After our last article about possible termination from a DMO’s network for filing a complaint with HHS before all company complaint procedures have been exhausted, we picked up online copies of the Medicaid Provider manuals for DentaQuest, MCNA and UnitedHealthcare … Read More
Dr. Janice Reardon, Chief Dental Officer of the Office of Inspector General, has been honored with the Lifetime Membership Award by the Texas Dental Association. The award recognizes her 30 years of continuous membership in the TDA. A graduate of … Read More
After we published our article last week about the HHS complaint line and its email address, we received a few emails from dentists. Several were excited about the possibility of complaining to HHS about their DMO troubles, but one had … Read More
We received an email from a dentist a few weeks ago who was having trouble with a particular DMO. In the process of trying to assist them, we reached out to Texas HHS in an attempt to find a state-level … Read More
Our 2021 survey of Texas dental maintenance organizations is complete and the results have been compiled. Survey says: long-term providers MCNA and DentaQuest have improved their performance in the minds of Medicaid dentists from previous years while newcomer United Healthcare … Read More
The U.S. Department of Health and Human Services Office of the Inspector General just published an audit report this week that Texas paid out incorrectly $922,557 in CHIP payments to Medicaid managed care organizations. Now a million dollars in the … Read More
Medicaid fraud or fraud of any type is serious business, and something TDMR decries. Those low enough to use their position as healthcare professionals to bilk federal and state governments for personal gain that cheats the taxpayer and young underprivileged … Read More
SURVEY IS CLOSED As we come out of the pandemic and into a hopefully normal July 4 weekend, TDMR is issuing our annual survey to find out how dental maintenance organizations have been performing for Medicaid dentists over the last … Read More
On Tuesday, Texas HHS OIG sent out its June email newsletter. Out of the three articles promoted, one is again about dental Medicaid issues. This time the article is about common billing errors committed by Medicaid dentists, an article that … Read More
This past week the Attorney General of Texas sent out a press release that deemed agency personnel who had complained about potential conflicts of interest by the AG himself were “rogue political appointees” rather than whistleblowers because they had only … Read More
AUSTIN — Texas has the highest number and percentage of uninsured children in the country. According to the United States Census, the child uninsured rate in Texas rose from 9.8% in 2016 to 12.7%, over double the national average, in … Read More
Some stories never die. Here we are a decade later still talking about “Crooked Teeth” and the outcome of all those stories that ran on WFAA alleging hundreds of millions of dollars of Medicaid fraud committed by Texas orthodontists and dentists. … Read More
A recent open records request to the Texas Office of the Attorney General reveals that the state has paid out so far $457,416.67 to qui tam relator Joshua Lafountain. No knowledge or evidence of wrongdoing TDMR reported, starting last May, … Read More
By Ross Ramsey, The Texas Tribune – When this legislative session comes to an end on Memorial Day, Texas will still have more uninsured residents than any other state, and a higher percentage of uninsured residents, too. The Texas Legislature … Read More
The testimony in favor of changes to the Texas Medicaid Fraud Prevention Act by Austin administrative attorney Jason Ray is important for Medicaid providers to read. He testified on April 14 supporting the committee substitute version of bill HB3802 regarding … Read More
On April 14, the House Committee on Judiciary & Civil Jurisprudence held a public hearing and a few days later voted on CSHB 3082, a bill brought forward by House Representative Matt Krause. The purpose of HB 3082 is to … Read More
April 23: Texas House votes down budget amendment aimed at giving health coverage to more uninsured Texans: The Texas Legislature has declined to pass any broad expansion of state and federal health care coverage for uninsured Texans since the Affordable … Read More
We thought we would publish this on our website from the latest TSBDE newsletter received today. The PREP Act was changed back on March 11. Becoming a COVID-19 Vaccine Provider The latest amendment to the PREP Act expands qualified persons … Read More
Almost a decade ago, on May 13, 2011, Byron Harris, famed WFAA investigative reporter, started a large freight train roaring down the track with his first story of a series, “Texas taxpayers pay big for straight teeth.” False narrative destroyed … Read More
This article is reprinted from the OIG Monthly Newsletter received today. The majority of Texas Medicaid dental providers take pride in their work and deliver excellent care to their patients. Those who try to cheat the system and fail to … Read More
