Dentaquest headquarters in Boston, MA We want to remind Medicaid dentists that DentaQuest is starting a new protocol on February 1 for reviewing restorations done on the same tooth within 36 months. This includes prior authorization along with other criteria detailed below in a copy of the letter sent out to dentists in December. Codes that are affected are D2140, D2150, … [Read more...]
State Accused of Withholding Documents in $2 Billion Medicaid Fraud Suit Against Xerox/Conduent
While we are now in 2019, there are some things from 2018 that are still pretty relevant regarding the $2 billion Medicaid fraud case against Xerox/Conduent that we haven't reported on. "Withhold discovery fundamental to this case" For example, that July 2018 court filing by Xerox/Conduent that we have previously cited also accuses the state of a systematic attempt to "withhold … [Read more...]
Members Sought for State Medicaid Managed Care Advisory Committee
Last Friday, HHSC sent out the following notice: If you're interested in Medicaid managed care issues, you might be interested in being a member of the State Medicaid Managed Care Advisory Committee. The Texas Health and Human Services Commission executive commissioner will appoint members to the committee to serve a two-year term or complete the term of a current … [Read more...]
TDMR Six Years Old and Still Going Strong
As we approach the New Year, we at TDMR have taken a few minutes to contemplate the last few years - six so far. We had no idea back in 2012 that we would still be going strong today. Come a long way On December 7, 2012, we launched this website and published our first article "Harlingen Family Dentistry Wins Major, Precedent-Setting Decision in Texas Medicaid Orthodontics … [Read more...]
Texas Lawyers Behind Samson Dental Partners and ImmediaDent $5.1 million settlement in Indiana
It wasn't in the media articles we reviewed for our story back on November 6, but we have since found out that the same Texas qui tam attorneys that were hired by the Texas OAG a few years ago were behind the recent $5.1 million dental settlement in Indiana. Charles Siegel, Daniel Hargrove and James R. Moriarty represented Dr. Jihaad Abdul-Majid, the whistleblower in the Samson … [Read more...]
HHSC OIG Orthodontic Consultant Reluctant to “Second Guess” Xerox/Conduent Prior Authorizations
A board certified orthodontist hired by HHSC-OIG was apparently reluctant to "second guess" Xerox/Conduent prior authorization (PA) approvals per a March 2009 email contained as an exhibit in the July 2018 Xerox court filing mentioned in last week's TDMR articles. However, the consultant was not told that TMHP (Texas Medicaid & Healthcare Partnership with Xerox as the lead … [Read more...]
“I Guess No One Really Cares” – HHSC OIG Director of Medicaid Integrity
In the same Xerox/Conduent court filing from July 2018 mentioned in our previous article, there is another exhibit worth mentioning. It is the complete email chain involving HHSC OIG officials discussing OIG investigator Ray Acuña's meeting notes on the Xerox/Conduent ortho prior authorization (PA) process. Stopped requiring molds for PA Some of the correspondence … [Read more...]
Court Document Shows Altenhoff and HHSC Knew Xerox Dental “Clerks” Worked at Home and Rubber Stamped Ortho PAs in June 2008
In a court document filed in July 2018 by Xerox/Conduent, an exhibit containing HHSC OIG email correspondence and notes from June 2008 proves that Dr. Linda Altenhoff, the state dental director, knew all about the faulty Xerox/Conduent ortho prior authorization (PA) process which carried on another three years and cost the state hundreds of millions of dollars. Altenhoff, as … [Read more...]
Capitation? DentaQuest and Brident Dental Agree on Alternative Payment Method
Dentaquest headquarters in Boston, MA We received a copy of this release from DentaQuest's Boston PR firm this morning. It appears DentQuest did continue to work with a large provider in Texas to come up with an alternative payment model. The details below are sketchy. DentaQuest Enters into First-of-its-Kind Value-Based Contract in Texas Alternative Payment … [Read more...]
Public Meeting in Austin on Managed Care December 12
The State Medicaid Managed Care Advisory Committee of HHSC is holding a public meeting in Austin on December 12. Here is the information: December 12, 2018 - 1:00pm Health and Human Services Commission, Brown-Heatly Building, Public Hearing Room 4900 North Lamar Blvd. Austin, TX 78751 This meeting will be webcast. To access the webcast, go … [Read more...]