Some stories never die. Here we are a decade later still talking about "Crooked Teeth" and the outcome of all those stories that ran on WFAA alleging hundreds of millions of dollars of Medicaid fraud committed by Texas orthodontists and dentists.
Huge story keeps going
Remember the legislative hearings. Remember the introduction of MCNA, DentaQuest and Delta Dental without contract tender. Remember the timely retirements of HHSC executive commissioner Thomas Suehs and Medicaid director Billy Millwee. Remember the mad dog allegations of former Inspector General Doug Wilson and his henchman Jack Stick. Remember the state losing every payment hold case that went before an administrative court. Remember the state alleging $16 million in Medicaid fraud by Dr. Rachel Trueblood and settling the case for $39,000. Remember Jack Stick quitting and Doug Wilson getting fired. Remember the state finally firing and suing ACS/Xerox/Conduent for hiring high school dropouts and janitors to rubber stamp Medicaid orthodontic prior authorization requests. Remember the state settling that $1 billion case for less than a fifth of that to save litigation costs.
Oh, yes, remember the federal audits that put responsibility for the massive Texas spending on Medicaid orthodontia at the feet of state bureaucrats.
We remember those things.
Not much in qui tam awards
Well, the lead whistleblower was Dr. Christine Ellis, a professor of orthodontics at the University of Texas Southwestern Medical School in Dallas who has her own orthodontic practice in Dallas, Ellis Orthodontics. She even testified before a congressional committee in Washington in April 2012 to inform them of the "alleged Medicaid fraud in orthodontic billings by Texas dentists and corporate dental chains," according to a press release on her law firm's website. She also claimed to be one of the whistleblowers uncovering the wrongdoing of Xerox et al.. Odd, that she doesn't mention any of this in her bio on her practice's website. Something to be proud of, no?
Considering the allegations of hundreds of millions of dollars in orthodontic Medicaid fraud that ruined the lives and finances of many of her peers, she must have been rewarded handsomely for her investigative perspicacity.
An open records request to the Texas Office of the Attorney General reveals that Dr. Ellis has received only $574,689.14 in qui tam awards to date with another $25,000 set to be paid out in the near future. As far as Xerox is concerned, no relator has received anything.
Lafountain did almost as well
My goodness, a low-profile, uncredible guy with little dental education like Joshua Lafountain has done almost as well.
Deflection of responsibility from the state
The reason we haven't let this story die is that it is a scam. It has been a scam from the beginning to deflect responsibility from the Texas government for the extraordinary amount of Medicaid orthodontic spending from 2007 to 2011 to Medicaid dentists who weren't supposed to fight back.
If all had gone according to plan, this story would have been buried back in 2012 along with a lot more bankrupt dentists and qui tam awards piled high.
Even the relatively recent summary judgment against Dr. Richard Malouf had nothing to do with falsifying HLD scoring sheets or providing braces to unqualified cases. All the state proved was that his billing number was used incorrectly to bill for cases not done by him. The service was provided by a qualified professional to an eligible patient.
It is important to keep this story alive while there is a story to tell. There is a lot to be said for telling your side of the story and being very public about it when you have been wronged.
This situation has had repercussions on the whole profession of dentistry in Texas and its public perception.