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
A long time dental Medicaid provider recently sent to TDMR an old article that was written in the March/April 2005 edition of the Texas Medicaid Bulletin. It is interesting because both the Texas Medicaid and Health Partnership (TMHP) and the … Read More
Yesterday the Dallas Morning News reported that a North Dallas psychotherapist plead guilty to a five-year health care fraud scheme and agreed to surrender his license to practice psychology. The US Attorneys Office press release states that Michael Ellis Wolf, … Read More
At the beginning of December, 2013, the Health and Human Services Commission published online its budgetary figures for 2014. Included in the document are the 2012 and 2013 expenditures and metrics for the Office of the Inspector General and its … Read More
Texas State Office of Administrative Hearings judges, the Honorable Howard Seitzman and the Honorable Catherine Egan, provided their final Proposal for Decision in the case of Houston’s Antoine Dental Center to HHSC Excecutive Director Dr. Kyle Janek on Thursday. Antoine … Read More
TDMR is pleased to present the first 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; … Read More
Back on October 15th, 2012, now more than a year ago, Texas Deputy Attorney General for Civil Litigation John Scott testified before the House Committee on Public Health in the Capitol. TDMR has just reviewed the archived video from the … Read More
Before the Thanksgiving long weekend, TDMR received a copy of the August 2012 audit conducted by the HHSC Office of the Inspector General on the Texas Medicaid and Healthcare Partnership. As far as we know this is the first time … Read More
The Texas Sunset Commission is evaluating the state Health and Human Services Commission this coming year under its mandate to periodically review Texas state agencies for their operation and need to exist. About the Commission The Texas Legislature created the … Read More
After a 40-year career, Dr. Paul Dunn is now on the verge of bankruptcy because he helped Medicaid children. In 2012, HHSC-OIG placed Dunn’s practice in Levelland under a 100% “credible allegation of fraud” payment hold for his orthodontic Medicaid … Read More
Austin: (PR Web): Two administrative law judges with the Texas State Office of Administrative Hearings (SOAH) have issued their proposal for decision in the case of Antoine Dental Center of Houston (ADC) SOAH Docket No. 529-13-0997. ADC had been placed … Read More
by Becca Aaronson, The Texas Tribune November 5, 2013 The Texas Health and Human Services Commission’s Office of Inspector General, which says that hundreds of millions of dollars have been misspent on fraudulent Medicaid orthodontic and dental claims, has lost … Read More
The Office of the Inspector General website now has a report detailing the 2012 fraud detection and recovery activity of all managed care organizations (MCOs) that participate in Texas Medicaid. Under Texas Government Code, Section 531.113, the MCOs are required … Read More
At the recent Texas Tribune Tribunefest on health care held between September 27th to 29th, there were a number of interesting sessions. The second session moderated by Tribune health care reporter Becca Aaronson discussed Medicaid. Entitled, “The Fight of Over … Read More
by Becca Aaronson October 15, 2013 Texans discovered nearly two years ago that the state was spending more on orthodontic claims in its Medicaid program than the other 49 states combined, but recovery of millions in purportedly misspent Medicaid money … Read More
By Donna Domino, Features Editor October 9, 2013 — A jury has found that Small Smiles dentists did not perform unnecessary dental procedures on a young boy at one of the chain’s clinics in New York. The judge found that … Read More
The following is from a story from the October 5th Austin American Statesman. Texas AG sued by own lawyer Plaintiff says his initial complaints about office garnered reprisals. By Jazmine Ulloa A lawyer for the Texas attorney general’s office has … Read More
Here is the final judge’s order directing the Texas Health and Human Services Commission’s Executive Commissioner Dr. Kyle Janek and Inspector General Doug Wilson to return $1,255,195.20 to Harlingen Family Dentistry. The order can be downloaded here. AMENDED FINAL JUDGMENT … Read More
TDMR has put together this article to give dental and other Medicaid providers some common language understanding of the provisions of Senate Bill 1803 now in force to protect their due process rights. We have used the text of … Read More
This morning the San Antonio Express published a feature article headlining the case of Harlingen Family Dentistry and Dr. Juan Villarreal and his fight against the Office of Inspector General and their “credible allegation of fraud” payment holds. Reporter Jeremy … Read More
