medicaid fraud

A proposed class action settlement has been reached with Managed Care of North America (MCNA), MCNA Insurance Company and Healthplex over a massive 2023 data breach that affected approximately 8.9 million people. As reported by TDMR at the time, the … Read More

DentistryIQ recently published an important article examining how two Texas Medicaid fraud lawsuits are shining a spotlight on compliance risks facing pediatric dental practices. The title of the article is Is Pediatrics the Most Heavily Scrutinized Specialty in Dentistry? Ouch! The … Read More

The Texas Supreme Court has issued a significant decision that could reshape how Medicaid fraud cases are pursued in Texas, ruling that the State cannot simply point to an alleged regulatory violation. Instead, it must also prove that the alleged … Read More

OIG recently published the following article on its website.  Providers should know that AI is on the job at OIG now.   New tech tools increase OIG productivity Teams within the OIG Data Operations Division recently launched new efficiency-focused tools … Read More

Last Friday, TDMR published our article highlighting growing concerns about dental marketing in Texas Medicaid, as raised by a recent interagency report from the Office of Inspector General (OIG)/Office of the Attorney General (OAG). Well, the proverbial shit hit the … Read More

The latest Joint Annual Interagency Coordination Report from the Texas Health and Human Services Office of Inspector General and the Texas Office of the Attorney General, which was published this month, offers a useful reminder for Medicaid dentists about where … Read More

Over the past nine years, Jeff Leston of Castlestone Advisors has written several articles for TDMR examining why Medicaid fraud continues despite decades of enforcement efforts. In his previous pieces, Why States Aren’t Really Interested in Reducing Medicaid Fraud, A … Read More

Almost 15 years ago, on May 13, 2011, WFAA’s Byron Harris uttered the famous phrase, “Nobody has ever died from crooked teeth,” which ushered in the Great Texas Medicaid Fraud Debacle. To think that today, in 2026, TDMR would still … Read More

And the story rolls on. The Delaware Supreme Court this week ruled against insurance giants AIG, ACE, and Lexington Insurance, upholding a lower court’s decision to order a new trial in their dispute with Conduent State Healthcare (ACS/Xerox/Conduent) over coverage … Read More

ACS State Healthcare and Conduent State Healthcare LLC have filed an appeal with the Texas Supreme Court, hoping to prevent a trial in which it must defend its flawed Medicaid prior authorization process, which rubber-stamped hundreds of millions of dollars … Read More

This week, a federal judge in Tennessee found that an algorithmic system similar to the one in Texas and designed by the same company illegally denied Medicaid benefits to thousands of Medicaid-eligible individuals. The TennCare Connect system, developed by Deloitte, … Read More

Justice for Medicaid dentists and orthodontists, whose lives, reputations, and practices were ruined in the great Texas Ortho Debacle, appears to be coming—slowly, but surely. Legal losses continue to mount for Conduent State Healthcare LLC, spun off from Xerox in … Read More

In what can only be described as a bombshell decision, the Texas Supreme Court has sided with Dr. Richard Malouf and his legal team.  The Court not only reversed the $16 million summary judgment against Dr. Malouf but granted his … Read More

BY KAREN BROOKS HARPER, Texas Tribune APRIL 26, 2024 “State’s premature release of bid proposal info touches off new battle over $116 billion in Medicaid contracts” was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs … 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

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

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

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

OIG announced on their website yesterday that they were updating their self-reporting protocol for Medicaid providers. Here is what is said with a PDF copy of the protocol below. The OIG has updated the protocol providers use to voluntarily disclose … Read More

Considering that one of the largest DMOs in the country was hacked by the Russian ransomware group LockBit and their entire network data stolen, there has been surprisingly little media coverage about this massive data theft.  The consequences of identity … Read More

The number of privacy law firms “investigating” MCNA for its massive data breach is growing exponentially. Here are just a few of the announcements made since our last article. Silver Golub & Teitell LLP Investigates MCNA Dental Data Breach Class … Read More

MCNA has been making the news the last few days because it placed a notice on its website May 26 as well as sent letters to several state Attorney Generals that it was hacked back in February and that the … Read More

Last week, TDMR filed a complaint with the Texas Health and Human Services Office of Inspector General over the continuing complaints received by TDMR about the unacceptable delays in the credentialing of Medicaid dentists, particularly relating to the need to … Read More

The latest Texas HHS-OIG Quarterly Report issued last month, again for some reason, under provider integrity, focussed on findings made on investigations of Medicaid dental providers when these investigations only account for a tithe of full-scale investigations conducted by OIG. … Read More

We’re not exactly sure what happened, but Raymond C. Winter, who headed up the Civil Medicaid Fraud division of the Office of the Attorney General of Texas for the last 15 years, is no longer there. According to his LinkedIn … Read More

More trouble for Texas’s latest Medicaid contractor, Conduent. Needless to say, insurance providers AIG and partner companies are appalled that the Delaware judge in their case against Conduent granted a retrial and dismissed the jury verdict that Conduent had committed … Read More

You just can’t make this stuff up. HHS just contracted with Conduent again Texas just rehired Conduent, the company it had fired in 2014 as its lead Medicaid contractor and then accused of $1.2 billion in Medicaid fraud which it … Read More

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

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 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

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

It is with some irony that a company that has been found guilty of insurance fraud by a jury in Delaware (and apparently colluding with the Texas Office of the Attorney General to do so) is still a major player in … Read More

In March TDMR reported on the federal HHS-OIG report about the 2021 cumulative activities of state Medicaid Fraud Control Units around the country.  As there were no state breakdowns, we filed an access to information request with the Office of … Read More

This was posted on the Texas HHS-OIG website yesterday.  Thought we would republish.. ————————— Ensuring Texas Medicaid dollars are spent for their intended purpose requires the OIG to work with health care professionals to prevent fraud, waste and abuse. Accurate … Read More

The Department of Health and Human Services Office of Inspector General recently released its 2021 Medicaid Fraud Control Units (MFCU) Fiscal Year 2021 Annual Report. Investigates criminal fraud Medicaid Fraud Control Units have the job of investigating criminal fraud by … Read More