TDMR has learned from a staffer in the office of Sen. Juan “Chuy” Hinojosa that they have been informed by Health and Human Services that managed care organizations, including MCNA, do not have any right under any Texas or federal law to place a “credible allegations of fraud” payment hold on Medicaid providers – only the HHS Inspector General can do that.
Meetings with HHS
Since the January 4 letter from Sen. Hinojosa to HHS Executive Commissioner Charles Smith, asking Smith if MCOs such as MCNA could place CAF holds, representatives from Sen. Hinojosa’s office have met twice with Smith, the last meeting held last week. HHS has determined that no MCO has a legal right to place a CAF hold for any reason on any provider. MCOs are to contact the IG if they encounter provider fraud. HHS will be issuing a notice to all MCOs to inform them of this fact.
The representative from Sen. Hinojosa’s office expressed surprise that they had to look into this.
MCO told to stop placing CAF holds
TDMR also learned that representatives from HHS sat down with representatives from an unnamed MCO (we assume it was MCNA) and told them that their practice of placing CAF holds was to end. If the MCO discovered any provider fraud, they were to alert the IG, not take matters into their own hands. Apparently, the MCO has promised to end the practice of placing CAF holds and has told HHS that there are currently none any longer in Texas.
Let us know if they have
We would like to hear back from dental providers if this is indeed the case.
Apology to providers minimum action
We also wonder if there will be an apology to those providers affected or any sanction made against the company for its unlawful action against providers.