Texas HHS-OIG published on their website June 24 an audit they completed on DentaQuest back on January 9. The audit found that DentaQuest had $1.53 million in "unallowable, unsupported, and overstated expenses on its Administrative Expenses FSR [Financial Statistical Report]" which allowed DentaQuest to reduce the initial experience rebate amount paid to HHSC.
Unallowable expenses for sales and marketing among other things
The unallowed expenses were for "communications and postage costs, sales and marketing costs, and amortization costs. It also overstated its salary expenses and did not have support for some depreciation costs."
According to the audit, Medicaid and CHIP Services "will (a) require DentaQuest to address and correct unsupported and overstated expenses, (b) ensure DentaQuest corporate allocations are appropriately tracked, recorded, and reported, (c) require DentaQuest to timely disable individuals’ access to its financial and claims system upon termination of employment, and (d) require DentaQuest to implement a control process to address inactive accounts for systems that create, process, transfer, or store confidential HHS System information."
We're not sure why the audit took six months to finally publish. The audit report states "DentaQuest indicated in a comment letter that it agreed with some of the audit issues but did not agree with others."
Double standard enforcement
Pretty benign, friendly relations there. $1.5 million isn't much, is it?
We wonder what would happen to the dental provider who screwed up their billing codes to the same extent. Wait a minute, didn't Dr. Richard Malouf have roughly $500,000 of services incorrectly billed to his Medicaid number? No chummy relations there. The Medicaid Civil Fraud office went after him for $12 million on that one.
These close, friendly relations between the state and its contractors are why the state didn't go after Xerox until it became too embarrassing not to. They went after the dentists right away despite the fact that Xerox had approved all orthodontic prior authorization requests, however.
Previous audit of MCNA
A similar audit of MCNA done late last year found $766,000 in unsupported expenses.