The latest quarterly report issued by IG last week reminds Medicaid providers that CMS has a deadline of September 25 for re-enrollment of all Medicaid providers (deadline originally March). All providers who enrolled prior to January 1, 2013, must … Read More
In his recent quarterly report, Health and Human Services Commission Inspector General Stuart Bowen announced the kickoff off his initiative to increase awareness and cooperation on fraud, waste and abuse between Medicaid stakeholders. The IG Integrity Initiative (IGII) is described as … Read More
This week the Health and Human Services Commission Inspector General released his June 2016 quarterly report on the activities of his agency. Besides announcing the creation of a Pediatric Dentistry Action Team, the report also discloses that more Medicaid dentists … Read More
One of the main items of interest to Medicaid dentists from the latest quarterly report from the Health and Human Services Commission Inspector General Stuart Bowen is that a “Pediatric Dentistry Action Team” has been created within his agency. The … Read More
Today, Health and Human Services Commission Inspector General Stuart Bowen Jr. issued his fourth quarterly report since he took office back in early 2015 replacing former Inspector General Doug Wilson. Please find a copy of the report below. It can … Read More
TDMR has learned that a number of dental providers have reported being placed on payment hold by MCNA for “willful misrepresentation or abuse of claims.” Payment holds placed for mistakes and missing paperwork In these reports, dentists claim that MCNA’s … Read More
If you remember the heyday of HHSC/TMHP/Xerox program spending on orthodontia back in 2011 that begat allegations of Medicaid fraud, it was at a sky-high $249 million. In 2015, it was $13.6 million. So it is little wonder that the number … Read More
In case you might be wondering how much Texas now spends on dental care for Medicaid children, we now have an answer for you. TDMR filed an open record request earlier this year to get the spending figures for 2014 and … Read More
Over the past two weeks, it has been a major story that Attorney General Ken Paxton took a $100,000 donation for his personal legal fees from a friend whose company was accused of Medicaid fraud. The company just settled the … Read More
reported this morning on a new contracting scandal involving current Medicaid claims administrator Accenture and the Office of Attorney General. Outrage of use of “emergency leave” for fired staff You might remember back in May, the OAG was found to … Read More
Back in July 2013, TDMR surveyed Medicaid dentists about their opinions and problems with Medicaid at that time. 139 providers answered up and “provider rights” was the most popular response for the challenges Medicaid providers were facing then. Things have … Read More
Dr. Juan D. Villarreal of Harlingen Family Dentistry and founder of Texas Dentists for Medicaid Reform has completed the writing of a book about his personal experience with Texas Medicaid and its attempt to falsely accuse Texas dentists of healthcare … Read More
Back on May 19, Sen. Chuy Hinojosa and Rep. Richard Peña Raymond hosted a town hall meeting for providers on Medicaid managed care in Edinburg at the Edinburg Conference Center at Renaissance. It has taken a while but here are … Read More
On Thursday, June 23, the Texas Sunset Advisory Commission held its mandated public hearings on state agencies under review this legislative session. Four hours of testimony Over the 12 hours of testimony were given before the Commission on that date … Read More
Recently, TDMR filed an open records request with the Texas Health and Human Services Commission to find out how many individual Texas dentists are currently participating in Medicaid and how those participation numbers have changed since the Frew settlement in … Read More
Those that want to make their views known about the current state of the Texas State Board of Dental Examiners can testify in Austin next week before the Sunset Advisory Commission. The staff report from the Commission is highly critical … Read More
You might remember the case of Austin dentist, Dr. Rachel Trueblood. $16 million overpayment demand settled for $39,000 Back in 2014, Dr. Trueblood had been accused of Medicaid fraud, placed on “credible allegations of fraud” payment hold which closed her … Read More
McAllen dentist Dr. Jose “Joey” Cazares has been elected by members of the Texas Dental Association’s House of Delegates to be the 2016-2017 President-Elect of the Association, and will automatically ascend to the Presidency in 2017-2018. Dr. Cazares will be … Read More
The policy revision to the Medicaid orthodontic benefit process contemplated by representatives of the Texas Medicaid and Healthcare Partnership and the Health and Human Services Commission in 2009 was sweeping. Per the final draft of the confidential policy revision attached … Read More
The Health and Human Services Commission in February 2009 asked the individuals working on the new Medicaid orthodontic benefit policy to review whether or not a board certified orthodontist should review each and every prior authorization request for orthodontic treatment. … Read More
