Columnist Blasts HHSC-OIG Treatment of Medicaid Providers as “Politically Motivated”

Inspector General Doug Wilson
Inspector General Doug Wilson

Houston Chronicle business columnist Chris Tomlinson blasted the Texas Health and Human Services Commission Office of Inspector General for its treatment of Medicaid providers in his column Wednesday. His criticism however goes further than OIG and alleges that OIG’s overzealousness in going after Medicaid providers, including dentists and orthodontists, is a reaction to pressure from the agency’s conservative political masters to find fraud even when it isn’t there.

In “Time to stop kicking around Medicaid providers – Judge rightfully reins in anti-fraud unit after abusive action,” Tomlinson writes that “Doctors, dentists and other health care providers who care for the state’s most disadvantaged got some much needed relief Tuesday from an over-zealous, politically motivated anti-fraud unit in the Texas Department of Health and Human Services.”

Claim that conservative political pressure “drove” OIG recklessness

Tomlinson goes on to make the case that it is the political majority’s pressure to find fraud in the Medicaid program that has bred such an attitude within OIG to “invent” fraud, using the example of Medicaid dentists and orthodontists, when it can’t find it.

The answer is that the Republican majority in the Texas Legislature wanted proof that the health care program for the disabled, poor children and impoverished seniors was full of fraud. When the OIG staff couldn’t find the fraud, they thought they’d invent some.

The OIG began cracking down on dentists and orthodontists in 2011, after Texas paid more for Medicaid orthodontic services in 2010 than the other top 10 most populous states combined. Angry lawmakers alleged that much of the $184 million in treatments were fraudulent.

Accusing health care providers who accept Medicaid has a long tradition in conservative Texas. Medicaid, which is paid for by both state and federal governments, is the fastest growing portion of the state budget. The fact that Texas must pay its fair share angers Republicans who don’t want to raise taxes to cover those costs.

Political anger against Medicaid providers actually driven by bureaucrats

While there maybe truth in this assertion, overall there is nothing wrong with political pressure to ferret out all fraud from the Medicaid system. It needs to be pointed up that politicians of both stripes have been ill-served by bureaucrats who have promoted this negative attitude against Medicaid providers for their own ends.

“I can find a program violation on Jesus Christ”

Both HHSC’s Jack “I could find a program violation on Jesus Christ” Stick and Inspector General Doug Wilson, who apparently lied to a member of the Sunset Commission [Rep. Raymond video except] in his testimony recently, drive OIG’s ruthlessness against providers. They used claims of massive dental fraud to press for millions of dollars in additional funding for their agency for staff increases and expensive untried data mining software last legislative session.

Bureaucrats told politicians that dentists “gamed” the system

But more importantly, both Republicans and Democrats were earlier betrayed by the incompetence of HHSC bureaucrats who in 2008 knew (Medicaid claims administrator contractor) Xerox’s orthodontic pre-authorization process was compromised yet did nothing.  Xerox’s “dental specialists” who approved each request apparently worked from home, had no dental training and simply rubber stamped anything with an HLD score greater than 26, per the state’s lawsuit against the company.   It was these bureaucrats who told the politicians that dentists had “gamed” the system back in legislative hearings in early 2012 in an apparent move to minimize their own foibles and redirect political vengeance.

Negative influence of qui tam attorneys “crying wolf”

The further influence of qui tam attorneys, such as Houston’s Jim Moriarty, obsessively crying wolf on the dental fraud issue to both media such as WFAA and politicians at both the state and federal level has remained uninspected as well.

Getting it right on Medicaid providers

That being said, Tomlinson rightly recognizes that the majority of Medicaid providers, especially health care professionals such as doctors and dentists, take on Medicaid patients for altruistic reasons and end up getting punished for being successful in doing so.

Medicaid reimbursement rates are in most cases far below what it actually costs to treat a patient. Doctors and dentists tell me that they treat Medicaid patients out of a sense of duty. Others have found a way to treat Medicaid patients at a scale that makes it economical.

Operating at scale, though, is what attracts the OIG. Before Tuesday’s ruling, one minor paperwork error was all it took for the OIG to suspend all Medicaid payments to a provider, basically shutting the provider down. Thankfully, that ended on Tuesday.

The point is that honest Medicaid providers should be cherished and protected from an abusive system.

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