DMOs Report Less Than $600,000 in Medicaid Dental Fraud and Abuse for 2021

The 2021 annual report published by Texas HHS-OIG on fraud and abuse recoveries by MCOs and DMOs again shows a minimal amount of Medicaid fraud being found and recovered considering the state's whooping multi-billion dollar healthcare budget.  For 2020/2021, the state's general fund accounted for $33.6 billion of the $84.3 billion in total allocated to Article II funding.

The Special Investigative Units of the DMOs found and recovered:

DentaQuest - $443,057

MCNA - $87,149

UnitedHealthcare Dental - $0

DentaQuest was more industrious this past year than the previous year while MCNA was less so.  UnitedHealthcare Dental's contract just started September 1, 2020.

Smelly TMFPA cases return more money to the state

It appears that a single whistleblower who has no personal evidence or knowledge of wrongdoing by a provider and a checkered past can return more to the state coffers than three of the largest healthcare corporations in the country.  Well, two really.

It's no wonder that the Texas Medicaid Fraud Prevention Act as it is currently enacted is a godsend to the state despite its unfairness to providers.

Wouldn't it be something if DMOs were to be included as defendants in such lawsuits as they approved all payments to providers and failed to uncover any alleged fraud?

Bet the TMFPA would be changed real fast.



Leave a Reply

Your email address will not be published. Required fields are marked *