Wednesday, TDMR received a notice that HHSC had put online a report from Deloitte Consulting LLP entitled, “State of Texas Medicaid Payment Reform – Market Assessment and Recommendation Analysis.” The report is dated March 31st, 2014 and is 51 pages … Read More
Yesterday, HHS-OIG issued an audit entitled “Acute-Care Hospitals In Texas Did Not Always Reconcile Invoice Records With Credit Balances And Refund To The State Agency The Associated Medicaid Overpayments.” The federal auditors, in looking over eight acute care hospitals in Texas, … Read More
This morning it was reported that the Inspector General of the Department of Health and Human Services issued a report that roughly 20% of all Medicare payments for evaluation and management claims in the United States are overpayments to physicians, … Read More
As this information is all a matter of public record, we have compiled the total amount of money that ACS/Xerox paid for lobbying Texas politicians since 2004. The amount is substantial, some $7,254, 999. Still got hit but it took time … Read More
HHSC yesterday sent out a notice that a new draft HHSC strategic plan has been issued to cover 2015 to 2019. They have invited public comment. Naturally, the report is 348 pages long and their first public hearing on the report … Read More
With the Attorney General of Texas filing suit against Xerox and the Health and Human Services Commission publicly washing its hands of the Fortune 500 company as lead contractor in the Texas Medicaid and Healthcare Partnership, Xerox now joins dental … Read More
Last week, Attorney General Greg Abbott filed a lawsuit against Xerox and its subsidiary, ACS Healthcare, alleging that the company had not properly vetted dentists’ pre-authorization requests to perform Medicaid orthdontic work on poor children, saddling taxpayers with hundreds of … Read More
TDMR filed an open record request a while ago to obtain the Texas dental Medicaid spending figures for the years from 2000 to 2005 and 2012, 2013. Texas Medicaid orthodontic spending from 2006 to 2011 has been heavily reported so we … Read More
Several suits by Medicaid providers filed today in Travis County’s 53rd Civil District Court seek to intervene in the recent lawsuit brought by the state of Texas against former state Medicaid claims contractor, ACS/Xerox (henceforth “Xerox”). Recover damages from both … Read More
On Sunday, the Austin American Statesman’s Eric Dexheimer reported on a brand new problem with due process rights for dental Medicaid providers dealing with HHSC-OIG – they must pay tens of thousands of dollars upfront as security for SOAH (State Office … Read More
REPUBLISHED FROM THE TEXAS TRIBUNE BY BECCA AARONSON Editor’s Note: This story has been updated throughout to reflect the state’s decision to cancel its contract with the Texas Medicaid and Healthcare Partnership, and the company’s response to the state’s actions. As the … Read More
AUSTIN – The Texas Attorney General’s Office today filed a civil lawsuit in state district court against Xerox Corporation and its wholly owned subsidiary, ACS Healthcare LLC. The State’s legal action seeks to recover fraudulent Medicaid payments for orthodontic and … Read More
Date: May 9, 2014 Contact: Stephanie Goodman, 512-424-6951 The Texas Health and Human Services Commission (HHSC) today notified Xerox Corp. that the state is terminating the company’s Medicaid claims administration contract for cause after Xerox staff approved thousands of requests for braces … Read More
Back in mid-April, TDMR sent to our dental Medicaid provider mailing list a simple one question survey – What is your biggest practice challenge? We received over 90 responses and results are now tabulated. The survey shows that Medicaid dentists are now most … Read More
The New York Times has published Trib reporter Becca Aaronson’s article on TMHP. For nearly five years, a state contractor allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on … Read More
by Becca Aaronson, The Texas Tribune May 2, 2014 Part two of two. For nearly five years, a state contractor allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on … Read More
by Becca Aaronson, The Texas Tribune May 1, 2014 Part one of two. In 2010 and 2011, Antoine Dental was among Texas’ top-billing Medicaid providers for orthodontic services, collecting more than $1 million annually for putting braces on poor children. … Read More
The Washington Times reported yesterday that ACS/Xerox is being sued in a class action by Nevada residents who purchased health insurance from the state health insurance exchange that was set up by the company. The state government contracted with ACS/Xerox … Read More
HHSC appeals “judge” Keith Grantham has denied a motion to disqualify HHSC appeals “judge” Rick Gilpin from presiding over the overpayment “hearing” of M&M Orthodontics of San Antonio. The ruling came out April 4th. “Court,” not court TDMR is now placing … Read More
In an unheralded August 2012 audit report that is available online, the federal Health and Human Services Office of Inspector General found that the Texas Health and Human Services Commission had not returned $2.6 million in Medicaid funding back to … Read More
