HHSC Inspector General “Pediatric Dentistry Action Team” Launched

children health insurance programOne of the main items of interest to Medicaid dentists from the latest quarterly report from the Health and Human Services Commission Inspector General Stuart Bowen is that a “Pediatric Dentistry Action Team” has been created within his agency.

The impetus for the team’s creation is, per the report,  the “recent incidents involving the pediatric sedation or anesthetization of Medicaid pediatric dental patients.”  There was a tragic incident in Houston earlier this year with a young girl whose family is now represented by Houston attorney Jim Moriarty who specializes in dental injury cases.

The report states the following:

Responding to a series of recent incidents involving the pediatric sedation or anesthetization of Medicaid pediatric dental patients, the IG launched the Pediatric Dentistry Action Team (PDAT). The PDAT organizationally integrates key elements from across the agency — i.e., inspections, investigations, audit, medical services, data, and legal — to address a key public safety issue: the endangerment of Texas Medicaid children. The IG effort embraces collaborative engagement with the Texas Dental Board.

Consistent with the IG’s mission to detect and deter fraud, waste, and abuse in the delivery of health-care services by Medicaid providers, the PDAT is examining the following two critical issues:

• Are Medicaid dental providers meeting the required medical necessity criteria for performing procedures that use anesthetization and sedation?

• Do the anesthetization/sedation services performed on children meet Medicaid standards?

The PDAT will finalize its survey work in July, conduct field work in August and September, and issue a final report with recommendations and lessons learned in October.

7 Responses

  • This reminds me of the people who want more gun control after a mass shooting. The problem is not the guns but the people.
    The problem is that there will always be doctors who push the limits. More sedation regulations will not stop this.

  • The criteria in which the state grants licensure for pediatric sedation requires no formal training!!!! If there is going to be a team formed to “deter” FWA, a team needs to be formed to properly train the dentist who are not formally trained in the areas of pediatric sedation and general anesthesia. Children are not little adults! Furthermore, even when the dentist is formerly trained there is always a risk of having an untoward event. Thus, in addition to creating a team of nonclinical, auditors and investigators, a team of experienced clinical providers need to be apart of the team to suppress the tendency of investigators to make the investigations center around the “required medical necessity criteria” which only serve to establish the need to recoup fees. In addition, the standards required for sedation should be based solely on the clinical needs of the patient and not only on standards set forth by Medicaid, HHS, MCNA or Dentaquest. With the assistance of a team of Pediatric Dentist in private practice who treat the MCD population and our fine Texas institutions, our children will be guaranteed safety and this will allow the governing bodies to interact with those of us who care and who are at ground zero!
    Or, is this just another FWA contingency plan to recoup the very services which were provided by honest and dedicated specialist; who are grossly underpaid for the services provided. The undertone of the PDAT seems a bit suspicious… Given the debauchery which occurred with the orthodontic IOG, IG investigation! What oversight will the PDAT have? I only can hope their intent is the aforementioned…

    • The majority of Pediatric Practices are booked in average for the next 2, 3, or 4 months to see kids -general check ups or to do dental treatment under sedation-. If These Dentists or their offices are not able to accommodate our kids in their tight schedule -some works only 4 days a week no Saturday-, who else is going to see them? The answer: Our General Dentists who has the expertise and desire to treat and care them using behavior techniques and other techniques such as papoose board, oral sedation, etc.

  • We need to rethink if we want general anesthesia for such young patients covered by Medicaid. Dentists that accept Medicaid are often tempted to recommend treatment that Medicaid pays higher returns in order to collect more per patient. We should find a way to completely remove this temptation.

    • Sam.

      Let’s educate Parents and Kids in good habits and how to take care of their mouths to avoid those large dental treatment. The key factor here is “Prevention” if we do not make prevention among all our people we are going to continue to see patients all ages -no matter who- going to the dentist to get treatment doing under sedation.

      “Temptation” is out of question when the most important fact here is to do the best dental care possible for a human being. Have any of you interested in this subject taken the time to research on the internet to understand how those kids patients arrives to dental offices after months without teeth brushing or washed their mouths, and in a terrible pain and with the urgency to see a Dentist. Totally agree to investigate those professionals who only want to make money, but at the same time let’s thank to all of them who really care and do treatment on those kids.

    • Sam how is the blame on the dentist when the Medicaid nonshow rate is 50% at most offices. These people have free dental care and half don’t show us to their appointments with zero notice to the office. How does this help reduce cost to Medicaid?

  • This is a good news. I have a kid too and I got scared after hearing the incident that’s why I became cautious in choosing the right pediatric dentist for my son. My friends referred this one of the top dentist in Gilbert https://timberfallspediatricdentistry.com/. I am happy because the pediatric dentist is so good in handling kids. My kid doesn’t have trauma or fear in dentist visit anymore.

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