Dentist’s Outrage Over MCNA Secret Recoupments on Child’s Pre-Approved Treatments

MCNA's headquarters in Florida
Texas dentist supposed to go to MCNA’s headquarters in Florida for hearing on recoupments

In response to TDMR’s latest story on payment holds placed on Medicaid dentists by MCNA, TDMR received an emotional missive from a Medicaid dentist about his negative experience with MCNA.  He gave permission to publish his comments.

The legislative session is starting and we will do our best to inform legislators about such issues.

If you have a similar experience, please don’t hold back.  Let us know.

Here is what he had to say:

MCNA is withholding more providers than they will admit. Based on my experience with them, MCNA is not treating the hard working providers fairly. They are falsely accusing these doctors of fraud and other infractions which have no merit. They are illegally withholding payments, even when the doctors prove their treatments were completed as claimed.

Young cancer patient left with severe dental problems approved for treatment

For example, I have a patient who was recovering from years of complicated cancer treatments,which left her dentally handicapped. Her lower jaw had been resected and many teeth had either been lost or severely damaged due to inability to do daily oral hygiene for long lengths of time. After extensive oral hygiene instruction and many hours of planning with all the diagnostic tools; X-rays, models, intraoral pictures, preauthorization of all planned treatment, MCNA approved all of these”medically necessary” treatments.

MCNA secretly recoups payments – “changed their minds” on approval

After months of treatments and being close to completion of planned treatments, MCNA silently began to “recoup” the payments already paid on completed treatments from my bank account. When my business manager noticed these recoupments, she promptly called MCNA to ask what was going on. They told her that they “changed” their mind and “reversed” the pre-authorizations.

MCNA stops paying for child’s routine cleanings 

After months of “reproving” the “medical” necessity, and getting many sympathetic comments from MCNA employees, they upheld their recoupments AND stopped paying on all the other pre-approved treatments of over 17 crowns and a partial denture. Even the following routine cleanings and check-ups were unpaid.

Dentist wonders why he does this

Like most sincerely committed Texas Medicaid dentists, I continued to treat and follow up with this brave little patient. After all, I thought she had already been through so much, it’s not her fault that the Texas Medicaid system doesn’t care about her. I do! I care! I have been practicing in Texas for over 40 years. Even before Medicaid was ” invented,” I was providing the needy in my community with the dental care they couldn’t get anywhere else at little or most of the time ” no cost.”

Many, many times, I asked myself, ” why am I doing this for so many patients”?  Even during very hard times, I still continued to do it. When I asked my “dental friends” if they felt the same way, about 10% said yes and the others either laughed at me or said I shouldn’t do it.

Now the plot thickens.

MCNA stopped paying for all dentist’s patients

When we asked MCNA what recourse,  we had they stopped communicating with us. They stopped paying on any of our MCNA patients.

Texas Medicaid officials provide no help

When we contacted our Texas Medicaid representatives they said we had to completely exhaust ALL avenues with MCNA before they could help us! So we asked MCNA to hear us out. They said we would have to go to Florida to state our case!

Supposed to go to Florida for an MCNA hearing!

I couldn’t believe it. Our Texas Medicaid program wants to adjudicate me in Florida!

I need help! I’m like Mr. Trump, I’m fed up! Our government doesn’t care. The Texas Dental Association doesn’t care.

13 Responses

  • i am not sure what difference we can make unless all the dds in all states form an organization that can lobby on our behalf. We do so much free work for our medicaid patients, and CHIPs, and even their parents because we know that is what our duty is to take care of the community. We have now implemented so much more documentation such as intraoral photos of every thing and long narratives, pre and post tx xrays, and the pt suffers by being in the chair for so much longer than needed, parents are getting frustrated because they dont understand why every procedure now takes over an hour or more just. MCNA needs to outline exactly what they want us to do so that there can spend less money on creating GOTCHA issues for all of us who work long and hard hours in an already stressful environment.

