In March, Attorney General Pam Bondi announced she had nailed someone for Medicaid fraud. The culprit was a 49-year-old home-health worker from dirt-poor Gadsden County, accused of bilking the state out of $13,000. For her crime, Melissa Letica Simmons was … Read More
Medicaid provides health insurance to about 500,000 Iowans. For decades, the government program has been operated by the state, which is not beholden to shareholders. Spending has been held down by reducing fraud, paying lower reimbursements to providers and giving … Read More
Sunday night on this Memorial Day weekend, the Texas House of Representatives passed Senate Bill 207, the legislation that will reform the Health and Human Services Commission Office of Inspector General. The recorded vote was 142-0. The bill now goes back … Read More
HARLINGEN, Texas, May 18, 2015 /PRNewswire/ — Nestled within its 900-plus pages of legalese, the Patient Protection and Affordable Care Act, or ACA, requires healthcare providers participating in federal programs to have an effective compliance program in place. For providers without … Read More
Texas regulators entered a courtroom late last year claiming they should be able to keep more than $300,000 confiscated from a Corpus Christi dentist they claimed defrauded the state through a Medicaid billing scheme. Source: State’s decisive legal loss could … Read More
TDMR has started a regular video news segment that will be carrying Texas Medicaid news plus relevant stories from around the country. Over the next few weeks, we will be starting to include interviews with key players in Texas. Our … Read More
Today, the Health and Human Services Commission announced that it has put up a new page on its website for Medicaid providers to comment and stay abreast of policy changes relating to Medicaid covered medical and dental treatments. The new … Read More
UPDATE: After publishing this article, TDMR was alerted that it is a DENTIST, not a medical doctor that is involved in this case. It involves the Rhoden Group from Corpus Christi with Dr. Cheryl Rhoden, DDS as the principal. This … Read More
With billions of dollars in hospital aid at stake, health care officials are anxious for state leaders to resolve the federal government’s concerns about extending a program that helps cover the staggering cost of caring for uninsured and needy Texans. … Read More
Dr. Paul Dunn, a small town general dentist who practices orthodontics out of Levelland, has had a case outstanding with the Health and Human Services Commission Office of Inspector General since 2011. He has been under severe financial strain since … Read More
Senate Bill 207 which details legislative reforms to be made to the structure and function of the Health and Human Services Commission Office of Inspector General as recommended by the Sunset Advisory Commission has cleared the Texas Senate and is set … Read More
This past week, the Texas Health and Human Services Commission in its monthly In Touch newsletter announced that Deputy Executive Commissioner Chris Traylor is retiring as of May 31st. Traylor has been in the Texas public service for 25 years … Read More
Two articles from the Houston Chronicle this last week should send shivers down the spine of every Texan about what kind of government his or her tax dollars are buying. The whole contracting fiasco in the Texas Health and Human Services … Read More
Yesterday, the Texas Senate passed and sent down to the House of Representatives Senate Bill 207, the bill setting out much needed reforms to the Health and Human Services Commission Office of Inspector General that came out of the Sunset … Read More
AUSTIN — A new bill to curb alleged abuses of an organization that is itself supposed to police abuses got Texas Senate approval Tuesday. Senators voted 30-0 to pass Senate Bill 207 by state Sen. Juan “Chuy” Hinojosa, D-McAllen, which … Read More
AUSTIN — A discussion about restructing the Texas health agency morphed into a heated argument about President Obama’s health care law in the state Senate on Wednesday, as Democrats frustrated at not getting a committee hearing on a Medicaid expansion plan … Read More
The Texas Senate on Wednesday tentatively approved a measure to partially consolidate the state’s massive health and human services system. Under Senate Bill 200 by Jane Nelson, R-Flower Mound, three of the state’s five health and human services agencies — the … Read More
April 2, 2015 — Dentists and other private healthcare providers cannot sue to force states to raise their Medicare reimbursement rates, according to a U.S. Supreme Court ruling issued on March 31. This ruling means that dentists and other healthcare … Read More
The news that Smile Magic Dental clinics recently settled with the Texas Health and Human Services Commission Office of Inspector General over allegations of Medicaid fraud confirms what TDMR has been saying for a long time – that the purpose … Read More
Rep. Bobby Guerra filed H.B. No. 3023 this week. The purpose of the bill is to make it mandatory for Medicaid providers to get an overpayment hearing before the State Office of Administrative Hearings if they dispute an recoupment demand from the Health and Human … Read More
