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
It was announced yesterday that Emily Zalkovsky will replace Stephanie Stevens on July 1 as Medicaid and CHIP Director for Texas HHS. Ms. Zalkovsky has been deputy director since September 2020. There is no mention of why Ms. Stephens is … Read More
MCNA has been making the news the last few days because it placed a notice on its website May 26 as well as sent letters to several state Attorney Generals that it was hacked back in February and that the … Read More
Texas Medicaid nursing providers received a rate increase this past weekend as the Texas legislature approved an extension to a COVID-era add-on until August 31 and a further $900 million general Medicaid rate increase as part of the state’s overall … Read More
Last week, TDMR filed a complaint with the Texas Health and Human Services Office of Inspector General over the continuing complaints received by TDMR about the unacceptable delays in the credentialing of Medicaid dentists, particularly relating to the need to … Read More
The latest Texas HHS-OIG Quarterly Report issued last month, again for some reason, under provider integrity, focussed on findings made on investigations of Medicaid dental providers when these investigations only account for a tithe of full-scale investigations conducted by OIG. … Read More
Back in March, Rep. Mike Simpson, D.M.D., R-Idaho, introduced federal legislation to reduce administrative barriers for Medicaid dentists. Simplify credentialing According to an ADA release, “H.R. 1422, the Strengthening Medicaid Incentives for Licensees Enrolled in Dental Act [SMILED Act], would … Read More
TDMR has learned that Dr. Margaret Laccabue is no longer the Dental Director, Office of the Medical Director, Medicaid and CHIP Services for Texas HHS. We have it on good authority that she was released from employment with HHS, but … Read More
We’re not exactly sure what happened, but Raymond C. Winter, who headed up the Civil Medicaid Fraud division of the Office of the Attorney General of Texas for the last 15 years, is no longer there. According to his LinkedIn … Read More
Texas needs to attract more dentists to help serve the ever-increasing number of Medicaid-eligible children in the state. Medicaid dental provider statistics Back at the end of 2013, there were roughly 3.2 million Medicaid-eligible children with 3,468 Medicaid dental providers … Read More
UPDATE: The Texas HHS Open Records Office sent TDMR a further document that contains only the active number of dentists in the Texas Medicaid program from 1996 to 2022. The previous document used contained both active and inactive combined. This … Read More
More trouble for Texas’s latest Medicaid contractor, Conduent. Needless to say, insurance providers AIG and partner companies are appalled that the Delaware judge in their case against Conduent granted a retrial and dismissed the jury verdict that Conduent had committed … Read More
You just can’t make this stuff up. HHS just contracted with Conduent again Texas just rehired Conduent, the company it had fired in 2014 as its lead Medicaid contractor and then accused of $1.2 billion in Medicaid fraud which it … Read More
UPDATE: Taxpayers to pay settlement which the Legislature must approve. Attorney General Ken Paxton and four of his former top deputies who said he improperly fired them after they accused him of crimes have reached a tentative agreement to end … Read More
Recently, an OIG audit of a managed care organization (MCO) found issues when determining the fair market value of outsourced services and behavioral health claims. The audit reviewed multiple financial statistical reports (FSR) for UnitedHealthcare Community Plan of Texas, L.L.C. including Medical … Read More
What happens if a company gets sued for $2 billion by the State of Texas for Medicaid fraud as its former Medicaid claims administrator, then tries to pay the settlement by committing insurance fraud? Texas gives them a new contract! … Read More
TDMR received an email from a provider that a new problem had developed in credentialing a dentist that adds even more time to the process. No TPI in welcome letter Apparently, TMHP is no longer including the TPI (Texas Provider … Read More
This seems like a silly question because surely the agency that pays billions of dollars to DMOs and MCOs and keeps the Medicaid show on the road in Texas should know something—and perhaps should know everything– about the credentialing of their Medicaid dentists in Texas. You wouldn’t be … Read More
The American Dental Association’s Health Policy Institute last month published the results of an ongoing survey it has been conducting since January 2022, quizzing some 3,000 participating private practice dentists each month to measure the impact of COVID-19 and other … Read More
Over the last several months TDMR has been receiving an increasing number of complaints regarding credentialing for Texas Medicaid dental providers. There have been numerous fixes over the years such as PEMS, the Provider Enrollment & Management System, which is … Read More
The American Dental Association Health Policy Institute has reported that national spending on dental care has recovered from the pandemic and in 2021 was higher than pre-pandemic levels. Patients coming back and government funding The increase is attributed to patients … Read More
The Great State of Texas, a leader in so many other things, unfortunately, is not a leader in healthcare. United Healthcare Foundation, UnitedHealth Group This is according to America’s Health Rankings, an annual state-by-state survey of healthcare in the nation … Read More
Texas Health and Human Services Office of the Inspector General came out with its last quarterly report for fiscal year 2022 this month. OIG provider settlements One of the key takeaways from the report is that 16% of the 147 … Read More
TDMR received this letter highlighting the difficulty Medicaid dental providers are having in today’s current economic climate and the need for the legislature this session to take corrective action. We publish it in hopes that it will reach open and … Read More
Becker’s Dental & DSO Review published a list of things about dental care in Texas a while ago. Some of them are not very flattering to this great state. Many underserved areas While Texas has the second most number of … Read More
Texas Health and Human Services is looking for a dental policy analyst for its HHSC Medical and Dental Benefits Program. As they say, “If you enjoy researching, writing policy and remaining current with dental practices, and are interested in being … Read More
This case has finally come to an end. The Court of Appeals, Eighty District in El Paso, on October 14 confirmed the May 2020 lower court summary judgment award obtained by the state against Dr. Richard Malouf for violations of … Read More
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
