Several suits by Medicaid providers filed today in Travis County’s 53rd Civil District Court seek to intervene in the recent lawsuit brought by the state of Texas against former state Medicaid claims contractor, ACS/Xerox (henceforth “Xerox”).
Recover damages from both state and company
The providers seek to recover substantial damages from both the state of Texas and Xerox.
“All of the different parties’ claims are inextricably intertwined, as they relate to Intervenors’ submission of prior authorization requests to Xerox, the handling of those claims by the Xerox Defendants, the State’s handling and oversight of its agent Xerox in Xerox’s performance of its contractual and legal duties, and State’s subsequent legal action against the Intervenors for services approved by Xerox” says one suit.
The suits allege that Xerox reneged on its contractual obligation to thoroughly review and approve orthodontic services before they were actually rendered, violating the law “tens of thousands of times.” Under Xerox’s contract with the state from 2004 to 2012, the company approved almost $1.1 billion for Medicaid orthodontic treatment per HHSC budget figures.
Per the filing, “Xerox allowed ‘dental specialists’ — unlicensed, unqualified individuals — to render prior authorization opinions regarding the medical necessity of requested orthodontic services… It is believed these unlicensed Xerox ‘specialists’ rendered tens of thousands of prior authorization approvals/medical opinions in violation of Texas law”.
Target dentists rather than Xerox
The suits further allege that the Health and Human Services Commission’s Office of the Inspector General targeted providers rather than Xerox, despite two state audits showing that Xerox was failing to fulfill its contract: “(R)ather than prosecute Xerox for its failure to properly evaluate dentists’ prior authorization requests, the State and the Texas Attorney General protected Xerox.”
The suits cite several causes of action as their basis, including negligence, fraud, breach of contract, and conspiracy. According to providers, “the State conspired with Xerox to breach the contract or allow the breach to continue, conspired to withhold funds from (providers) but not Xerox, and conspired to falsely accuse (providers) of fraud/crime.”
Download a copy of one of the filings.