Harlingen Family Dentistry has won a tremendous legal victory this week. Travis County District Court Judge Amy Clark Meachum has granted HFD’s motion for a writ of mandamus to force the Office of Inspector General to return more than $1 … Read More
Back on September 5th, the Texas Tribune hosted a conversation on the future of Latino health care with Dr. Esteban López, a regional president for Blue Cross Blue Shield of Texas, Dr. Amelie Ramirez, director of the Institute for Health … Read More
The Health and Human Services Commission has put online its self-report to the Sunset Commission as HHSC is coming up for review by the Commission this coming year. The link below will take you to the HHSC website where you … Read More
Here are the latest statistics just released by HHSC. Children Enrolled in Medicaid, CHIP and CHIP Perinatal Programs by Month Month Children Enrolled in Medicaid¹ Children Enrolled in CHIP² Children Enrolled in CHIP Perinatal Coverage Total Children Enrolled Sep-13 2,511,311 … Read More
This past week State Office of Administrative Hearings (SOAH) Judge Roy G. Scudday ruled that Christine Ellis and her qui tam lawyers had no standing to appear in a hearing regarding an HHSC-Office of Inspector General payment hold placed on … Read More
The following was in the latest HHSC newsletter “In Touch.” HHSC’s Office of Inspector General (OIG) will hire 127 new employees over the next year, two-thirds of whom will be in enforcement as the division looks to speed up fraud … Read More
Ever wonder why Medicaid and Medicare rates are so low or why there was a Frew lawsuit? What about the future for reimbursement rates for Medicaid or Medicare health care providers in Texas? No need to wonder. Here’s your answer. … Read More
This past week attorneys for Antoine Dental Center (ADC) and those representing the Office of the Inspector General filed their closing arguments in the pending State Office of Administrative Hearings (SOAH) case. The case challenges the 100% payment hold that … Read More
Karen Nelson is no longer with the Office of Inspector General. The former Deputy Inspector General for the HHSC-OIG is now working for the Austin office of the DLA Piper law firm. Nelson apparently left OIG last month. One can … Read More
Hearing Transcripts Now Available for Download Antoine Dental Clinic vs. HHSC-OIG – Vol. 1 Antoine Dental Clinic vs. HHSC-OIG – Vol. 2 Antoine Dental Center v. THHSC, OIG – Vol. 3 Antoine Dental Center v. THHSC, OIG – Vol. 4 … Read More
The Texas Tribune published today an article outlining the coming changes to the Texas State Board of Dental Examiners as a result of House Bill 3201 that was passed by the legislature and signed by the governor. The legislation will … Read More
Here are some recent media stories that relate to Medicaid and Medicaid fraud. June 18th – Medicaid Orthodontist found guilty July 19th – Perry orders investigation into oversight of troubled rural hospital chain _ Dallasnews July 24th – AG, Planned Parenthood Affiliate … Read More
This week the staff of the Committee on Finance and Committee for Judiciary for the U.S. Senate released a negative report about DSOs entitled the “JOINT STAFF REPORT ON THE CORPORATE PRACTICE OF DENTISTRY IN THE MEDICAID PROGRAM.” The report suggested that one … Read More
The following is information on upcoming court hearings that are vitally important to this whole dental Medicaid provider issue. On August 13 at 9:00 a.m., an HHSC Appeals Judge will hear M&M Orthodontics of San Antonio’s Plea to the Jurisdiction. … Read More
Last week, Antoine Dental Centers of Houston and Harlingen Family Dentistry of Harlingen brought a motion before the Travis County District Court to unseal the massive Christine Ellis qui tam suit filing that in redacted form appears to have 46 … Read More
TDMR has learned that Harlingen Family Dentistry has filed a lawsuit against HHSC and the OIG challenging their authority to impose a payment hold on Medicaid providers for a simple program violation. The case, styled Harlingen Family Dentistry, P.C. vs. … Read More
As was reported in the media, on June 25th, 2012, Texas orthodontist Christine Ellis filed a qui tam suit against dental chain All Smiles with the Dallas firm of Waters and Kraus acting on her behalf. Ellis has been one of the … Read More
Before the end of the legislative session, TDMR posted an online survey, asking dental Medicaid providers their opinions about a number of important questions. What are the biggest challenges Medicaid providers face today? In your opinion, what is a Medicaid … Read More
TDMR has learned that Jason Ray, attorney at the Austin law firm of Riggs, Aleshire & Ray, P.C., recently negotiated a full settlement of an OIG complaint and payment hold against a dentist in the Dallas area. The dentist, who … Read More
