In September when TDMR learned that the new Medicaid Dental Services RFP had gone out, we also learned and reported that Dr. Linda Altenhoff, former dental director for the Department of State Health Services and dental director for Texas OIG had become a Vice President of MCNA, one of the current Texas DMOs.
HHSC bosses lost jobs
A dentist in his 70s who lost his retirement money defending himself against unproven allegations of Medicaid fraud for giving under-privileged Texas children orthodontic treatment approved by Xerox and the state, contacted us after reading the article to express his disbelief.
He wondered how villains such as Jack Stick and Doug Wilson, former high HHSC executives, could lose their jobs and the person that was best in a position to know about the flawed Xerox ortho prior authorization process was now a VP for a Texas DMO.
He recalled that it was Dr. Altenhoff's statements which gave dental stakeholders the misleading impression back in 2009 that a "board certified orthodontist" was reviewing the prior authorization requests after dentists demanded to know who was approving them. In reality, high school graduates and a janitor among other untrained individuals acting as Xerox/Conduent "dental specialists" were rubber stamping the requests and dentists were misled.
This dentist who still has to practice to make ends meet said it was ironic that not only was Altenhoff a VP at MCNA but that she was a VP of program compliance. Surely, an oxymoron if he had ever heard one.
Dentists sought to file complaint with TSBDE
We have to agree.
Altenhoff has little respect. A couple of years ago there was a movement by several aggrieved dentists seriously damaged by the ortho mess to file a complaint against Altenhoff with the State Board of Dental Examiners for unprofessional conduct for her misleading statements. However, upon review, the TSBDE complaint process relates to dentists practicing dentistry, not dentists operating in government.
Dithers and dissembles on a simple question
Concerns about Altenhoff's program compliance competence is not a joke. We found a short segment of a deposition she gave several years ago as the dental director of OIG.
She is asked if the state is responsible for enforcing the standards of medical necessity for Medicaid orthodontic treatment. Her unwillingness to answer with a simple "yes" leads into almost seven minutes of dithering and dissembling. In the end, she only admits that the state is responsible for enforcing the state's contractor to do so because she is given a copy of the federal audit which says so.
A perfect bureaucrat. Take as little responsibility as possible.
Spreading the sunshine
It has been said that the best disinfectant is sunshine. Jack Stick and Doug Wilson were high enough and visible enough that their destructive acts were eventually seen for what they were and they no longer had jobs.
A player behind the scenes such as Altenoff wasn't that noticeable. But now that she has made out like a bandit and steps into the spotlight as a private sector VP, the sunshine follows.
If anyone at HHSC was responsible for the ortho mess, in our opinion, Dr. Linda Altenhoff was a major factor.
More to come
This article is the just first in a series relating to "who knew what when" between Xerox/Conduent and the state on this orthodontic mess that will be rolling into its 8th year in early 2019.
Quite a few dentists out there will be cheering when they read this article and also wondering why Altenhoff is a VP at MCNA.
That the ortho/Xerox/ State of Texas mess is 8 years running tells all one needs to know about who the Medicaid system really serves. It’s not the recipients. It’s not the mom and pop providers. Medicaid serves big money first and foremost. MCNA is big money. Of course former public servant Linda Altenhoff moved seamlessly into leadership at private government contractor MCNA. Who better to protect their interests in keeping the juicy government money flowing? Who knew what when? Does it really matter?
Dr. Altenhoff is one of the reasons I stopped accepting Medicaid several years ago. One of my Medicaid mothers sent in a complaint about me because I had refused to see her child when they came in very late for their appointment. That had been explained to her when she made the appointment. She submitted a complaint to Medicaid, and rather than put it through regular channels, which she certainly knew, she sent it to the TSBDE when they should have called me about it. The first I knew of it was when the State Board sent me notification of it and asked for my side of the story, which is what Medicaid should have done. When they got my reply, that was the end of it and I heard no more about it, as was proper. There was absolutely no reason for that action and certainly no excuse. I decided that if that was an example of the head person at Medicaid dental, I was not going to expose myself to further harassment just to be able to get paid a fraction of normal for work on people who didn’t have any respect for the dental profession.
How about Jennifer Stansbury and Billy Millwee? They were absolutely in charge of the Xerox contract and did nothing when red flags started going up? Are they basking in sunshine too?
http://www.sellersdorsey.com/team/millwee-billy
https://www.linkedin.com/in/jennifer-stansbury-5766bb6
It just to show that Medicaid should never paid for orthodontic treatment to start with. Orthodontic treatment is considered a luxury in stead of medical necessity. The purpose of the Medicaid is to provide medical necessity for children in poverty. The state is only allocated so much from the federal government, it shouldn’t be wasted on orthodontic on few individual. Rather, it should been given to greater population in need. It is simply a Revolving Door that policy maker sold themselves out to the companies that take in the Federal money. Just like the Washington, no difference.
The state decides how much money it will spend on a program. What embarrassed Texas is that California was only spending $19 million a year on ortho while Texas had ballooned the figure to over $100 million. The full story is condensed here https://www.tdmr.org/truth-finally-comes/ and here https://www.tdmr.org/side-texas-medicaid-orthodontic-fraud-debate/