, and consumer spending on dental care continues … Read More
For those of you still following this 15 year orthodontic debacle, in a long-awaited decision, the Fifteenth Court of Appeals has reversed a trial court’s ruling and held that Alexandra Alvarez, Joshua LaFountain, and Christine Ellis, DDS, are not entitled … Read More
Last Friday, TDMR published our article highlighting growing concerns about dental marketing in Texas Medicaid, as raised by a recent interagency report from the Office of Inspector General (OIG)/Office of the Attorney General (OAG). Well, the proverbial shit hit the … Read More
The latest Joint Annual Interagency Coordination Report from the Texas Health and Human Services Office of Inspector General and the Texas Office of the Attorney General, which was published this month, offers a useful reminder for Medicaid dentists about where … Read More
The Texas Health and Human Services Office of Inspector General (OIG) is under review by the Texas Sunset Advisory Commission this year, as a part of an overall evaluation of HHSC. OIG itself is inviting public input on its mission … Read More
Over the past nine years, Jeff Leston of Castlestone Advisors has written several articles for TDMR examining why Medicaid fraud continues despite decades of enforcement efforts. In his previous pieces, Why States Aren’t Really Interested in Reducing Medicaid Fraud, A … Read More
Almost 15 years ago, on May 13, 2011, WFAA’s Byron Harris uttered the famous phrase, “Nobody has ever died from crooked teeth,” which ushered in the Great Texas Medicaid Fraud Debacle. To think that today, in 2026, TDMR would still … Read More
DentaQuest has named a new dental director for its operations in Texas. Dr. Ronke Ogunbameru, a board-certified pediatric dentist based in Mansfield, will take the reins of the troubled Texas DMO. The Sunlife-DentaQuest press release sent out Thursday says that “she … Read More
The following is a press release from the Office of the Governor. ————————————- Governor Greg Abbott today sent a letter directing the Texas Health and Human Services (HHS) Office of Inspector General and the Texas Health and Human Services Commission (HHSC) … Read More
A new federal class action lawsuit alleges that Delta Dental Plans Association and more than 40 affiliated Delta Dental entities systematically mislead insured patients regarding the extent of coverage for out-of-network dental care. The lawsuit was filed in the U.S. … Read More
TDMR has received and confirmed a new complaint about DentaQuest regarding the DMO’s handling of primary tooth extractions. The issue has now been independently verified by three additional dental offices, indicating it is not an isolated incident but a recurring … Read More
Texas Health and Human Services has sent notifications that it is now accepting applications to serve on the State Medicaid Managed Care Advisory Committee for a two-year term. The first line says it all. “If you’re interested in issues related … Read More
Stephanie Muth, the former commissioner of the Texas Department of Family and Protective Services, has been named Texas’ next health commissioner. Her first day will be on Jan. 3. On Wednesday, Gov. Greg Abbott announced that he has appointed Muth … Read More
We have received numerous emails asking, “What can we do about DentaQuest’s [name your problem]?” Beyond quitting, we need a new adage. Yes, “the squeaky wheel gets the grease,” but a broken wheel needs more than grease because DentaQuest is … Read More
Sun Life, the Canadian parent company of DentaQuest, has reported a $64 million drop in income for its U.S. dental and group benefits segment. Their explanation for the dental drop? Americans use too much dental care. Yep. On the Q3 … Read More
Our article earlier this month, DMO Credentialing Practices Continue to Burn Dental Providers, on the continuing problems with DMO credentialing drew a quick response from several frustrated Texas dentists — and the stories are all too familiar. “What a mess, … Read More
TDMR took a look at the most recent enrollment figures for Texas Medicaid on the HHSC website. HHSC used to keep this up pretty well, but for some reason, the latest data is from July 2025. What we discovered was … Read More
MassHealth posted a notice on its website on October 1 that it will be “transitioning back to DentaQuest in early 2026. BeneCare will continue to provide services as our Dental TPA through the transition period. MassHealth is committed to processing … Read More
Back in early 2023, TDMR reported on the credentialing mess involving TMHP, UnitedHealthcare Dental, MCNA, and DentaQuest. We wrote the following articles, including filing a complaint with OIG on the continuing debacle. Credentialing Still a Disaster for Texas Medicaid Dentists … Read More
A federal judge in Chicago on Monday denied class certification to dentists in the long-running antitrust case against Delta Dental, which sought damages estimated to be worth $13 billion. The suit accused Delta Dental Plans Association and its affiliates of … Read More
Last Thursday, TMHP posted the revised Medicaid dental fee rates on its website. Finally. We were continuously told that the DMOs had updated their fee schedules, but nothing had been posted on TMHP, which is where they were supposed to … Read More
We’ve watched. We’ve waited. We’ve inquired numerous times to see when and if the Medicaid dental fee schedule would be modified as a result of the July 22 public hearing. Notification supposed to have been posted Last Friday, around 1 … Read More
TDMR has been in contact with HHSC Provider Services over the last week to find out when or even if there would be any revisions to the Medicaid dental fee schedule before the September 1 implementation deadline, as stated at … Read More
At the end of July, WalletHub released a report on the “Best & Worst States for Health Care (2025).” WalletHub is a personal finance website and mobile app that provides users with tools and resources to manage their credit and … Read More
As we reported in our last story about the fee schedule, Texas Health and Human Services Commission (HHSC) Provider Finance was holding a public hearing to receive comments on the proposed Medicaid reimbursement rate changes, including the long-awaited dental rate … Read More
The Kansas legislature recently took a major step forward to improve Medicaid dental care by approving a major increase in its Medicaid dental fee schedule. The increase became effective July 1. Fees increased up to 50% Fees for exams are … Read More
The Health and Human Services Commission (HHSC) has released the revised schedule of Medicaid dental fees as a result of the state budget amendments as follows: Rider 24 directs HHSC to increase reimbursement rates for maternal fetal medicine radiological services … Read More
The state budget signed by Gov. Abbott on Sunday includes a provision approved by the Texas legislature that adjusts Medicaid dental reimbursement rates for a selected group of procedure codes, which will greatly benefit dental providers. According to the TDA, … Read More
After 18 years of no increases in Medicaid dental fees, Arkansas has taken meaningful legislative action to increase Medicaid dental reimbursement rates — a move that providers and advocates have long awaited. Fee increase now law Signed into law on … Read More
Governor Greg Abbott reappointed Raymond Charles “Ray” Winter as the Inspector General for Health and Human Services for a term set to expire on February 1, 2026. Raymond Charles “Ray” Winter of Austin is the Inspector General for Health and … Read More
A Medicaid dental provider with multiple offices in the state contacted TDMR this past week, voicing serious concerns about recent restrictions imposed on their practice by Canadian-owned DMO DentaQuest regarding the use of substitute dentists. Violation of Texas Administrative Code … Read More
