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
UPDATE: The Travis County Public Integrity Unit has forwarded the criminal investigation into the 21 CT matter to another undisclosed investigative unit. Per the Unit’s head, the investigation is starting to move faster and was moved for reason of expertise … Read More
There have been many changes for Medicaid dental providers over the last few years. The change from fee-for-service to managed care. The upheaval caused by the former Health and Human Services Commission Office of Inspector General and rampant allegations … Read More
No, that wasn’t $200 million. It wasn’t $50 million. It wasn’t even $500,000 or $250,000. The amount of dental fraud found and recovered by Texas dental management organizations in 2015 was only $243,982.84 per the “HHSC OIG Annual Report on … Read More
The Texas Tribune this morning reported that former Texas governor Rick Perry is now the chief strategy officer over at MCNA, one of the two managed care organizations Texas now employs to handle Medicaid dental. It is Perry’s first employment position after … Read More
This afternoon, the Health and Human Services Commission Inspector General Stuart Bowen sent out his second quarterly report – quite unlike his predecessor who sent out no such reports. It is a remarkable 28-pages and will take some time to … Read More
We want to close out 2015 with a round-up of the year’s most important stories relating to TDMR issues. It has been an exceptional year for changes at the Health and Human Services Commission. The implosion that occurred at HHSC … Read More
With the Government Accounting Office estimating that in 2014 some $124 billion was siphoned off the Medicaid and Medicare system nationally, we are again witnessing the truly schizophrenic nature of Medicaid enforcement actions in this country. In New York, this past week the … Read More
The Texas Health and Human Services Commission sent out an email notification this morning that it is holding a number of public forums about the restructuring of the agency and requesting stakeholder input. We strongly suggest that Medicaid providers take … Read More
A suit to compel the Texas Health and Human Services Commission to release the full list of names of Medicaid providers that have been placed under a “credible allegation of fraud” payment hold since 2010 has been filed in Travis … Read More
This past Friday, the Texas Supreme Court dismissed a petition from the Texas Office of Attorney General to review a 3rd Court of Appeal decision preventing the Health and Human Services Commission Office of Inspector General from placing payment holds … Read More
As TDMR reported back at the end of September, the new Health and Human Services Commission Inspector General Stuart Bowen had started settling outstanding investigations and cases against Medicaid dentists and providers. Senator Charles Perry was quoted in the media … Read More
Earlier this month, the Attorney Generals of Illinois and Arkansas announced the arrest and/or conviction of three individuals in different cases for Medicaid fraud. Going to jail for $1,000 The amounts of the fraud involved were around $1,000 per party … Read More
Last Friday, the Health and Human Services Commission sent out a notice that it had “updated its Medicaid Medical and Dental Policy web page by posting stakeholder comments and HHSC responses for the THSteps Diagnostic Dental Services policy in development.” … Read More
A document received from an open records request filed in early September shows that the Civil Medicaid Fraud division of the Office of Attorney General (OAG) has expended some 20,953 staff legal hours against 16 dentists and dental practices accused … Read More
The Texas State Board of Dental Examiners is under review by the Sunset Advisory Commission this year. The Board has published a 154-page self-evaluation report that can be downloaded from the Commission website. TDMR has not yet reviewed it. The Sunset Commission … Read More
As reported in the press this week, there has been a tremendous effort on the part of the new Health and Human Services Commission Inspector General Stuart Bowen to settle old, outstanding investigations against Medicaid providers—including dentists. Per the Chronicle, … Read More
UPDATE: Stick has been sentenced to six days in jail. The man who famously carried a toy stuffed wolf into informal resolution meetings with Medicaid providers and quipped that he could “find a program violation on Jesus Christ” if Jesus … Read More
As reported last week by the Austin American Statesman, Stuart Bowen, the new Inspector General for the Texas Health and Human Services Commission, is sending his first report to the Governor today. TDMR has obtained a copy of the full … Read More
The recent decision by a Travis County District Court judge that again vindicated Antoine Dental Center of Houston on allegations of Medicaid fraud and vacated a three-year “credible allegation of fraud” payment hold has been appealed by the Civil Medicaid … Read More
Back in May of 2014, the State of Texas terminated Xerox as the state’s Medicaid claims administrator and filed suit against the company. The state is seeking recompense for hundreds of millions of taxpayer dollars paid out by the company for … Read More
Dallas TV station WFAA is losing its long-time, award-winning investigative reporter Byron Harris to retirement. Harris announced a few weeks ago that he would be leaving the station in October, after spending 40 years with WFAA. It goes without saying … Read More
The Health and Human Services Commission has just put online proposed changes to the THSteps Diagnostic Dental Services Policy and is requesting stakeholder feedback on the changes. The updated policy will require the use of a professionally developed and … Read More
Yesterday, Travis County District Court Judge Amy Clark Meachum issued her decision in the case of Antoine Dental Centers of Houston, vindicating the practice in its payment hold case. The practice had been accused of “credible allegations of fraud” in … Read More
UPDATE, August 11, 2015: We have been informed by a very keen-eyed and interested observer that the definition of “physician” under the Social Security Act includes dentists. So we are not sure why the Texas Health and Human Services Commission … Read More
A name familiar to many Medicaid dentists who have felt the sting of Doug Wilson and Jack Stick’s Office of Inspector General in the last few years has resigned, per the Texas Tribune. Cody Cazares, an aide to former Health … Read More
The story about Dr. Rachel Trueblood settling in October 2014 with the Health and Human Services Commission Office of Inspector General for $39,000 after the agency was demanding $16 million in Medicaid overpayments is well-known. However, the story of another … Read More
In January, Stuart Bowen took charge of a state office rocked by accusations of corruption, incompetence and inefficiency. Responsible for ferreting out fraud amid the programs and procedures of the sprawling Health and Human Services Commission, the office of Inspector General … Read More
TDMR has learned that the new Health and Human Services Commission Inspector General Stuart Bowen, Jr. has been taking on and overhauling the agency’s use of statistical sampling and extrapolation. This is the most controversial tool that the agency had … Read More
The vicissitudes of Dr. Paul Dunn have been chronicled by TDMR over the last several years. Dunn first appeared on the scene when he came to Austin during the 2013 legislative session. “Credible allegation of fraud” payment hold, but told … Read More
Last Wednesday, July 16, lawyers for Antoine Dental Centers of Houston again went to court. Going Travis County District Court This time they appeared before Travis County District Court to appeal the Medicaid payment hold final decision by former Health … Read More
The eight steps you need to take to put together a program for yourself! Many people have asked what the process for establishing an effective compliance program is. At one point, having a compliance program was optional. As a result … Read More
Here is the June/July edition of the Texas Medicaid News! Hello and welcome to the Texas Medicaid news update, I’m Andy Zajac. Things have been hot and heavy over the last few weeks in Austin. 1) Our top story is … Read More
Four firms provided “proof of concept” demonstrations of their Medicaid fraud detection software to the Texas Health and Human Services Commission and its Office of Inspector General back in 2011. These proof of concept projects allowed the firms to access … Read More
