Questionable Billing for Medicaid Pediatric Dental Services in New York March 26, 2014 Lucia Fort, a program analyst for the Office of Evaluation and Inspections, is interviewed by Meridith Seife, the Deputy Regional Inspector General for the Office of Evaluation and … 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
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
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
TDMR has received notification that HHSC-OIG has begun a Provider Education series that will cover topics of particular interest to Medicaid providers. It is about time. The first topic is Understanding Waste, Abuse and Fraud and TDMR has rabble roused … Read More
TDMR presents the second in a series of articles on health care compliance penned by TDMR President Greg Ewing. Greg is a health care lawyer with over fifteen years of experience in transactional health law; health information technology; privacy and security … Read More
March 11, 2014 — Church Street Health Management (CSHM), which operates 70 Small Smiles dental clinics in 22 states and the District of Columbia, has been excluded from participation in the Medicaid and Medicare programs for a minimum of five … Read More
WASHINGTON — The share of Americans without health insurance is dropping to the lowest levels since President Barack Obama took office, but sign-ups under his health care law lag among Hispanics — a big pool of potential beneficiaries. With just … Read More
According to a government source, Jack Stick has been elevated from his position at the Texas Health and Human Services Commission as Deputy Inspector General for Enforcement to that of interim Chief Legal Counsel, replacing the retiring Steve Aragorn. A further … Read More
On February 27th, administrative law judge Rick Gilpin of Texas Health and Human Services Commission issued a final order in the “credible allegation of fraud” payment hold case of Antoine Dental of Houston, fully reversing the Proposal for Decision written … Read More
LUBBOCK, TX (KCBD) – A Lubbock dentist is voicing concerns about patient privacy and complaining about “Big Brother” after the FBI seized his patient records on Thursday morning. The FBI executed multiple search warrant around 8 a.m. Thursday at the … Read More
In a highly unusual move, a judge working for the Texas Health and Human Services Commission last week overturned findings of an outside judge — essentially changing a finding of innocence to one of guilt. The case is particularly unusual … Read More
HOUSTON—Augustine Ihenacho Nnadi, aka Austin, 60, of Houston, has been arrested for accepting a bribe in exchange for assistance in an ongoing health care fraud case, announced United States Attorney Kenneth Magidson. The FBI arrested Nnadi this morning shortly after … Read More
Last September 27th, TDMR published an article concerning the fact that the Texas Health and Human Services Commission Office of the Inspector General at that time had not yet made available on its website, information on due process rights for … Read More
EDINBURG — Sitting at an old picnic table in front of a dilapidated house, María Díaz, a hotel housekeeper, tells stories of the rejection that comes with living in impoverished Texas colonias. The trash on her street is not picked … Read More
On Sunday, the Austin American Statesman published a feature article on the current state of affairs regarding how Texas regulators are dealing with the claims of large scale Medicaid orthodontic fraud that have been swirling around Texas since 2011. The … Read More
Citing shortfalls in Medicaid financing and billions in annual uncompensated care costs, the president and chief executive of the Texas Hospital Association said Friday that it was time for medical facilities to join together on a long-term strategy to compensate … Read More
In 2011, state regulators announced that they were taking a giant stride toward fighting blatant insurance fraud. They said they had identified nearly four dozen dentists and orthodontists who had ripped off taxpayers by billing Medicaid tens of millions of … Read More
This past week a number of Medicaid dentists filed suit against ACS, Affiliated Computer Systems, the state’s Medicaid claims administrator better known as TMHP or the Texas Medicaid and Health Partnership. The dentists allege that ACS was negligent in their … Read More
Antoine Dental Center of Houston, Harlingen Family Dentistry of Harlingen, M&M Orthodontics of San Antonio and Dr. Paul Dunn of Levelland filed suit this past Monday against ACS, Affiliated Computer Services, the state’s private contractor which handles claims administration for … Read More
More than 40 health and community groups launched a campaign Wednesday to raise awareness of the coverage gap created when Texas officials declined to expand Medicaid as part of the Affordable Care Act. Advocating that poor Texans should have greater … Read More
