GAO identified a gap in state and federal efforts to ensure Medicaid managed care program integrity. Federal laws require the states and the Centers for Medicare & Medicaid Services (CMS) to ensure the integrity of the Medicaid program, including payments … Read More
Work continues to move the Medicaid claims administration contract from Xerox to Accenture. HHSC is reviewing Accenture’s readiness to take over the contract, which also includes processing claims for the Children with Special Health Care Needs program and vendor drug … Read More
Apparently TMHP/Xerox “dental specialists” were only trained to add up HLD scores on Medicaid orthodontic pre-approval requests and determine whether the total was 26 points or more, per allegations contained in the lawsuit filed against Xerox by the Attorney General … Read More
Michael McMillen, former Deputy Chief Counsel, Texas Health and Human Services Commission Office of Inspector General, is suing the HHSC for wrongful dismissal after reporting alleged violations of law within the agency. The nature of the alleged violations are not known. The … Read More
On May 7th, Dr. Kyle Janek, the Executive Commissioner of the Texas Health and Human Services Commission, issued his final order in the case of Antoine Dental Center of Houston. Upheld reversal of favorable SOAH ruling on Antoine Dental As expected, … Read More
As was reported in the Austin American Statesman back on May 25th, the Texas Health and Human Services Commission is seeking tens of thousands of dollars in advance from dentists who wish to go before the State Office of Administrative … Read More
Xerox Corp at the end of May was awarded a $500 million contract to revamp New York’s Medicaid system despite Texas suing the company and discontinuing their contract as chief Medicaid claims administrator in the state. The Rochester Democrat and … Read More
Wednesday, TDMR received a notice that HHSC had put online a report from Deloitte Consulting LLP entitled, “State of Texas Medicaid Payment Reform – Market Assessment and Recommendation Analysis.” The report is dated March 31st, 2014 and is 51 pages … Read More
Yesterday, HHS-OIG issued an audit entitled “Acute-Care Hospitals In Texas Did Not Always Reconcile Invoice Records With Credit Balances And Refund To The State Agency The Associated Medicaid Overpayments.” The federal auditors, in looking over eight acute care hospitals in Texas, … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the Texas Health and Human Services Commission (State agency). However, the seven remaining hospitals in our sample did not always … Read More
Deloitte Report for Texas As market pressures continue to mount, states are not only looking to derive more value from their managed care programs but also seeking to use these programs to address CMS’ Triple Aim: better health, better quality, … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the State agency. However, the seven remaining hospitals in our sample did not always reconcile patient account credit balances and … Read More
HHSC yesterday sent out a notice that a new draft HHSC strategic plan has been issued to cover 2015 to 2019. They have invited public comment. Naturally, the report is 348 pages long and their first public hearing on the report … Read More
May 27, 2014 — In the latest flurry of lawsuits in the Texas Medicaid scandal, eight dentists have filed suits claiming the state and attorney general (AG) “protected” Xerox because they feared a federal clawback for hundreds of millions of … Read More
With the Attorney General of Texas filing suit against Xerox and the Health and Human Services Commission publicly washing its hands of the Fortune 500 company as lead contractor in the Texas Medicaid and Healthcare Partnership, Xerox now joins dental … Read More
May 20, 2014 — In the wake of a Texas lawsuit that claims Xerox wrongly approved Medicaid claims for orthodontic services that were not medically necessary, some of the dentists being pursued for orthodontic overpayments are now suing Texas for … Read More
The Texas Tech University System Board of Regents officially named state Sen. Robert Duncan, R-Lubbock, the sole finalist to be the system’s next chancellor in a press release issued Monday afternoon. Duncan is expected to start in his new position … Read More
Last week, Attorney General Greg Abbott filed a lawsuit against Xerox and its subsidiary, ACS Healthcare, alleging that the company had not properly vetted dentists’ pre-authorization requests to perform Medicaid orthdontic work on poor children, saddling taxpayers with hundreds of … Read More
TDMR filed an open record request a while ago to obtain the Texas dental Medicaid spending figures for the years from 2000 to 2005 and 2012, 2013. Texas Medicaid orthodontic spending from 2006 to 2011 has been heavily reported so we … Read More
Several suits by Medicaid providers filed today in Travis County’s 53rd Civil District Court seek to intervene in the recent lawsuit brought by the state of Texas against former state Medicaid claims contractor, ACS/Xerox (henceforth “Xerox”). Recover damages from both … Read More