A study published this week in the Journal of Public Health Dentistry concluded that low-income individuals who received dental care under Medicaid expansion in Michigan had improved job outcomes as a result of better oral health. The paper entitled “Beneficiaries’ … Read More
We recently received a copy of a presentation to the House Appropriations Committee done by Cecile Young, the Executive Commissioner of Texas Health and Human Services. The presentation outlines the current scope of HHS and contains more than a few … Read More
UPDATE: Two days before we originally published this article on December 18, then entitled “Dentists Not Included as First Tier Healthcare Workers to Receive COVID-19 Vaccines,” the American Dental Association sent a letter to the CDC asking the agency to … Read More
Texas HHS-OIG has just published its report for 2020 on Medicaid fraud uncovered and reported by MCOs in Texas. The report shows that DentaQuest and MCNA found only $234,098 and $127,264 in Medicaid fraud, respectively for 2020. According to the … Read More
Bill filing has started for the upcoming legislative session at the Texas Capitol. One of the early filings is HB 648, a bill introduced by House Rep. Richard Peña Raymond of Laredo to modify the mandate of the HHSC Office … Read More
TDMR recently reported about an open record request filed with the Office of the Attorney General to find out how many dentists were indicted for Medicaid fraud by the OAG’s Medicaid Fraud Control Unit (MFCU), the section of the OAG … Read More
Online research has found that lawyers for Joshua Lafountain held a high-powered fundraiser in August of 2016 for the current trial judge in the case, Judge Maricela Moore of Dallas District Court 162. The event held at the offices of … Read More
More details have emerged about Joshua Lafountain, the relator in a Texas Medicaid Fraud Prevention Act qui tam lawsuit filed against 71 dental organizations and dentists in 2016. The case is now before a judge in Dallas County District Court. … Read More
TDMR recently received information from an open records request to the Texas Medicaid Fraud Control Unit of the Office of the Attorney General. The request asked for a list of investigations conducted by MFCU on dentists between 2011 and 2016 … Read More
Senior officials in the Texas Attorney General’s Office have asked federal law enforcement to “investigate allegations of improper influence, abuse of office, bribery and other potential crimes” by their boss, the Austin-American Statesman and KVUE-TV first reported Saturday. By Emma … Read More
A few weeks ago, we published our analysis of the latest Texas Health and Human Services Office of Inspector General quarterly report and were struck by the fact that despite the large number of Medicaid health professions represented, dentists received a … Read More
Remember back in 2012 when the media and the state were outraged by dentists giving out gift cards or other small inducements to have Medicaid children get under care? In case you don’t, here are links to some media articles … Read More
TDMR took the opportunity to send a few questions to the new president of the Association of Dental Service Organizations (ADSO) Emmet Scott about the results of our latest DMO survey. We received back the following thoughtful responses and hope … Read More
We are pleased to make public the results of our Texas Medicaid Dental Maintenance Organization Annual Survey 2020. This year 90 dentists took the opportunity to give us their views on the performance of MCNA and DentaQuest. Last year we … Read More
Attorney General Ken Paxton’s office yesterday sent out a press release announcing a final judgment in the civil Medicaid fraud case against Dr. Richard Malouf. Here is the text of the release: AUSTIN – Attorney General Ken Paxton today announced … Read More
Is it us or does Medicaid dentistry seem to get more attention in these reports than other specialties? Are we being sensitive? We couldn’t help but be struck by the fact that again complaints against Medicaid dentists make up only … Read More
Texas HHS-OIG published on their website June 24 an audit they completed on DentaQuest back on January 9. The audit found that DentaQuest had $1.53 million in “unallowable, unsupported, and overstated expenses on its Administrative Expenses FSR [Financial Statistical Report]” … Read More
Cecile Young has been named the new head of the Texas Health and Human Services Commission as the agency fights an ever-growing number of coronavirus cases in the state. Young, who has more than three decades of experience working in … Read More
At the end of April, a three-judge panel of the Fifth District Court of Appeals in Dallas ordered a malpractice lawsuit against the firm of Sommerman McCaffity Quesada & Geisler and Al Ellis, of counsel at the firm, to continue. The case … Read More
The Association of Dental Support Organizations (ADSO) is pleased to announce Emmet Scott, Community Dental Partners/National Dental Partners CEO, has been elected as the new president of the ADSO. Mr. Scott will succeed Michael Bileca of Dental Care Alliance, who … Read More