The following is an opinion piece written by Jason Ray, attorney for a number dentists who are being prosecuted by HHSC-OIG for their Medicaid orthodontic billings. Mr. Ray is with the firm of Riggs Aleshire & Ray, P.C. I … Read More
The American Association of Orthodontists have updated their definition of “medically necessary” care to include “emotional well-being.” They have done so because they state that recent studies have linked a “patient’s dental appearance and the incidence of bullying.” Will such … Read More
A recent review of our website content revealed to us that while PDF files containing these photos have always been on the site, perhaps they have not been as prominently displayed as they should be. Medicaid after all is about … Read More
A new security risk assessment (SRA) tool to help guide health care providers in small to medium sized offices conduct risk assessments of their organizations is now available from HHS. The SRA tool is the result of a collaborative effort … Read More
The NY Times, in conjunction with the Texas Tribune, has published an article on the recent $3.75 million settlement between Carousel Pediatrics and the Texas Health and Human Services Commission Office of the Inspector General and its affect on the … Read More
This week the Texas Attorney General filed a remarkable brief to oppose the motion to disqualify HHSC judge Rick Gilpin from a Medicaid payment hold case because he was a senior lawyer in the Attorney General’s office for some 38 … Read More
A motion has been filed with the Texas Health and Human Services Appeal Division to have Judge Rick Gilpin disqualified as a hearing officer for cases involving dentists that started while Gilpin was still an attorney within the Attorney General’s … Read More
The same HHSC judge that overturned a favorable SOAH (State Office of Administrative Hearings) decision in the payment hold case of Antoine Dental of Houston, has denied a motion to have a Medicaid overpayment hearing held at SOAH. HHSC Administrative … Read More
The Health and Human Services Commission issued a press release this afternoon that OIG has now settled with Carousel Pediatrics of Austin on claims of Medicaid fraud, now deemed billing errors, for $3.75 million. $22.1 million settled for $3.75 million … Read More
The Big Conversation If the University of Texas System regents tap Gov. Rick Perry favorite Kyle Janek as their next chancellor, they won’t get pushback from the president of the system’s flagship campus. “I’ve known Kyle for a long … Read More
TDMR has received notification that HHSC-OIG has begun a Provider Education series that will cover topics of particular interest to Medicaid providers. It is about time. The first topic is Understanding Waste, Abuse and Fraud and TDMR has rabble roused … Read More
TDMR presents the second in a series of articles on health care compliance penned by TDMR President Greg Ewing. Greg is a health care lawyer with over fifteen years of experience in transactional health law; health information technology; privacy and security … Read More
According to a government source, Jack Stick has been elevated from his position at the Texas Health and Human Services Commission as Deputy Inspector General for Enforcement to that of interim Chief Legal Counsel, replacing the retiring Steve Aragorn. A further … Read More
On February 27th, administrative law judge Rick Gilpin of Texas Health and Human Services Commission issued a final order in the “credible allegation of fraud” payment hold case of Antoine Dental of Houston, fully reversing the Proposal for Decision written … Read More
When Steve Aragon’s daughter invited him to speak to her students for career day, he wasn’t sure what he was going to say. He was lined up behind a judge, a SWAT team member and a zoologist. But when it … Read More
On Monday, Augustine Ihenacho Nnadi, a Medicaid fraud analyst with the Texas Attorney General’s Office, was arrested for bribery. Agents with the FBI and the Texas Attorney General’s Office arrested Nnadi Monday morning in Houston, Texas. According to the criminal complaint, … Read More
Last September 27th, TDMR published an article concerning the fact that the Texas Health and Human Services Commission Office of the Inspector General at that time had not yet made available on its website, information on due process rights for … Read More
On Sunday, the Austin American Statesman published a feature article on the current state of affairs regarding how Texas regulators are dealing with the claims of large scale Medicaid orthodontic fraud that have been swirling around Texas since 2011. The … Read More
This past week a number of Medicaid dentists filed suit against ACS, Affiliated Computer Systems, the state’s Medicaid claims administrator better known as TMHP or the Texas Medicaid and Health Partnership. The dentists allege that ACS was negligent in their … Read More
Antoine Dental Center of Houston, Harlingen Family Dentistry of Harlingen, M&M Orthodontics of San Antonio and Dr. Paul Dunn of Levelland filed suit this past Monday against ACS, Affiliated Computer Services, the state’s private contractor which handles claims administration for … Read More