Last year, state regulators accused Dallas-area dentist Everett Evans of bilking Medicaid out of millions of dollars by performing unnecessary procedures and billing for work he didn’t do. They froze more than $800,000 in pending payments to him from the … Read More
The state of Texas on Friday moved against the contractor in charge of pre-authorizing controversial orthodontic and dental procedures, canceling a large contract with ACS Healthcare and suing the company and its corporate owner, Xerox Corp., to recover hundreds of … Read More
As the Texas Attorney General’s office on Friday announced it filed a lawsuit against state contractor Xerox, in an effort to reclaim hundreds of millions of dollars the company allegedly erroneously doled out for medically unnecessary Medicaid claims, the Health … Read More
AUSTIN — Attorney General Greg Abbott sued Xerox Corp. Friday over allegations that it let unscrupulous dentists put braces on thousands of poor children who didn’t meet the government’s strict criteria for the expensive work. Also Friday, the state’s Medicaid … Read More
REPUBLISHED FROM THE TEXAS TRIBUNE BY BECCA AARONSON Editor’s Note: This story has been updated throughout to reflect the state’s decision to cancel its contract with the Texas Medicaid and Healthcare Partnership, and the company’s response to the state’s actions. As the … Read More
Date: May 9, 2014 Contact: Stephanie Goodman, 512-424-6951 The Texas Health and Human Services Commission (HHSC) today notified Xerox Corp. that the state is terminating the company’s Medicaid claims administration contract for cause after Xerox staff approved thousands of requests for braces … Read More
Back in mid-April, TDMR sent to our dental Medicaid provider mailing list a simple one question survey – What is your biggest practice challenge? We received over 90 responses and results are now tabulated. The survey shows that Medicaid dentists are now most … Read More
by Becca Aaronson, The Texas Tribune May 2, 2014 Part two of two. For nearly five years, a state contractor allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on … Read More
by Becca Aaronson, The Texas Tribune May 1, 2014 Part one of two. In 2010 and 2011, Antoine Dental was among Texas’ top-billing Medicaid providers for orthodontic services, collecting more than $1 million annually for putting braces on poor children. … Read More
In an unheralded August 2012 audit report that is available online, the federal Health and Human Services Office of Inspector General found that the Texas Health and Human Services Commission had not returned $2.6 million in Medicaid funding back to … Read More
The following is an opinion piece written by Jason Ray, attorney for a number dentists who are being prosecuted by HHSC-OIG for their Medicaid orthodontic billings. Mr. Ray is with the firm of Riggs Aleshire & Ray, P.C. I … Read More
A recent review of our website content revealed to us that while PDF files containing these photos have always been on the site, perhaps they have not been as prominently displayed as they should be. Medicaid after all is about … Read More
This week the Texas Attorney General filed a remarkable brief to oppose the motion to disqualify HHSC judge Rick Gilpin from a Medicaid payment hold case because he was a senior lawyer in the Attorney General’s office for some 38 … Read More
Private contractors should be held to the same accountability as the agencies that contract them, says University of Baltimore law professor Kimberly Brown. “From Abu Ghraib to Blackwater, a string of scandals has heightened public awareness that highly sensitive federal … Read More
A motion has been filed with the Texas Health and Human Services Appeal Division to have Judge Rick Gilpin disqualified as a hearing officer for cases involving dentists that started while Gilpin was still an attorney within the Attorney General’s … Read More
The same HHSC judge that overturned a favorable SOAH (State Office of Administrative Hearings) decision in the payment hold case of Antoine Dental of Houston, has denied a motion to have a Medicaid overpayment hearing held at SOAH. HHSC Administrative … Read More
Carousel Pediatrics, a chain of Austin clinics originally accused of defrauding the government of $18 million in Medicaid payments, has agreed to repay $3.75 million for what regulators called a “pattern of billing errors” over four years. The settlement allowed … Read More
by Alexa Ura, The Texas Tribune March 17, 2014 Carousel Pediatrics, which has been the subject of a multiyear investigation in Texas, has settled its Medicaid fraud case with the Health and Human Services Commission’s Office of Inspector General, agreeing to … Read More
The Health and Human Services Commission issued a press release this afternoon that OIG has now settled with Carousel Pediatrics of Austin on claims of Medicaid fraud, now deemed billing errors, for $3.75 million. $22.1 million settled for $3.75 million … Read More
The Big Conversation If the University of Texas System regents tap Gov. Rick Perry favorite Kyle Janek as their next chancellor, they won’t get pushback from the president of the system’s flagship campus. “I’ve known Kyle for a long … Read More