The TMHP document reported about in our last story that was recently appended to a court filing by Xerox shows that staff from the Health and Human Services Commission and its Office of Inspector General were well aware of the … Read More
A new document has come to light out of the lawsuit the state filed in 2014 against Xerox, its former Medicaid claims administrator, that shows Medicaid dentists were concerned as early as 2007 about Xerox’s prior authorization process and demanded … Read More
This coming Thursday, May 19 from 8:30 am to noon, a town hall meeting on Medicaid managed care is being held at the Edinburg Conference Center at Renaissance, 118 Paseo Del Prado, Edinburg,TX. The meeting has been set up to allow Medicaid providers … Read More
The Houston Chronicle reported this morning that Frianita Wilson, the wife of former Health and Human Services Commission Inspector General Doug Wilson and an HHSC executive in her own right, is now back at work at HHSC after being on administrative … Read More
Charles Smith, a longtime ally of Gov. Greg Abbott, will be the next executive commissioner of the Texas Health and Human Services Commission, the governor announced Tuesday. Smith, the chief deputy executive commissioner at the massive agency, will start his … Read More
Earlier this week, TDMR received an email from a mother who had her sons under Medicaid orthodontic treatment back in 2011 and 2012 and is still very upset at the both the state handling of the matter and the lack … Read More
Dr. Michael Goodwin of Amarillo pleaded guilty to one charge of health care fraud back in 2012 relating to the investigation into allegations of statewide Medicaid orthodontic billing fraud. Goodwin is the only dentist out of that morass to so … Read More
Health and Human Services Commission Inspector General Stuart Bowen Jr. announced in his quarterly report a new initiative to help combat Medicaid fraud and also help Medicaid providers. This is the IG Integrity Initiative. It was formally rolled out on … Read More
This morning Health and Human Services Commission Inspector General Stuart Bowen Jr. issued his latest quarterly report on OIG activities and results. Bowen has ushered in a new era of transparency and accountability for the agency and these reports provide … Read More
The investigative digging of the Texas media into the operations of state government has once again revealed to the public, otherwise blissfully ignorant, the tremendous apparent hypocrisy of several state officials who view their positions as the divine right of … Read More
Since 2012, there have been a large number of outstanding but here-to-date sealed False Claims Act lawsuits against Texas dentists who billed Medicaid for orthodontic treatment from 2007 to 2011. Some are known and high profile but there are 46 pages … Read More
The Sunset Advisory Commission today released its staff report on their observations and recommendations relating to the State Board of Dental Examiners. Basically, they found it had too many board members who did too little and got mired in business- … Read More
Today the Sixth Court of Appeals issued their decision in the Medicaid payment hold case of Antoine Dental Center of Houston. The court again exonerated the practice from allegations of Medicaid fraud, again terminated the payment hold and, for the … Read More
Gov. Rick Scott of Florida has signed into law changes that bring back DMOs such as MCNA and Dentaquest into Florida’s dental Medicaid program if all goes well. Florida governor signs new bill relating to dental Medicaid Florida HB 819, … Read More
Governor Greg Abbott has named Steve Austin chair of the State Board of Dental Examiners. The governor has also appointed Diane Garza for a term set to expire February 1, 2017, appointed Bryan Henderson, II, Jorge Quirch and Rich Villa … Read More
Four federal lawmakers from New Mexico – Sen. Martin Heinrich, Sen. Tom Udall, Rep. Ben Ray Luján and Rep. Michelle Lujan Grisham – filed a bill last week to guarantee due process rights to Medicaid providers across the country who are … Read More
Well, the answer to that question is about to be answered shortly. TDMR was contacted today by none other than Dr. Paul Dunn, the long-suffering dentist from Levelland who thought his troubles with Medicaid were over when he settled his … Read More
USA Today reported last week that 27 corporations listed in the Standard & Poor’s 500 paid no income tax for 2015 despite having pre-tax profits. The corporate giants include General Motors, Hewlett Packard, United Continental, News Corp, Weyerhauser amongst others. … Read More
The Texas Supreme Court this week issued a ruling allowing a whistleblower suit filed by Michael McMillen, a former Health and Human Services Commission Office of Inspector General attorney, to continue. McMillen contends he was fired in early 2012 for reporting … Read More
UPDATE: MCNA has responded to our recent request for a contact for provider complaints and provided information about their complaint process. See information below. Managed Care Organizations (MCOs) received significant mention in the report issued by the Health and Human … Read More
