A striking aspect of Medicaid fraud news is that it took so long for public officials to figure out that private companies have a profit motive. Also notable is that Managed Care Organizations (MCO) are not only lax in addressing … Read More
State Medicaid Director Stephanie Stephens, in a speech given on September 27 at the 2022 North Texas State of Reform Health Policy Conference, stated that an HHS priority for the upcoming legislative budget is Medicaid provider rates. Provider fees a … Read More
The American Dental Association recently held a webinar in which members of a key study about Medicaid dental practitioners provided details of their findings. Estimate drops by 11% The main takeaway is that the ADA has now readjusted downward from … Read More
TDMR received an email from Texas Health and Human Services this week requesting everyone’s help to come up with ideas to save some dough. Apparently, the Texas Legislature directed HHS to figure out how to save $350 million for the … Read More
OIG recently published the following article on its website which we thought to republish here along with the PDF documents linked to in the article. Texas providers encouraged to self-report overpayments Providers continue to participate in the OIG’s self-report process, … Read More
According to a recent report entitled “Access to Oral Health Workforce Report, Part I” by the Pennsylvania Coalition for Oral Health, the state lost 13.5% of its dentists participating in its Medicaid program between the beginning of 2019 and the … Read More
Ensuring Texas Medicaid dollars are spent for their intended purpose requires the Texas Health and Human Services (HHS) Office of Inspector General (OIG) to work with health care professionals to prevent fraud, waste and abuse. Accurate medical and dental coding … Read More
The recent business headlines about Sun Life, the Canadian insurer that purchased DentaQuest earlier this year, and its Q2 financial results are quite bipolar – either dismal or glowing. Good Q2 or not for DentaQuest purchaser Several publications spotlight the … Read More
The American Dental Association has reported that dental services increased 1.9% in June, the highest single-month rise ever recorded since the Department of Labor started keeping track in 1995. Job Market Increases The increase is attributable in part, according to … Read More
The American Dental Association reports that 14 state legislatures have passed progressive legislation regarding Medicaid dental care this year, partly due to increased budget surpluses in those states. Connecticut, Georgia, Illinois, Maryland, Mississippi, Missouri, Nebraska, South Dakota, Tennessee, Vermont, and … Read More
Thanks to the excessive prices for oil products due to the attempted embargo of Russian oil to punish the country for its war on Ukraine, the Texas state budget will benefit to the tune of some $27 billion, according to … Read More
The Texas Exclusions Database simplifies applicant screening for Medicaid providers, offering the ability to better protect their patients with real-time verification of potential employees before they are hired. Texas Health and Human Services (HHS) Office of Inspector General (OIG) protects … Read More
After our article about the need for a review of Medicaid dental fees was published in May, we received a number of comments from dentists about how the lack of a fee increase is impeding service to their clients and … Read More
TDMR has learned that a number of Medicaid dentists around the state have been receiving informal letters from the Office of Inspector General about their billings. Avoid formal process Apparently, OIG is looking to resolve billing situations informally rather than … Read More
PRESS RELEASE BY Sun Life Financial Inc. Jun 01, 2022, 08:27 ET BOSTON and WELLESLEY, Mass., TORONTO, June 1, 2022 /PRNewswire/ – Sun Life Financial Inc. (TSX: SLF) (NYSE: SLF), through its U.S. business, announced today the completion of its acquisition of DentaQuest, the second-largest dental benefits provider … Read More
It is with some irony that a company that has been found guilty of insurance fraud by a jury in Delaware (and apparently colluding with the Texas Office of the Attorney General to do so) is still a major player in … Read More
Everyone remembers the Frew case back in 2004 when the Supreme Court forced Texas to provide basic healthcare services including dental care for Medicaid-eligible children. Reason for fee increase in 2007 For those that don’t remember, let’s recap. Linda Frew, … Read More
In March TDMR reported on the federal HHS-OIG report about the 2021 cumulative activities of state Medicaid Fraud Control Units around the country. As there were no state breakdowns, we filed an access to information request with the Office of … Read More
This was posted on the Texas HHS-OIG website yesterday. Thought we would republish.. ————————— Ensuring Texas Medicaid dollars are spent for their intended purpose requires the OIG to work with health care professionals to prevent fraud, waste and abuse. Accurate … Read More
The list of complaints about DentaQuest from Medicaid providers keeps growing. It seems that new Canadian ownership hasn’t changed any business practices so far, but we hear they like their money too. While some problems have been reported about MCNA … Read More
