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
AUSTIN — The White House’s signature health care law is loathed by Texas’ political leadership, and the idea of expanding Medicaid likely remains a non-starter when the Legislature reconvenes this month. But Gov.-elect Greg Abbott and many top conservatives support … Read More
Andy Pasternak, a family doctor in Reno, Nev., has seen more than 100 new Medicaid patients this year after the state expanded the insurance program under the Affordable Care Act. But he won’t be taking any new ones after Dec. … Read More
It is now official – Jack Stick, HHSC Chief Counsel and former OIG deputy inspector general for enforcement, has resigned from HHSC over published allegations of interference in the HHSC contracting process on two contracts – one for data mining software … Read More
State administrators cannot withhold Medicaid payments from physicians suspected of program violations without evidence of fraud, a Texas appeals court has ruled. Appellate judges also struck down a rule that enabled the Texas Health and Human Services Commission (THHSC) to … Read More
In today’s public hearings, members of the Texas Sunset Advisory Commission passed staff recommendations and supplemental additions made by a special work group, relating to the Health and Human Services Commission Office of the Inspector General. The final report is now online and … Read More
WHY WE DID THIS STUDY Examining access to care takes on heightened importance as enrollment grows in Medicaid managed care programs. Under the Patient Protection and Affordable Care Act, States can opt to expand Medicaid eligibility, and even States that … Read More
Texas and the federal government tentatively resolved a high-stakes health care funding inquiry on Monday, averting a major disruption to hospital funding. The Texas Health and Human Services Commission and the federal Centers for Medicare and Medicaid Services reached the … Read More
December 2, 2014 — A Texas appeals court has invalidated several rules related to payment holds imposed during Medicaid fraud investigations, saying they violate due process rights. The Third Court of Appeals invalidated rules that authorized the Texas Office of … Read More
Judge rightfully reins in anti-fraud unit after abusive action By Chris TomlinsonNovember 26, 2014 Doctors, dentists and other health care providers who care for the state’s most disadvantaged got some much needed relief Tuesday from an over-zealous, politically motivated anti-fraud … Read More
November 18, 2014 — The Texas agency charged with investigating Medicaid fraud is finalizing a $90 million contract for Medicaid fraud detection software. of software licenses and services from the company, 21CT, according to a statesman.com story . Austin-based 21CT is a … Read More
The Austin American Statesman reported this weekend that the Texas Health and Human Services Commission Office of Inspector General is finalizing a deal with an Austin company for Medicaid fraud detection software. The company involved, 21CT, is primarily a defense … Read More
The state office charged with investigating Medicaid fraud and waste, criticized this week by state auditors and legislators as dysfunctional and “broken,” is finalizing a $90 million contract with an Austin analytics company that had no experience with Medicaid before … Read More
The Texas Sunset Commission held public hearing both Wednesday and Thursday this week on the Health and Human Services Commission as well as its beleaguered Office of Inspector General. Sunset and HHSC staff testified on Wednesday about the recent Sunset Commission … Read More
Gov.-elect Greg Abbott’s pick for Texas secretary of state voted for a local resolution last year endorsing the expansion of Medicaid — a central tenet of the federal Affordable Care Act that Abbott fiercely campaigned against. In a phone interview, Carlos Cascos, a Republican … Read More
AUSTIN, November 11 – State Sen. Juan “Chuy” Hinojosa does not like the way the Texas Health and Human Services Commission Office of the Inspector General treats Medicaid providers and he wants to rein in the agency next session. “It … Read More
If Texas wants to keep receiving billions of federal dollars to help hospitals care for uninsured patients, state lawmakers may have to look again at expanding Medicaid coverage for impoverished adults, some political observers say. That’s because in 2016, Texas will have to … Read More
The Sunset Commission has set out their agenda for the upcoming public hearings on the Texas Health and Human Services Commission to be held on Wednesday and Thursday, November 12 and 13. Meeting materials will be available on the Sunset … Read More
AUSTIN – The Texas Rangers have opened a criminal investigation into a recently fired state employee whose alleged falsification data could cost the state the chance to recoup millions of dollars from dentists and orthodontists of Medicaid fraud, officials confirmed … Read More
The 3rd Texas Court of Appeals has agreed with a Travis County District Court judge and has issued a ruling that the Office of the Inspector General should return over $1.2 million in withheld Medicaid funds to Harlingen Family Dentistry. TDMR received a … Read More
In another setback for the state health agency charged with rooting out Medicaid fraud, an appeals court Thursday said almost $1.26 million was improperly withheld from a dental practice even after state regulators acknowledged that no fraud had taken place. … Read More
The Austin American Statesman reported this morning that Rep. Richard Peña Raymond, D-Laredo, has requested that the Texas Health and Human Services Commission Office of Inspector General review all Medicaid cases that were worked on by the now-terminated actuary that admitted to … Read More
The St. Mary’s University Mu Psi Chapter of the Pi Sigma Alpha National Political Science Honor Society is holding The Texas Medicaid Fraud Issue Forum on Wednesday, November 5th, 2014 in San Antonio. The purpose of the forum is to … Read More
Also during the debate, Abbott proposed Texas seek and receive a block grant to reform the state’s Medicaid system. It is a proposal similar to the ones Patrick and Perry have laid out for how to deal with the state’s … Read More
Republican lawmakers in Florida and Texas snubbed the Affordable Care Act’s Medicaid expansion for adults, but their states did broaden the program this year — for school-age children. Those states were among 21 – including some big Democratic-led states, such … Read More
September 29, 2014 — Late last week, California Gov. Jerry Brown signed a bill that establishes standardized requirements for dental plans to disclose how they spend patient premiums. The bill, AB 1962 introduced by Assemblymember Nancy Skinner (D-Berkeley), puts the … Read More
AUSTIN – Call it the billion-dollar blame game. Six years after auditors discovered signs that some Texas orthodontists were putting unneeded braces on teeth of the state’s poorest children, an army of lawyers are battling over who is liable for … Read More
Erin Fair Taylor’s job isn’t easy. That’s because every day, she must figure out how to pay doctors. Taylor works for CareOregon, which is playing an active part in Oregon’s effort to overhaul its Medicaid system. As such, it’s her … Read More
The following is a writeup done by a dentist on the Medicaid orthodontic program. He previously wrote on his experience with the program. This is a discussion of the Medicaid Insurance Program that covered general dentistry and the specialty of … Read More
TDMR received the following from a Texas Medicaid dentist who wishes to tell his story about his history with the HLD scoring system and the current state of Medicaid for orthodontia. He asked to remain anonymous. When I began working with … Read More
