The hearing before the Senate Committee on Health and Human Services September 13 held a few more surprises for Medicaid providers, particularly dental providers. It turns out that all MCOs (managed care organizations) in Texas Medicaid including Dentaquest and MCNA get to keep any monies they recover from providers based on allegations of fraud, waste or abuse.
Not seen as returned to taxpayers
Sen. Lois Kolkhorst brought this point up to Inspector General Stuart Bowen during the hearing and she was displeased that these monies didn’t immediately get returned to taxpayers.
Said to be taken into account in setting premiums
Later in the hearing, Jamie Dudensing, the executive director of the Texas Association of Health Plans, which represents MCOs in the state, told the committee that recovery of such monies is taken into account when the premium is set by the state for the MCOs. Therefore, if the MCOs did not receive these monies, the premium paid by the state would be higher.