  • This is not at all surprising. I had a meeting this morning with a Houston news network about this very issue. I represent an organization that advocates for quality access to care specifically with providers who participate in the Dental Medicaid program in Texas. Many providers in Houston share this same experience. MCNA has bullied recoupments without explanation along with placing payment holds on an entire practice without notification based on minimal and erroneous findings. Law abiding providers continue to see and treat patients without any information or communication from MCNA. MCNA has also gone so far as to drop a provider from EFT payments without any kind of notification. There have been numerous emails and phone calls to HHSC to meet with us. Yet very little has been done by HHSC to address these outcomes. This is giving DSO’s more power than the OIG based on their tactics. Unfortunately providers have to cut back on operations and staff while payments holds are sorted through MCNA without the courtesy of a timeframe. Is a credible third party vendor doing their audit sweeps? My lingering question is…. Does MCNA have the financial stability to handle and manage federal dollars? Will the Texas Senate subpoena MCNA to answer for this? Are other providers in different states having these same issues? Is this a financial trend with MCNA to gain interest on the monies that are collected or withheld?

    • Can I get your contact information so I may speak to you about our own issues with MCNA. I’m actually waiting for them to give me an in person meeting at their headquarter. Like you have mentioned, there is no help from anyone within our state to turn to in these kind of situations.

      I’ve left messages with TDMR to seek advice on this matter but my calls haven’t been returned. So I’m just trying to be heard and get to someone who could help.

        • Thank you so much and I look forward to hearing from you. It has been a painstaking ordeal, especially with MCNA acting like bullies and not giving providers any due process.

  • I seriously doubt that MCNA will be subpoenaed or will be treating Texas dentists any better when they have Rick Perry lobbied for them to bury all the dirty dealings that they are doing.

    • Christopher,

      These are the same issues that happened in big pharma and insurance years ago….. This is no different. Have to look at the big picture of how to stop their illegal doings.

  • If the states does not plan to do anything with MCNA. We the Medicaid dentists can still do something about it. We can advise our Medicaid patient families not to choose MCNA as their Medicaid insurance company, they have the other option such as DentaQuest. I think the more patients abandon MCNA, the more attention from the states will get and rethink about this company.

  • Glenn says

    November 14, 2016 at 7:57 pm

    Why we dentist are now the HMO bull eye of these $$$ target?

    My understanding . Three HMO options are to be given and It is writing somewhere in the providers agreement. Meaning a breach of contract have happened and still since delta dental was out,

    DentaQuest and MCNA have been severely arbitrary. DQ is breaching the contacts as well. penalizing providers for documentation no needed for payment and claiming no medical necessary recoups when payments had been already issue under the protocols set in the agreement.. The providers agreement rules and the definition of medically necessary has been disregard and penalize when providers performing procedures consider medically necessary and with out the need of documentation.
    MCNA do not stay behind the fence when ,the field providers relation representatives disregard the agreement terms true facts , when in the field the rep. are crossing the line into the providers practices with all sort wrong practices out of the agreement and incorrect statements that defame providers when manipulating the providers staff against practitioners. All when providers intervene trying to set the limits between their practices and the HMO.

    The HMO\’s threaten common practices of their audits protocols; the out number of file charts, without affidavit and mail delivery makes the documentation information no accountable, no verifiable , no reliable and no true. The use of subjective diagnostics as objective when they need to invalidate a medical necessity procedure where the only verifiable means is a visual clinical provider diagnostic evaluation and documented charting.

    Why we did not have all this persecution from HHDC and the HMO when the compensations were half of what is today and there were no third parties ?? Are they are trying to make us pay for their mistakes and legal accountable for the moneys no paid years past to fit their budget??

  • I am planning a meeting in early May. Possibly around the time of TDA. I have sourced an attorney who is willing to help. Many of us share the same problems but it’s econmically not feasible to go at it alone. But together we could have a voice. Let me know if any of you are interested.

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