What happens if a company gets sued for $2 billion by the State of Texas for Medicaid fraud as its former Medicaid claims administrator, then tries to pay the settlement by committing insurance fraud? Texas gives them a new contract! … Read More
TDMR received an email from a provider that a new problem had developed in credentialing a dentist that adds even more time to the process. No TPI in welcome letter Apparently, TMHP is no longer including the TPI (Texas Provider … Read More
This seems like a silly question because surely the agency that pays billions of dollars to DMOs and MCOs and keeps the Medicaid show on the road in Texas should know something—and perhaps should know everything– about the credentialing of their Medicaid dentists in Texas. You wouldn’t be … Read More
The American Dental Association’s Health Policy Institute last month published the results of an ongoing survey it has been conducting since January 2022, quizzing some 3,000 participating private practice dentists each month to measure the impact of COVID-19 and other … Read More
Over the last several months TDMR has been receiving an increasing number of complaints regarding credentialing for Texas Medicaid dental providers. There have been numerous fixes over the years such as PEMS, the Provider Enrollment & Management System, which is … Read More
The American Dental Association Health Policy Institute has reported that national spending on dental care has recovered from the pandemic and in 2021 was higher than pre-pandemic levels. Patients coming back and government funding The increase is attributed to patients … Read More
The Great State of Texas, a leader in so many other things, unfortunately, is not a leader in healthcare. United Healthcare Foundation, UnitedHealth Group This is according to America’s Health Rankings, an annual state-by-state survey of healthcare in the nation … Read More
Texas Health and Human Services Office of the Inspector General came out with its last quarterly report for fiscal year 2022 this month. OIG provider settlements One of the key takeaways from the report is that 16% of the 147 … Read More
TDMR received this letter highlighting the difficulty Medicaid dental providers are having in today’s current economic climate and the need for the legislature this session to take corrective action. We publish it in hopes that it will reach open and … Read More
Becker’s Dental & DSO Review published a list of things about dental care in Texas a while ago. Some of them are not very flattering to this great state. Many underserved areas While Texas has the second most number of … Read More
Texas Health and Human Services is looking for a dental policy analyst for its HHSC Medical and Dental Benefits Program. As they say, “If you enjoy researching, writing policy and remaining current with dental practices, and are interested in being … Read More
This case has finally come to an end. The Court of Appeals, Eighty District in El Paso, on October 14 confirmed the May 2020 lower court summary judgment award obtained by the state against Dr. Richard Malouf for violations of … Read More
A striking aspect of Medicaid fraud news is that it took so long for public officials to figure out that private companies have a profit motive. Also notable is that Managed Care Organizations (MCO) are not only lax in addressing … Read More
State Medicaid Director Stephanie Stephens, in a speech given on September 27 at the 2022 North Texas State of Reform Health Policy Conference, stated that an HHS priority for the upcoming legislative budget is Medicaid provider rates. Provider fees a … Read More
The American Dental Association recently held a webinar in which members of a key study about Medicaid dental practitioners provided details of their findings. Estimate drops by 11% The main takeaway is that the ADA has now readjusted downward from … Read More
TDMR received an email from Texas Health and Human Services this week requesting everyone’s help to come up with ideas to save some dough. Apparently, the Texas Legislature directed HHS to figure out how to save $350 million for the … Read More
OIG recently published the following article on its website which we thought to republish here along with the PDF documents linked to in the article. Texas providers encouraged to self-report overpayments Providers continue to participate in the OIG’s self-report process, … Read More
According to a recent report entitled “Access to Oral Health Workforce Report, Part I” by the Pennsylvania Coalition for Oral Health, the state lost 13.5% of its dentists participating in its Medicaid program between the beginning of 2019 and the … Read More
Ensuring Texas Medicaid dollars are spent for their intended purpose requires the Texas Health and Human Services (HHS) Office of Inspector General (OIG) to work with health care professionals to prevent fraud, waste and abuse. Accurate medical and dental coding … Read More
The recent business headlines about Sun Life, the Canadian insurer that purchased DentaQuest earlier this year, and its Q2 financial results are quite bipolar – either dismal or glowing. Good Q2 or not for DentaQuest purchaser Several publications spotlight the … Read More
