Last July, Louisiana quietly and significantly increased its EPSDT Dental program fee schedule. According to online information, the increase came about because Louisiana Medicaid was using the Full Medicaid Pricing program to establish fees. Its creator, the Centers for Medicaid … Read More
TDMR has reported on a number of recent controversies regarding dental loss ratios and value-based care outside of Texas. Now, to address these issues nationally, a Massachusetts-based dental organization, the American Alliance for Dental Insurance Quality (AADIQ), has been formed … Read More
The latest OIG Quarterly report was released last month. It contains several important trends for dentists and trends in OIG investigations into dental practices. Firstly, OIG preliminary investigations into dentists and dental practices remain at their traditional level of 6%, … Read More
HHSC announced this morning that Conduent’s recently awarded contract as TMHP’s claims vendor had been terminated for convenience. Termination for convenience means “a party to a contract to bring the contract to an end without the need to establish that … Read More
For the last decade flying under the radar, a couple of dentists and their attorneys have quietly and doggedly pursued the private contractor that approved their Medicaid orthodontic prior authorizations from 2004 to 2012. These dentists are seeking damages for … Read More
Yesterday, we received an OIG update that is valuable for Medicaid dentists. OIG has found concerns “about inappropriate administration of sedation and local anesthesia, discharging the patient before they fully recovered from anesthesia, and billing for sedation levels the provider … Read More
Since Massachusetts voters overwhelmingly voted in favor of Question 2, the “Patient Access to Affordable Dental Care Act” in November 2022, instituting the nation’s first dental loss ratio, there has been a push to get other states on board with … Read More
In a landmark case for antitrust law and the dental industry, roughly 240,000 dentists and dental practices have initiated a class action lawsuit against Delta Dental, the United States’ largest dental insurance system. The case, formally known as In Re … Read More
TDMR received notification of a new report from Texas HHS on the End of Continuous Medicaid Coverage in Texas. The upshot for children who were under Medicaid coverage during the public health emergency (PHE) is that, at present, some 999,524 … Read More
Over the last several months, TDMR has been receiving anecdotal comments from Medicaid dental providers that they have found themselves truly between a rock and a hard place at this time. Although we have reported on a number of negative … Read More
On February 7, the Nebraska legislature passed the first reading on a bill to increase Medicaid dental reimbursement rates by a whopping 25%. In the only state with one state legislative body, that legislative body passed the bill 35-0. Recognizes … Read More
UPDATE: YouTube video added of hearing 22-1046 Malouf v. State ex rel. Ellis Supreme Court Hearing, January 31, 2024 It might just be possible that more than a dozen years after the great WFAA expose on “Crooked Teeth,” a Medicaid … Read More
This week, Pro Publica and the Texas Tribune released the results of an investigation into the Texas Office of Attorney General Civil Medicaid Fraud unit and its recent tremendous loss of staff coinciding with the firing of its long-time head, … Read More
The movement to set a dental loss ratio (DLR) for the dental insurance industry is fast becoming a national issue and is now on the agenda of a number of state dental associations as well as the ADA thanks to … Read More
Inspector General Raymond Winter who came to post last October released his first quarterly report at the end of December. It is also the report for the first quarter of fiscal year 2024. No cases involving dentists highlighted OIG settled … Read More
This week, Attorney General Ken Paxton issued a press release touting his agency’s recovery of some $203 million in 2023 from Medicaid fraud, waste, and abuse. The figures come from the 2023 Joint Interagency Coordination Report, which “summarizes the collective … Read More
The Office of the Inspector General just published a short interview with Inspector General Raymond C. Winter, who was appointed to the position last year. The interview is about his 2024 priorities. IG Winter had previously been a deputy attorney … Read More
Arizona, through its Arizona Health Care Cost Containment System (AHCCCS). the state’s Medicaid agency, has instituted a value-based healthcare initiative with its Differential Adjusted Payment (DAP) program, which has been running for several years. Value-based healthcare initiative Value-based healthcare focuses … Read More
TDMR has written extensively on how the provisions of the Texas Medicaid Prevention Act may be used by apparently unscrupulous relators to seemingly blackmail honest dentists into hefty monetary settlements to avoid costly and lengthy litigation. Problems with TMFPA The … Read More
The Texas Supreme Court agreed this past week to hear arguments as to why the $16.5 million summary judgment against Dr. Richard Malouf should not be upheld. Oral arguments will be heard on January 31 next year. A dozen years … Read More