The following article was supplied by Texas HHS-OIG. Keeping accurate and complete patient records is part of providing quality patient care. Good record keeping can also help protect a practice against allegations of wrongdoing. The patient record is a legal … Read More
TDMR received an email notification today that Texas HHS is looking for a Dental Policy Analyst to assist in advanced complex dental and medical benefits policy analysis, development and consultation. No necessary dental requirements The odd about the advertisement for … Read More
The Department of Health and Human Services Office of Inspector General recently released its 2021 Medicaid Fraud Control Units (MFCU) Fiscal Year 2021 Annual Report. Investigates criminal fraud Medicaid Fraud Control Units have the job of investigating criminal fraud by … Read More
Just received this notification today. NOTICE OF STAKEHOLDER MEETING March 11, 2022 The Texas State Board of Dental Examiners will host a Stakeholder Meeting Friday, March 11, 2022 at 1:00 PM The meeting will be in person and broadcast via Zoom … Read More
The Houston Chronicle broke a bombshell story today (paywall, unfortunately). This ortho story still has legs. OAG assisted company they were suing to defraud insurer The Chronicle reported that the Office of the Attorney General had secretly made last-minute modifications … Read More
TDMR has done a review of the Texas Medicaid dental maintenance organization contract available publicly on the Texas HHS website and found a requirement that all medical necessity determinations be based on “valid and reliable clinical evidence or a consensus … Read More
We found an article recently published on the OIG website that we thought should be republished here. Providers encouraged to self-report errors More providers are participating in the OIG self-audit process so they can determine if they need to self-disclose … Read More
The 2021 annual report published by Texas HHS-OIG on fraud and abuse recoveries by MCOs and DMOs again shows a minimal amount of Medicaid fraud being found and recovered considering the state’s whooping multi-billion dollar healthcare budget. For 2020/2021, the … Read More
It has been reported in two Florida business publications this week that children of the late MCNA founder Dr. Jeffrey Feingold have sold the company’s headquarters in Ft. Lauderdale to a Florida capital firm. According to The Real Deal, a … Read More
TDMR published a letter from a dentist a month ago who expressed their outrage about DMO self-made rules that restrict and inhibit treatment of young Medicaid-eligible children to their detriment. Now that the holiday season is well out of the … Read More
It is remarkable that in a state that cherishes free enterprise, it is okay for dental maintenance organizations to offer money and other inducements to encourage parents with Medicaid-eligible children to use their company yet it is a crime for … Read More
After our article last month on rate and coverage drops in Webb county for Medicaid waiver patients when DentaQuest took over the program, it didn’t take too long for us to be contacted about similar concerns within CHIP and children’s … Read More
We just received a press release from the Office of the Attorney General. Paxton Stops Vaccine Mandate for Healthcare Workers AUSTIN -Texas Attorney General Ken Paxton secured a preliminary injunction for the State of Texas, stopping the Biden Administration from imposing vaccine mandates on the employees of Medicaid and Medicare providers and suppliers. “This … Read More
Almost three hundred seniors and patients with disabilities were stranded mid-treatment plan in Laredo thanks to a change in dental insurance providers in July of this year. Since 2017, Dr. Amin Abdul of the Asclepius Dental Center of Laredo has … Read More
Texas Medicaid dental providers should know that DentaQuest was purchased by Canadian group benefits giant Sun Life Financial Inc, the country’s largest. The sale took place back in early October. The price? $2.475 billion US. Bloomberg reported: The acquisition gives … Read More
On Friday, TDMR received an email notification from the Office of the Governor that its Regulatory Compliance Division is now reviewing and accepting public comments on the Texas State Board of Dental Examiners rule change to establish the standards of … Read More
This is a trial balloon. We’ve written numerous articles about the need for changes to the Texas Medicaid Fraud Prevention Act. The Act needs to be a deterrent for real fraudsters, not a state-supported protection racket to be used against … Read More
Dr. Jeffery Feingold passed away on October 7 after a battle with cancer at the age of 75. His passing has received little press attention. Surprisingly, no major media have reported on it considering Dr. Feingold’s important contribution to healthcare … Read More
Last week TDMR obtained a copy of the latest HHS Ombudsman report on complaints about managed care to the agency from Medicaid clients. The report contains a significant section on Dental Managed care. Medicaid dentists may not get a copy … Read More
Our last story on reputationally challenged qui tam relator Joshua Lafountain and the highly questionable settlements forced from a large number of Medicaid dental entities, supported by the Office of the Attorney General, brought about an outraged comment from an … Read More
