AUSTIN – As lawmakers on Capitol Hill continue to discuss the future of the CHIP program, Texas is set to receive $135 million from the federal government to keep benefits in place thru February. CHIP, which stands for Children’s Health Insurance Program, … Read More
UPDATE: After conferring with colleagues, this is not the major reimbursement changes that were discussed earlier this year but an annual update of codes with minor changes. Hope you are having a nice Friday afternoon, the Friday before the Christmas … Read More
UPDATE: Arguments in this case were heard by the Supreme Court on Wednesday, December 6. The 39-minute video of the oral arguments is here. The court’s decision is not expected until spring of next year. As a heads up for dentists … Read More
TDMR is releasing the results of its 2017 Medicaid Provider survey today. Not much has changed Not much has apparently changed for Medicaid providers from 2016. per the 337 individuals who answered our anonymous, 6 question survey in October and … Read More
AUSTIN — Under Gov. Greg Abbott, more and more top officials at Texas’ social services superagency command big salaries. Not counting staff physicians, the Health and Human Services Commission has 11 administrators making $200,000 a year or more. A decade ago, … Read More
Pfizer (PFE) lost a round in the larger fight over pharmaceutical pricing when a federal judge ruled that Texas lawmakers should be able to obtain state Medicaid rebate data about its medicines. The drug maker last year filed a lawsuit … Read More
According to a story in today’s Texas Tribune, a large number of experienced executive staff of Texas Health and Human Services have exited the mega-agency due to conflicts with current Executive Commissioner Charles Smith. So far, these include, according to the … Read More
Today, the Texas Supreme Court agreed to hear oral arguments from orthodontic providers regarding the dentists’ counterclaims in the pending State vs. dentists vs. TMHP/Xerox cases. The general facts of the underlying dispute about orthodontic prior authorization have been well-covered … Read More
UPDATE: September 1, HHS announced this morning that it has put on hold the proposed rate changes per legislative sources. Original story: August 1, 2017 TDMR has received a copy of an email from the Texas Academy of Pediatric Dentistry … Read More
On August 9, the House Committee on Human Services held a public hearing. Part of the agenda was to hear testimony relating to the proposed dental Medicaid reimbursement rate cuts for many necessary codes that have been called “devastating” by … Read More
From the Texas Dental Association: ATTENTION TDA MEMBER MEDICAID DENTISTS: CALL TO ACTION Texas Health and Human Services (HHS) is moving forward with a devastating proposal that will significantly cut certain Medicaid dental reimbursement rates. The proposed cuts include dental codes that … Read More
From the Texas Dental Association: As a part of ongoing efforts to prevent potentially devastating “rebalancing” of Medicaid dental fees, the Texas Dental Association (TDA) will meet with Health and Human Services officials in the coming weeks to discuss each … Read More
Several ambulance services from across Texas are working to stave off a potential 10 percent cut to their Medicaid reimbursements. The Texas Health and Human Services Commission is planning to cut the amounts ambulance services can bill the government for … Read More
The Statesman published a landmark article this morning by reporter Eric Dexheimer regarding the great Texas orthodontic debacle. Story finally pieced together Thanks to the state’s fraud suit against Xerox, its former Medicaid claims administrator summarily terminated back in early … Read More
A dozen years ago, Texas health care administrators hired a company to help determine when taxpayers should cover the cost of dental care for the state’s poorer residents, particularly children. The company, later acquired by the giant corporation Xerox, deployed … Read More
The Inspector General wants your feedback on our website, https://oig.hhsc.texas.gov/. Please take our quick, 7 question survey and let us know how you use our site, what you like about it, and what we can improve on. Click on the link … Read More
The Texas Senate confirmed Charles Smith’s appointment on April 19 as the Health Human Services executive commissioner for a two-year term at the head of the state’s largest agency. Smith, a Childress native, oversees an agency of 53,000 employees that … Read More
The Texas Health and Human Services Commission did not always claim Federal Medicaid reimbursement for managed care payments in compliance with Federal requirements. Of the 3,170 beneficiary matches in our review, 3,045 were assigned more than 1 Medicaid identification number. … Read More
McALLEN — Five Valley residents have been charged with Medicare fraud and the payment of illegal kickbacks. According to the charging documents, each of the five individuals engaged in conspiracies to refer Medicare beneficiaries to a home health agency … Read More
Texas HHS placed on their website last week two new policies relating to Medicaid dentistry on which they would like stakeholder comments. Dental anesthesia The first is a draft policy relates to dental anesthesia which: Requires prior authorization for general anesthesia in conjunction … Read More
