UPDATE: TDMR has received a copy of the ImmediaDent and Samson Partners press statement from Samson Partners vice-president of marketing Stephen Valenti. It is at the bottom of our story in full. Indiana-based ImmediaDent and DSO Samson Dental Partners of Kansas have agreed to pay the federal government and Indiana some $5.139 million to resolve false claims allegations of … [Read more...]
UPDATE: HHSC Proposes to Reduce Monies an MCO Obtains from Fraud Recovery to 50% from 100%
UPDATE: We've added below an additional HHSC presentation given to the House Committee on General Investigating & Ethics which gives further details of MCO contract management. This morning HHSC sent out a notice that it was looking for public comments on several proposed rule changes relating to MCO fraud investigations of providers and fund recoveries. Draft rules on … [Read more...]
State Board of Dental Examiners Stakeholders Meeting November 20
The Texas State Board of Dental Examiners will be holding a stakeholders meeting in Austin on November 20. It will be held at the William P. Hobby Jr. State Office Building, Tower III, Room 100, 333 Guadalupe Street at 1:30 pm. Its purpose is to allow stakeholder input to the Dental Practice Committee which will be considering the following: Teledentistry, specifically … [Read more...]
Medicaid Managed Care Companies in Ohio Received $90 Million in Payments for Dead People
Reported in a shocking report released this week, the Office of Inspector General for the U.S. Department of Health found that the Ohio Department of Medicaid made $90.5 million in capitation payments to managed care organizations in the state on behalf of deceased beneficiaries. Over 81,000 payment made over two years The audit covered a two-year period from July 1, … [Read more...]
UPDATE: New RFP Out – Say What? Dental RFP Canceled by HHSC Over Proposal Problems
UPDATE: Christine Mann, the Press Officer at HHSC, has informed us that new RFP is out as of yesterday. The information is below and is available at http://www.txsmartbuy.com/sp/HHS0002879 Medicaid CHIP Dental Status: Addendum Posted Solicitation ID: HHS0002879 Response Due Date: 11/30/2018 Response Due Time: 2:00 PM Agency … [Read more...]
HHS Looking for Feedback on Proposed Rules
Texas Health and Human Services as a government body develops "rules" to implement laws passed by state and federal legislators. Their website states that "to be good stewards of the public trust, HHS takes into account stakeholder input when rules are being written or updated to ensure interested parties have a chance to contribute to the process." Unfortunately, … [Read more...]
Lifetime Limitation for Restorations and Stainless Steel Crowns
Back in August, a notice appeared on the TMHP website that Texas Medicaid was going to impose a lifetime limit for restorations and stainless steel crowns on September 1. Lifetime limits The notice said: Effective for dates of service on or after September 1, 2018, lifetime limitations for restorations and stainless steel crowns will change for Texas Health Steps. The … [Read more...]
Dentist Quits MCNA in Disgust Over $33,000 Recoup Demand
From time to time, TDMR receives correspondence from dentists expressing their frustration and anger with one or both of the current DMOs managing Texas Medicaid. Last week, we received an email from a dental provider about a recoupment demand made by MCNA. Apparently, it took the company three years to review the documents he had sent them per their initial request. He … [Read more...]
TDA Weighs in on DMO RFP and Capitation
In the last edition of TDA Today, the Texas Dental Association goes to bat for dental Medicaid providers on two issues. First, the publication reported that the TDA's Council on Public Health and Access to Care met with HHSC (HHSC, HHS; tomato, tomahto) reps from the Quality Oversight, Finance and the Medicaid/CHIP Services Department. They discussed the state requirement … [Read more...]
Valley Providers Heap Scorn on Medicaid Managed Care
The Statesman published an article this morning about the scathing testimony heard by the House Committee on Human Services, chaired by Rep. Richard Peña Raymond, at a special hearing held yesterday in Edinburg. Wanted public and provider feedback on managed care The Committee traveled to the Valley to hear testimony from Medicaid providers and public about "the impact … [Read more...]