February 6, 2014 — Thousands of applications for orthodontic approvals under Medicaid were delayed after Texas employed a single dentist to review them. The understaffing led to dentists, not the private company reviewing the applications, being accused of fraud for … Read More
DALLAS (AP) U.S. Health and Human Services Secretary Kathleen Sebelius says Texas is losing $18 million a day in federal funding by not expanding Medicaid under the federal health-care overhaul. Sebelius spoke Friday at Paul Quinn College in south Dallas. … Read More
Due to its reluctance to expand Medicaid under the Affordable Care Act, Texas may see more than 3,000 deaths due to a lack of insurance, according to a new Health Affairs study. The study looked at the uninsured rates for … Read More
January 30, 2014 — South Carolina health officials and dental providers are hopeful that state lawmakers will reinstate dental Medicaid coverage for low-income adults, saying the move will save emergency room (ER) costs and help people with painful oral infections … Read More
SAN ANTONIO — The facts are pretty basic: About 1 million Texans — 115,000 in Bexar County — could be eligible for insurance coverage under the Affordable Care Act, but won’t be able to get it. Because they live in … Read More
A long time dental Medicaid provider recently sent to TDMR an old article that was written in the March/April 2005 edition of the Texas Medicaid Bulletin. It is interesting because both the Texas Medicaid and Health Partnership (TMHP) and the … Read More
Yesterday the Dallas Morning News reported that a North Dallas psychotherapist plead guilty to a five-year health care fraud scheme and agreed to surrender his license to practice psychology. The US Attorneys Office press release states that Michael Ellis Wolf, … Read More
The Far North Dallas psychologist said he treated a single postal worker seven days a week, up to eight hours a day. A federal billing contractor responded by paying the therapist more than $1 million, court records say. Now Michael … Read More
The Texas Department of Insurance on Tuesday issued state regulations for health care “navigators,” the workers who assist people seeking health insurance in the federal marketplace created by the Affordable Care Act. The rules take into account some of the … Read More
January 17, 2014 — Idaho is considering restoring adult dental coverage in its Medicaid program after emergency room costs more than doubled following budget cuts and the elimination of nonemergency dental coverage. After the program was cut in 2011, dental-related … Read More
Comments on the story: “Don’t be so quick to dismiss Medicaid business” on the Dr. Bicuspid website.
At the beginning of December, 2013, the Health and Human Services Commission published online its budgetary figures for 2014. Included in the document are the 2012 and 2013 expenditures and metrics for the Office of the Inspector General and its … Read More
Texas is again sinking to the bottom of the barrel on a national health care measure. The state ranks 38th in the nation – down from 29th five years ago – for failing to support emergency patients. That’s according to the latest report card … Read More
AUSTIN — Hospital officials, Democratic lawmakers and advocates for the poor complained Monday that the state’s proposed rule on health insurance “navigators” could cripple efforts to educate Texans about their coverage options.At a final hearing and in written comments submitted … Read More
January 3, 2014 — Since I began my first dental client consultancy for a corporate dental practice in Arizona (about two years before the publication of my article, “The emergence of the dental practice management company,” in the September 2009 … Read More
On January 1, the Affordable Care Act changed the rules states use to determine whether people can get most types of Medicaid or Children’s Health Insurance Program (CHIP) coverage. Here’s a list of some of the more significant changes: Medicaid … Read More
TDMR believes that personal attacks on individuals are unwarranted and attempts to steer a high road in dealing with Medicaid issues. But TDMR also believes that the conduct of public officials, especially those in the employ of the Texas government … Read More
TDMR is pleased to present the first in a series of articles on health care compliance penned by TDMR President Greg Ewing. Greg is a health care lawyer with over fifteen years of experience in transactional health law; health information technology; … Read More
December 20, 2013 — Almost half a million Coloradans are expected to gain dental benefits under Medicaid by 2016, but they’ll have a hard time finding a dentist to treat them, according to a study by the Colorado Health Institute. … Read More