A purchasing director of Child Protective Services has been placed on administrative leave as officials launch an investigation into a pending contract involving a nonprofit where the director’s husband works, the American-Statesman has learned.It’s the second time Frianita Wilson has … Read More
Several legal media outlets reported yesterday that former Texas Medicaid claims administrator Xerox has brought an appeal before the Texas Supreme Court because the company says the state is “wrongfully blocking the company from designating the dentists who treated patients in the alleged … Read More
Jeff Leston, the founder of Castlestone LLC, has provided TDMR with his take on how to improve government healthcare plans such as Texas Medicaid to reduce waste, fraud and abuse. Castlestone is a company created to use the infrastructure of … Read More
TDMR has learned from a staffer in the office of Sen. Juan “Chuy” Hinojosa that they have been informed by Health and Human Services that managed care organizations, including MCNA, do not have any right under any Texas or federal … Read More
Did you know that HHS, formerly HHSC, has a Managed Care Inquiries and Complaints mailbox? It does. It also has a person to field those inquiries and complaints. That person is Dr. Marguerite Laccabue, MPH, DDS, Dental Director of the Office of … Read More
At the same stakeholders meeting last February that representatives from MCNA and Dentaquest provided briefings, the then-dental director for the Health and Human Services Inspector General, Dr. Linda Altenhoff, presented on rules and regulations regarding solicitation by dental providers. Altenhoff … Read More
In February of last year, Texas Health and Human Services Dental Director Marguerite Laccabue held a dental stakeholders meeting in Austin. It doesn’t appear from the HHSC online video of the proceedings that it was well-attended or promoted as the … Read More
TDMR has obtained a copy of a January 4 letter from State Sen. Juan “Chuy” Hinojosa to Charles Smith, the Executive Commissioner of Texas Health and Human Services asking Smith to review MCO “credible allegations of fraud” payment holds. While … Read More
TDMR received the following email from a Texas dentist. He has given permission for us to publish it and we are doing so anonymously to hopefully prevent any further retribution against himself and his practice. I am writing this email … Read More
Last Thursday, Texas Health and Human Services held its Biannual Managed Care Stakeholder Meeting in Austin. The meeting was primarily hosted by Jami Snyder, the Associate Commissioner for the Medicaid & CHIP Services Department of HHS. During the open discussion … Read More
2016 ended very badly for Texas Medicaid. It was a very poor Christmas for many. There were a number of important divisive events that occurred which we decided not to comment on during the holiday season. We didn’t want to spread … Read More
Back in December, TDMR asked dentists to take an online survey to ascertain their views on Texas Medicaid dental managed care. We now have these results which are provided below and can be downloaded. Limitation of survey results Before we … Read More
CVS Pharmacy, accused by the state of Texas of defrauding Medicaid of $30.5 million, is suing the state Health and Human Services Commission, claiming state officials approved the billing practices at the heart of the fraud case, court records show. … Read More
TDMR has been notified that Texas Health and Human Services is holding its biannual meeting on managed care next Thursday in Austin. It is open to the public and is taking public comment on several items. If you can’t make … Read More
After more than a year of delays, Texas is officially kicking Planned Parenthood out of the state’s Medicaid program. In a move that could affect thousands of low-income women, state health officials on Tuesday delivered a final legal notice to … Read More
Just before the Thanksgiving holiday, TDMR received a flurry of emails and phone calls regarding our story about a dentist who was having payments recouped by MCNA for treatments the company had previously approved. He was being forced to travel … Read More
When President-elect Donald Trump tweeted Sunday — without evidence — that “millions” of people voted illegally in the race for the White House, he invited a wrath of condemnation for again stoking doubts about the U.S. election system. But in … Read More
Our story on MCNA secretly recouping payments from a dentist who had an MCNA pre-approved treatment plan for a young Medicaid-eligible cancer patient touched a raw nerve with a number of dentists from around the state. The story received a … Read More
In response to TDMR’s latest story on payment holds placed on Medicaid dentists by MCNA, TDMR received an emotional missive from a Medicaid dentist about his negative experience with MCNA. He gave permission to publish his comments. The legislative session … Read More
There is a rumor circulating that the Texas Health and Human Services Commission is putting together a new request for proposals (RFP) for dental managed care organizations for Texas Medicaid. While this may or may not be the case as … Read More
