TDMR has reported on a number of recent controversies regarding dental loss ratios and value-based care outside of Texas. Now, to address these issues nationally, a Massachusetts-based dental organization, the American Alliance for Dental Insurance Quality (AADIQ), has been formed … Read More
The latest OIG Quarterly report was released last month. It contains several important trends for dentists and trends in OIG investigations into dental practices. Firstly, OIG preliminary investigations into dentists and dental practices remain at their traditional level of 6%, … Read More
HHSC announced this morning that Conduent’s recently awarded contract as TMHP’s claims vendor had been terminated for convenience. Termination for convenience means “a party to a contract to bring the contract to an end without the need to establish that … Read More
For the last decade flying under the radar, a couple of dentists and their attorneys have quietly and doggedly pursued the private contractor that approved their Medicaid orthodontic prior authorizations from 2004 to 2012. These dentists are seeking damages for … Read More
Yesterday, we received an OIG update that is valuable for Medicaid dentists. OIG has found concerns “about inappropriate administration of sedation and local anesthesia, discharging the patient before they fully recovered from anesthesia, and billing for sedation levels the provider … Read More
Since Massachusetts voters overwhelmingly voted in favor of Question 2, the “Patient Access to Affordable Dental Care Act” in November 2022, instituting the nation’s first dental loss ratio, there has been a push to get other states on board with … Read More
In a landmark case for antitrust law and the dental industry, roughly 240,000 dentists and dental practices have initiated a class action lawsuit against Delta Dental, the United States’ largest dental insurance system. The case, formally known as In Re … Read More
TDMR received notification of a new report from Texas HHS on the End of Continuous Medicaid Coverage in Texas. The upshot for children who were under Medicaid coverage during the public health emergency (PHE) is that, at present, some 999,524 … Read More
Over the last several months, TDMR has been receiving anecdotal comments from Medicaid dental providers that they have found themselves truly between a rock and a hard place at this time. Although we have reported on a number of negative … Read More
On February 7, the Nebraska legislature passed the first reading on a bill to increase Medicaid dental reimbursement rates by a whopping 25%. In the only state with one state legislative body, that legislative body passed the bill 35-0. Recognizes … Read More
UPDATE: YouTube video added of hearing 22-1046 Malouf v. State ex rel. Ellis Supreme Court Hearing, January 31, 2024 It might just be possible that more than a dozen years after the great WFAA expose on “Crooked Teeth,” a Medicaid … Read More
This week, Pro Publica and the Texas Tribune released the results of an investigation into the Texas Office of Attorney General Civil Medicaid Fraud unit and its recent tremendous loss of staff coinciding with the firing of its long-time head, … Read More
The movement to set a dental loss ratio (DLR) for the dental insurance industry is fast becoming a national issue and is now on the agenda of a number of state dental associations as well as the ADA thanks to … Read More
Inspector General Raymond Winter who came to post last October released his first quarterly report at the end of December. It is also the report for the first quarter of fiscal year 2024. No cases involving dentists highlighted OIG settled … Read More
This week, Attorney General Ken Paxton issued a press release touting his agency’s recovery of some $203 million in 2023 from Medicaid fraud, waste, and abuse. The figures come from the 2023 Joint Interagency Coordination Report, which “summarizes the collective … Read More
The Office of the Inspector General just published a short interview with Inspector General Raymond C. Winter, who was appointed to the position last year. The interview is about his 2024 priorities. IG Winter had previously been a deputy attorney … Read More
Arizona, through its Arizona Health Care Cost Containment System (AHCCCS). the state’s Medicaid agency, has instituted a value-based healthcare initiative with its Differential Adjusted Payment (DAP) program, which has been running for several years. Value-based healthcare initiative Value-based healthcare focuses … Read More
TDMR has written extensively on how the provisions of the Texas Medicaid Prevention Act may be used by apparently unscrupulous relators to seemingly blackmail honest dentists into hefty monetary settlements to avoid costly and lengthy litigation. Problems with TMFPA The … Read More
The Texas Supreme Court agreed this past week to hear arguments as to why the $16.5 million summary judgment against Dr. Richard Malouf should not be upheld. Oral arguments will be heard on January 31 next year. A dozen years … Read More
Inc. Magazine just published an article by Adam Levin, Chairman and Founder of CyberScout, with his take on the alarming increase in fraudulent claims within Medicare and Medicaid due to the proliferation of medical identity fraud. This figure now exceeds … Read More
