Texas Dentists for Medicaid Reform

NEW PHONE NUMBER
For more information call (512) 487-7584

  • Home
  • Issues
  • * Medicaid Difficulty Alert *
    • About the Medicaid Difficulty Alert
    • Alert Form
  • Articles
    • TDMR articles
    • Medicaid Media
    • Compliance Articles
  • Archive
    • The Facts About the Medicaid Orthodontic Scandal 2007 to 2012
    • Antoine Dental Case
    • HHSC-OIG Archive 2012 to 2014
      • TMHP
      • Harlingen Family Dentistry Case
        • Further HFD articles
      • OIG Never Returns Funds
      • Webinar March 19 2012
      • 2008 TMHP Audit by OIG
      • 2012 TMHP Audit by OIG
      • OIG Legislative Testimony
        • OIG Testimony March 19 2013
        • OIG Testimony February 13 2013
        • OIG Testimony February 4 2013
        • OIG Testimony January 30 2013
      • Jack Stick Arrest for DWI
    • Due Process Archive
      • Survey Results
      • Committees
        • Hearing Videos
      • TDMR Submission
      • HB 1536/SB 785
        • House Committee on Human Services
        • Written Testimony
        • Attorney Testimony Videos
        • Dental Provider Testimony Videos
      • SB 1803
        • Overview
        • Bill Moves to House
        • Public Testimony Videos
        • Passes House Committee
        • Bill Changed Before House Vote
        • SB 1803 Has Passed the House!
      • Other Proposed Bills
      • Due Process Legal Articles
      • Legislative Media
      • Media Archive
  • About
    • Dr. Juan D. Villarreal
    • Dr. Paul Dunn
    • Gregory Ewing
  • Contact

Dr. Gary P. Guillory DDS

I support bill 1536.

The bill doesn’t go far enough however and that there needs to be due process provisions to protect providers at the beginning of an investigation and at the payment hold stage.

In 2010, an associate of mine, an independent contractor – not an employee, performed procedure on a Medicaid patient that I still am not sure what was treated. The patient’s parent was not happy and contacted Medicaid. I was unaware of this. Nor was I given the opportunity to remedy whatever the situation was.

In November 2011 I was contacted by a Medicaid investigator that I was under investigation for the incident. He requested over 150 charts to audit. I promptly copied and handed over all he asked for.

I do good dentistry and have nothing to hide.

Then the phone calls from patients started coming in because Medicaid had sent out a form to my patients inquiring about their treatment which was confusing and alarming. I saw many forms the parents brought to me to ask what they meant.

Then patients began calling because the investigator was showing up at their homes flashing his badge and scaring the patient’s parents. The investigator insisted on seeing the children and looking in their mouths. I wasn’t aware the investigator could diagnose or practice dentistry. I have the names of the patient’s parents that called me. Who knows how many others there were that were too scared or confused to contact me.

I received a letter from Medicaid stating they were charging me back for all the procedures ever performed – $1.3 million.

Now I have to prove everything I did on all these patients. This is onerous and terribly burdensome. My patient charts state the facts. There are no lies.

Medicaid has become a monster looking to demonize dental practitioners. We already have a dental board for complaints and resolutions.

I don’t know all the goings-on behind the scenes at Medicaid, but from my perspective, I see a broken system.

Specifically:

1) the system of predetermination and eligibility fails.

2) the lack of licensed dentists overseeing predetermination and
Claims process.

3) the new HMO aspect of patients on a roster fails the patient and the dentist.

4) the arcane and inane rules for Medicaid which are not even disseminated for dentists to understand.

5) predeterminations are now required for treatment that is required asap. Do you honestly believe this is the way to treat infection and pain? Do you believe the parents will be compliant to return for treatment?

6) the outsourcing of Medicaid reimbursements to 3 companies, now 2, has added more rules to compliance with Medicaid requirements. There are 3 new rules, now 2, that have to be complied with.

7) slow payments on claims for an already reduced fee.