Inc. Magazine just published an article by Adam Levin, Chairman and Founder of CyberScout, with his take on the alarming increase in fraudulent claims within Medicare and Medicaid due to the proliferation of medical identity fraud. This figure now exceeds … Read More
Back in March, TDMR published an article on the number of active THSteps Enrolled Dental Providers obtained from an open records request filed with Texas Health and Human Services. Records since 1996 Texas HHS has been compiling these figures since … Read More
Looking for a fee increase for Medicaid services? Here is another opportunity to make your voice heard. We received this email notification for Texas HHS this week. The Texas Health and Human Services Commission is working on its Legislative Appropriations … Read More
Over the years, we have published the concerns of many dentists who informed us of the various and sometimes substantial shortcomings in the performance of the various DMOs contracted by Texas HHS for dental Medicaid. There have been wrongly placed … Read More
Governor Greg Abbott announced yesterday that he has appointed Raymond C. Winter (“Ray”), former head of the Civil Medicaid Fraud division of the Office of the Attorney General, as the Inspector General for Texas HHS. He will replace Sylvia Hernandez-Kauffman, … Read More
Two weeks ago, TDMR reached out to Texas HHS to find out if a new dental director had been hired for the Medicaid CHIP program to take the place of Dr. Margaret Laccabue. And, yes, that has occurred. We were … Read More
OIG announced on their website yesterday that they were updating their self-reporting protocol for Medicaid providers. Here is what is said with a PDF copy of the protocol below. The OIG has updated the protocol providers use to voluntarily disclose … Read More
NOTE: DentaQuest had contacted us and the fees used for comparison initially were their commercial fees, not the Medicaid fee schedule available to providers and not publicly available online. We did not receive the correct fees from DentaQuest. However, we … Read More
Last month, TDMR was told that Inspector General Sylvia Hernandez Kauffman was going to be leaving OIG sometime in September. Today, we received confirmation from an OIG spokesperson that Ms. Hernandez Kauffman will be leaving the position on October 2. … Read More
The Office of Inspector General has another proposed rule on the Texas HHS “Comment on Proposed and Draft Rules” webpage entitled – “Recoupment of Overpayments Identified by Retrospective Payment Review.” This one is another addition to the Texas Administrative Code … Read More
Last Friday, Texas Health and Human Services sent an email notification that OIG was proposing a new rule (bottom of page) concerning “recoupment of overpayments identified by inspection” and wants public feedback by August 11. Public feedback Public feedback? Well, … Read More
In our last article “ADA Says Dentists Need to Accept Value Based Care as “Inevitable,” we referenced an online discussion on the Dentistry in General YouTube channel held on June 13. This passionate discussion revolved around the JADA editorial advocating … Read More
REPUBLISHED FROM THE TEXAS TRIBUNE Neelam Bohra, The Texas Tribune For seven years, Maricela Delcid has guided Texans through the Medicaid application minefield, working past language barriers and documentation issues out of a community center in Houston. But her clients … Read More
A firestorm erupted last month with an editorial published in the Journal of the American Dental Association titled “Value-based care in dentistry – Is the future here?” by Marko Vujicic, the chief economist and a vice president of the ADA’s … Read More
On June 27, we reported that the Legislature would not be increasing the Medicaid fee schedule for dentists despite the overwhelming need and the record abundance of funds in the state coffers this legislative session. The reason cited was that … Read More
A second ransomware group has claimed that it has attacked MCNA, breached its network and taken data for ransom. MCNA hacked again on June 14? The Snatch ransomware group posted on its dark web portal on June 14 that it … Read More
Considering that one of the largest DMOs in the country was hacked by the Russian ransomware group LockBit and their entire network data stolen, there has been surprisingly little media coverage about this massive data theft. The consequences of identity … Read More
With the passage of the record $321.3 billion state budget by the legislature and recent certification by the State Comptroller, all hope for a fee increase for Medicaid dentists this legislative session has evaporated. Efforts unsuccessful Efforts to educate legislators … Read More
The number of privacy law firms “investigating” MCNA for its massive data breach is growing exponentially. Here are just a few of the announcements made since our last article. Silver Golub & Teitell LLP Investigates MCNA Dental Data Breach Class … Read More
A major consumer rights law firm is now looking into the possibility of a class action lawsuit against MCNA for its huge data breach of some 9 million clients back in February, but just made public recently. Hagens Berman describes … Read More
