The state's $235 million settlement this week with Xerox/Conduent, its former Medicaid claims administrator, unfortunately, leaves unresolved some disturbing questions about how the company could operate its insanely irresponsible orthodontic prior authorization process for so long with state officials either looking the other way or incapable of doing anything about it. While … [Read more...]
Texas Settles with Xerox for $235 Million Out of “Desire to Buy Peace and Avoid Further Litigation”
This morning Attorney General Ken Paxton announced that the State of Texas had settled its $2 billion Medicaid fraud lawsuit against Xerox/Conduent, its former Medicaid administrator from 2004 to 2012, for $235 million. The settlement over Xerox/Conduent's inadequate orthodontic prior authorization process was touted as a record recovery for Medicaid fraud in Texas. The … [Read more...]
Xerox Quality Assurance Checks on Ortho PAs Apparently Consisted of Re-checking the Addition of HLD Score Sheets
For those following the $2 billion Medicaid fraud case against Xerox/Conduent here in Texas, another plank in the state's case against the company is that it alleges that no meaningful Quality Assurance check was ever done to ensure medical necessity on some 500,000 orthodontic prior authorizations the company approved from 2004 to 2012. "Can't recall" Under deposition, … [Read more...]
“I approved all of them regardless” – Xerox/Conduent Dental Director on Ortho PAs
Dr. Jerry Felkner Some of the evidence that the state is using to pursue Medicaid fraud allegations against its former Medicaid claims administrator on its orthodontic prior authorization program from 2004 to 2012 comes directly from depositions of the Xerox/Conduent dental director, Dr. Jerry Felkner. Xerox/Conduent kept telling the state in their policy manuals that he was … [Read more...]
Texas lawmaker introduces bill requiring name and photo be added to Lone Star card to fight fraud
A Texas lawmaker has authored a bill that would require photographs and names on Lone Star cards to help fight fraud. Dade Phelan (R-Beaumont) filed HB 1250 on Jan. 31. The bill requires that the name and photograph of the recipient or other authorized person must be on the front of the card. The card also must show the words "Fraud Hotline" followed by the hotline's … [Read more...]
Dental Managed Care Issues Receive Legislative Attention with Meeting at the Capitol
Back on November 21, House Human Services Committee Chairman Richard Peña Raymond held a meeting with a select group of dental providers regarding dental managed care issues. Providers requested meeting The meeting was initially requested by South Texas Dental but was expanded to include other dental groups and the Texas Dental Association which were invited through Raymond's … [Read more...]
Comments on Dental Radiation Machine Regulations Proposed Rules Due 2/10
Texas Health and Human Services is accepting comments from stakeholders on the following proposed rules. The comment period ends February 10, 2019. Department of State Health Services 25 TAC, Part 1, Chapter 289, Radiation Control Interested parties can participate by: offering informal comments.commenting on proposed rules published in the Texas Register.providing … [Read more...]
Texas Health and Human Service Commission sued by Home Health Agencies Over Reimbursement Halt
A group of home health agencies is suing the Texas Health and Human Service Commission (HHSC) for allegedly halting reimbursements for telemonitoring services. The agencies claim they will go out of business and deprive Texans of necessary care if the court doesn’t step in. Unidos Healthcare LLC; Corazon Health Care Services LLC; Cleveland Health Care LLC, which operates as … [Read more...]
TDMR Six Years Old and Still Going Strong
As we approach the New Year, we at TDMR have taken a few minutes to contemplate the last few years - six so far. We had no idea back in 2012 that we would still be going strong today. Come a long way On December 7, 2012, we launched this website and published our first article "Harlingen Family Dentistry Wins Major, Precedent-Setting Decision in Texas Medicaid Orthodontics … [Read more...]
New Texas Medicaid and CHIP Guide, the Pink Book, Now Available
HHS has published the 12th edition of a reference guide for Texas Medicaid and CHIP, commonly known as the Pink Book. The new version that has under gone a complete redesign is posted here. … [Read more...]