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
You are here: Home / Medicaid Reform News / HHSC Allegedly Paid Out $104 Million to 8,000 Medicaid Providers the Agency Suspected Of Fraud

HHSC Allegedly Paid Out $104 Million to 8,000 Medicaid Providers the Agency Suspected Of Fraud

July 1, 2015 By TDMR Leave a Comment

Former HHSC Chief Counsel Jack Stick's $87 OIG Badges

Former HHSC Chief Counsel Jack Stick’s $87 OIG badges

Four firms provided “proof of concept” demonstrations of their Medicaid fraud detection software to the Texas Health and Human Services Commission and its Office of Inspector General back in 2011.

These proof of concept projects allowed the firms to access Medicaid claims data to evaluate it for fund diversion to fraud.

In the case of Reflective Medical (RMIS), as already reported in the press and by TDMR, they were able to look at three years of Texas Medicaid data and found inexplicable claims being paid such as for men giving birth, nine-year old girls receiving tubal ligations and 198-year old women getting testicular biopsies all paid for by the program.

RMIS Identified 6,470 fraud suspects, but HHSC already had a list of 8,000

David Gibson, CEO of Reflective Medical, told TDMR that after his group had conducted their review, they identified 6,470 suspect vendors.

However, when RMIS presented these results to HHSC, HHSC officials told Gibson and his team of highly regarded retired FBI special agents that HHSC already had a list of some 8,000 known or suspected fraudulent providers that included the RMIS targets.

HHSC was still paying them to the tune of $104 million over two years

Worse, RMIS found that HHSC was still paying these suspect providers and had paid out $103.9-million to them between 2008 and January 2010.

Gibson said he and his team were shocked that HHSC maintained such a list and continued to pay the suspected providers without further investigation or action over a period of multiple years.

They were surprised that the agency would be so lax in its handling of these cases since Texas would be on the hook to the federal government for any monies misspent and be open to significant penalties and reimbursement requirements.

Couldn’t understand why

RMIS, per Gibson, advised HHSC senior management that “a viable Medicaid program, managed by competent officials, would have immediately suspended all payments to those targeted providers and prioritized their investigations and prosecutions to eliminate the continued hemorrhaging of public funds.” Inexplicably, HHSC apparently chose to keep paying money to these entities for years.

In addition, Gibson said RMIS could not determine what criteria was used by HHSC to include the 8,000+ individuals and businesses on their list and why investigations were not initiated when there were apparently credible indications for contracted providers being included on the target list.

Agency goes berserk

“Initially we had great cooperation from the HHSC staff,” Gibson said. “But as we uncovered more and more evidence of inadequate program-administrative oversight, tempers started to flare at the senior management level and our welcome wore thin. Senior management’s threat to sue our company if we ever revealed the contents of our report to the legislature or the governor’s office was the final development that ended our interest in Texas. You simply cannot help an organization that actively resists assistance.”

“I believe no one wanted to take responsibility for how bad the problems were at HHSC. Candidly, we were surprised how bad it was too. ”

HHSC didn’t request “proof of concept,” the Governor’s Office did

TDMR was told by RMIS, which is a California based data mining company, that initially the firm did not seek a business relationship with the State of Texas.

Rather, it was invited by Governor Perry’s office to come to Texas and provide an independent evaluation of the management competency and magnitude of Medicaid funding diversion to fraud within the HHSC.

As a result, RMIS agreed to perform an analysis without charge to the state.

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)

Filed Under: Medicaid Reform News, Slider Tagged With: medicaid fraud, office of inspector general, scandal, texas health and human services commission

Leave a Reply Cancel reply

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

Search the TDMR Website

Most Viewed Posts & Pages

  • 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
  • Woman claims dentist pulled wrong tooth
    Woman claims dentist pulled wrong tooth
  • DMOs Find Less than $400,000 in Medicaid Fraud in 2020
    DMOs Find Less than $400,000 in Medicaid Fraud in 2020
  • DentaQuest Dinged $1.5 Million by OIG
    DentaQuest Dinged $1.5 Million by OIG

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