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
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