Members of the Texas Senate will likely propose significant additions to a bill introduced this week on agency contracting now pending before the Senate Finance Committee. Sen. Jane Nelson, R-Flower Mound, introduced Senate Bill 20 to address what she called … Read More
A new report out from the GAO suggests that state IT systems may not be up to snuff when it comes to judging Medicaid eligibility. The March 2 report says that even while some states have recently updated Medicaid Management … Read More
The new chief watchdog for the embattled Texas Health and Human Services Commission told lawmakers Monday he plans to right the department rocked by a contracting scandal by focusing not just on Medicaid and food stamp fraud, but all types … Read More
This past Friday, TDMR and the Medicaid Providers Alliance held a successful health care compliance seminar at the Knapp Medical Conference Center in Weslaco. A room-capacity 72 dental providers attended and were informed that the Academy of General Dentistry had … Read More
With the press pounding out incredible stories about Jack Stick’s tenure at the Health and Human Services Commission and its Office of Inspector General, would it be surprising to learn that Stick, before he came to HHSC, had possibly earned … Read More
This past Monday, the House Human Services Committee held a hearing about the current status of the Texas Health and Human Services Commission Office of Inspector General. A lot has happened in the last two months since the devastating hearings before … Read More
Gone are the sales quota-like performance standards imposed by Jack Stick, the embattled former general counsel of Texas’ Health and Human Services Commission. And the agency is still debating what to do with the $2,800 black leather executive chair he … Read More
AUSTIN, TEXAS (Texas House of Representatives) – After Speaker Straus released committee assignments last Wednesday, Rep. Richard Peña Raymond, Chairman of the House Committee on Human Services, began work with his nine member committee setting the first hearing date for … Read More
AUSTIN — There are a few doctors in the Texas Legislature, but the state Capitol is not the place to go for medical attention.Yet, along with public education and transportation funding, health care is expected to get lots of attention … Read More
There is a primary reason why states around the nation have trouble fighting Medicaid fraud. States inept fighting fraud Both the KCBS videos from California we posted and the recent Sunset Commission report on Texas HHSC-OIG highlight that state agencies can … Read More
The following is republished from the Texas Tribune: When Jack Stick became the deputy inspector general of the Texas Health and Human Services Commission in 2012, he saw an opportunity to help investigators beef up their production in bringing potential fraud … Read More
The double-sided city of Texarkana, its residents sometimes quip, has two of everything. There are the mayors: one for the 36,000 people living west of Highway 71 in Texas, another for the 30,000 on the Arkansas side of town. There are the … Read More
Can common sense trump partisan politics? The question is especially apropos these days in Texas, which accounts for about 25 percent of the 4 million Americans who would gain health insurance if their state’s lawmakers expanded Medicaid. The healthcare industry knows … Read More
One of the most shameful gaps in the American health care system involves the country’s poorest children. They can’t get basic dental treatment. It’s not that they don’t have insurance—many of them do. The problem is that dentists won’t treat … Read More
PALM BEACH GARDENS, Fla. — Rita Gorenflo’s 7-year-old son Nathaniel was in severe pain from a sinus infection. But since the boy was covered by Medicaid, she couldn’t immediately find a specialist willing to see him. After days of calling, … Read More
January 13, 2015 — Over the past 10 years, Medicaid reimbursement rates for pediatric dental services have not kept up with inflation, but private insurance rates in most states have seen inflation-related adjustments, according to a new report from the … Read More
January 6, 2015 — Due to the Patient Protection and Affordable Care Act (ACA), the Medicaid market for dental care will grow significantly nationwide, according to new research by the ADA Health Policy Institute. But translating expanded Medicaid dental benefits … Read More
A former aide to Jack Stick, hired by Stick when he was the OIG deputy inspector general for enforcement, has now been demoted and seen his salary cut, according to a late breaking story in the Austin American Statesman. The Texas Tribune has … Read More
January 2, 2015 — A federal judge has ruled that the 1.9 million children who depend on the Florida Medicaid program for medical and dental care are not receiving the care required by federal law. Federal Judge Adalberto Jordan found … Read More
December 30, 2014 — A new report from the University of North Dakota (UND) found that the state is fighting the same distribution-of-care issues as many other states, despite having one of the highest Medicaid dental reimbursement rates in the … Read More