In my humble opinion, if you continue down this path you will see dental Medicaid mills running children through them as fast as they can (for profit’s sake) with marginal dental quality. Is this what you would want for your children?

I am mad as hell at the way I’m being treated by Medicaid, for some super-secret treatment i’ve never been informed was performed, never giving me a chance to remedy it, and the way investigator tried to perform dental exams on my patients while scaring their parents with their badge and “authority” to do so.

Medicaid is out of control.

Share this:

  • Click to share on Facebook (Opens in new window)
  • Click to share on Twitter (Opens in new window)
  • Click to share on LinkedIn (Opens in new window)
  • Click to print (Opens in new window)
  • More
  • Click to share on Reddit (Opens in new window)
  • Click to share on Pinterest (Opens in new window)
  • Click to share on Tumblr (Opens in new window)

Search the TDMR Website

Most Viewed Posts & Pages

  • Woman claims dentist pulled wrong tooth
    Woman claims dentist pulled wrong tooth
  • UPDATE: Dentists Clarified as Healthcare Workers to Receive COVID-19 Vaccines
    UPDATE: Dentists Clarified as Healthcare Workers to Receive COVID-19 Vaccines
  • Judge Orders Dr. Richard Malouf to Pay Texas Back $12 Million for Medicaid Fraud
    Judge Orders Dr. Richard Malouf to Pay Texas Back $12 Million for Medicaid Fraud
  • Compounding Pharmacy Mogul Sentenced for Multimillion-Dollar Health Care Fraud Scheme
    Compounding Pharmacy Mogul Sentenced for Multimillion-Dollar Health Care Fraud Scheme
  • Longview clinic agrees to pay more than $330,000 in Medicare fraud case
    Longview clinic agrees to pay more than $330,000 in Medicare fraud case

Receive Updates on TDMR Activities

Recent Comments by Readers

  • Spence on Woman claims dentist pulled wrong tooth
  • Spence on Woman claims dentist pulled wrong tooth
  • Nilar Vargas on Dentists cleared to administer COVID-19 vaccine in California
  • TDMR on UPDATE: Dentists Clarified as Healthcare Workers to Receive COVID-19 Vaccines
  • Angela on UPDATE: Dentists Clarified as Healthcare Workers to Receive COVID-19 Vaccines
  • Marjaneh on UPDATE: Dentists Clarified as Healthcare Workers to Receive COVID-19 Vaccines

Recent Media of Interest

Woman claims dentist pulled wrong tooth

January 16, 2021

Compounding Pharmacy Mogul Sentenced for Multimillion-Dollar Health Care Fraud Scheme

January 16, 2021

Man Charged with $5 Million COVID-Relief Fraud

January 16, 2021

Justice Department Recovers Over $2.2 Billion from False Claims Act Cases in Fiscal Year 2020

January 14, 2021

Longview clinic agrees to pay more than $330,000 in Medicare fraud case

January 12, 2021

Texas legislature opens amid ongoing pandemic, political unrest

January 12, 2021

Latest TSDBE Newsletter

January 11, 2021

Dental workers anxiously wait for COVID-19 vaccine

January 8, 2021

Dentists cleared to administer COVID-19 vaccine in California

January 6, 2021

Stanford Healthcare Loses in Appeals Court, Accused of Alleged $468 Million Dollar Healthcare Billing Fraud

January 5, 2021

CEO of inpatient treatment center admits to Medicaid billing fraud

January 5, 2021

Despite what dentists may be hearing, now is a great time to buy a practice

January 4, 2021

Physician sentenced to prison for fraud that led to deaths

January 1, 2021

Owner of Texas hospice chain gets 20 years in prison for $150M fraud

December 30, 2020

Texas hospital pays $48M to settle false claims allegations

December 21, 2020

Florida physician pleads guilty to $29M fraud

December 21, 2020

More Articles...

Copyright © 2021 · All Rights Reserved. Texas Dentists for Medicaid Reform · Privacy Policy