In a court document filed in July 2018 by Xerox/Conduent, an exhibit containing HHSC OIG email correspondence and notes from June 2008 proves that Dr. Linda Altenhoff, the state dental director, knew all about the faulty Xerox/Conduent ortho prior authorization (PA) process which carried on another three years and cost the state hundreds of millions of dollars.
Altenhoff, as previously reported, is now the vice-president of program compliance for MCNA, a current dental maintenance organization contracted with Texas Medicaid.
Document shows state bureaucrats knew all about it
The Xerox/Conduent court filing relates to the massive $2 billion Medicaid fraud suit brought by the Texas AG in 2014 against the company, the state's Medicaid claims administrator from 2004 to 2014 and responsible for determining and approving the medical necessity of orthodontic prior authorization requests from Texas dentists from 2004 to 2012.
TDMR had already reported on a previous document showing HHSC had knowledge of the process in 2009.
The exhibit contains the meeting notes of Ray Acuña, an investigator with HHSC OIG, who met with Dr. Altenhoff and others to discuss problems with the ortho prior authorization process discovered by OIG in 2008.
Acuña reported that:
...stakeholders asked how or what TMHP requires to prior authorize Ortho treatment and Dr. Altenhoff discussed that she asked Dr. Felkner [Xerox/Conduent's dental director] to explain the requirements to the stakeholders, in which he replied that TMHP dental clerks, by contract language, review the HLD scoring sheet to make sure the provider documented that the required 26 points were met. No measurements, models, radiographs or tracings arc considered. Unless the dental clerk has a question. no dentist reviews the PA requests and it is not required by contract that a dentist or orthodontist review the PA requests. [link is ours]
...Dr. Altenhoff discussed an issue of TMHP dental clerks who are allowed to work from their home, which they question the availability to consult Dr. Felkner or any other TMHP management staff regarding authorizing ortho treatment.[link is ours]
The notes also clearly show the concern of dental stakeholders in how the ortho prior authorization was being done and the recommendations they made to improve the process.
In fact, it appears that dental stakeholders were the ones that originally brought HHSC's attention to the problems with the process as they had demanded to know in 2007 who was approving the PAs.
Medicaid dentists concerned but misled
Despite having this knowledge, Altenhoff told dental stakeholders in January of 2009 that they should assume a "board certified orthodontist" is reviewing the PA requests, misleading them into thinking that this was occurring and giving them a false sense of security.
When the large financial volume of the program became a topic of legislative outrage three years later, HHSC pretended they knew nothing about it and blamed the dentists in an apparent "bait and switch."
Two PDF files are below. One is a searchable copy of the original notes. The second is the original emails and notes from the court documents.