OIG recently published the following article on its website which we thought to republish here along with the PDF documents linked to in the article. Texas providers encouraged to self-report overpayments Providers continue to participate in the OIG’s self-report process, … Read More
According to a recent report entitled “Access to Oral Health Workforce Report, Part I” by the Pennsylvania Coalition for Oral Health, the state lost 13.5% of its dentists participating in its Medicaid program between the beginning of 2019 and the … Read More
The recent business headlines about Sun Life, the Canadian insurer that purchased DentaQuest earlier this year, and its Q2 financial results are quite bipolar – either dismal or glowing. Good Q2 or not for DentaQuest purchaser Several publications spotlight the … Read More
The American Dental Association has reported that dental services increased 1.9% in June, the highest single-month rise ever recorded since the Department of Labor started keeping track in 1995. Job Market Increases The increase is attributable in part, according to … Read More
The American Dental Association reports that 14 state legislatures have passed progressive legislation regarding Medicaid dental care this year, partly due to increased budget surpluses in those states. Connecticut, Georgia, Illinois, Maryland, Mississippi, Missouri, Nebraska, South Dakota, Tennessee, Vermont, and … Read More
Thanks to the excessive prices for oil products due to the attempted embargo of Russian oil to punish the country for its war on Ukraine, the Texas state budget will benefit to the tune of some $27 billion, according to … Read More
After our article about the need for a review of Medicaid dental fees was published in May, we received a number of comments from dentists about how the lack of a fee increase is impeding service to their clients and … Read More
TDMR has learned that a number of Medicaid dentists around the state have been receiving informal letters from the Office of Inspector General about their billings. Avoid formal process Apparently, OIG is looking to resolve billing situations informally rather than … Read More
Everyone remembers the Frew case back in 2004 when the Supreme Court forced Texas to provide basic healthcare services including dental care for Medicaid-eligible children. Reason for fee increase in 2007 For those that don’t remember, let’s recap. Linda Frew, … Read More
This was posted on the Texas HHS-OIG website yesterday. Thought we would republish.. ————————— Ensuring Texas Medicaid dollars are spent for their intended purpose requires the OIG to work with health care professionals to prevent fraud, waste and abuse. Accurate … Read More
The list of complaints about DentaQuest from Medicaid providers keeps growing. It seems that new Canadian ownership hasn’t changed any business practices so far, but we hear they like their money too. While some problems have been reported about MCNA … Read More
TDMR received an email notification today that Texas HHS is looking for a Dental Policy Analyst to assist in advanced complex dental and medical benefits policy analysis, development and consultation. No necessary dental requirements The odd about the advertisement for … Read More
TDMR published a letter from a dentist a month ago who expressed their outrage about DMO self-made rules that restrict and inhibit treatment of young Medicaid-eligible children to their detriment. Now that the holiday season is well out of the … Read More
It is remarkable that in a state that cherishes free enterprise, it is okay for dental maintenance organizations to offer money and other inducements to encourage parents with Medicaid-eligible children to use their company yet it is a crime for … Read More
After our article last month on rate and coverage drops in Webb county for Medicaid waiver patients when DentaQuest took over the program, it didn’t take too long for us to be contacted about similar concerns within CHIP and children’s … Read More
We just received a press release from the Office of the Attorney General. Paxton Stops Vaccine Mandate for Healthcare Workers AUSTIN -Texas Attorney General Ken Paxton secured a preliminary injunction for the State of Texas, stopping the Biden Administration from imposing vaccine mandates on the employees of Medicaid and Medicare providers and suppliers. “This … Read More
Almost three hundred seniors and patients with disabilities were stranded mid-treatment plan in Laredo thanks to a change in dental insurance providers in July of this year. Since 2017, Dr. Amin Abdul of the Asclepius Dental Center of Laredo has … Read More
On Friday, TDMR received an email notification from the Office of the Governor that its Regulatory Compliance Division is now reviewing and accepting public comments on the Texas State Board of Dental Examiners rule change to establish the standards of … Read More
Last week TDMR obtained a copy of the latest HHS Ombudsman report on complaints about managed care to the agency from Medicaid clients. The report contains a significant section on Dental Managed care. Medicaid dentists may not get a copy … Read More
Back in 2020, we started reporting on the various whistleblower claims brought by Joshua Lafountain, a former dental office manager in Dallas with no formal dental training, against 71 various Medicaid dentists and dental entities. Although he had never worked … Read More
After our last article about possible termination from a DMO’s network for filing a complaint with HHS before all company complaint procedures have been exhausted, we picked up online copies of the Medicaid Provider manuals for DentaQuest, MCNA and UnitedHealthcare … Read More
The U.S. Department of Health and Human Services Office of the Inspector General just published an audit report this week that Texas paid out incorrectly $922,557 in CHIP payments to Medicaid managed care organizations. Now a million dollars in the … Read More
Medicaid fraud or fraud of any type is serious business, and something TDMR decries. Those low enough to use their position as healthcare professionals to bilk federal and state governments for personal gain that cheats the taxpayer and young underprivileged … Read More
This past week the Attorney General of Texas sent out a press release that deemed agency personnel who had complained about potential conflicts of interest by the AG himself were “rogue political appointees” rather than whistleblowers because they had only … Read More
A recent open records request to the Texas Office of the Attorney General reveals that the state has paid out so far $457,416.67 to qui tam relator Joshua Lafountain. No knowledge or evidence of wrongdoing TDMR reported, starting last May, … Read More
By Ross Ramsey, The Texas Tribune – When this legislative session comes to an end on Memorial Day, Texas will still have more uninsured residents than any other state, and a higher percentage of uninsured residents, too. The Texas Legislature … Read More
The testimony in favor of changes to the Texas Medicaid Fraud Prevention Act by Austin administrative attorney Jason Ray is important for Medicaid providers to read. He testified on April 14 supporting the committee substitute version of bill HB3802 regarding … Read More
April 23: Texas House votes down budget amendment aimed at giving health coverage to more uninsured Texans: The Texas Legislature has declined to pass any broad expansion of state and federal health care coverage for uninsured Texans since the Affordable … Read More
Almost a decade ago, on May 13, 2011, Byron Harris, famed WFAA investigative reporter, started a large freight train roaring down the track with his first story of a series, “Texas taxpayers pay big for straight teeth.” False narrative destroyed … Read More
A study published this week in the Journal of Public Health Dentistry concluded that low-income individuals who received dental care under Medicaid expansion in Michigan had improved job outcomes as a result of better oral health. The paper entitled “Beneficiaries’ … Read More
Bill filing has started for the upcoming legislative session at the Texas Capitol. One of the early filings is HB 648, a bill introduced by House Rep. Richard Peña Raymond of Laredo to modify the mandate of the HHSC Office … Read More
TDMR recently reported about an open record request filed with the Office of the Attorney General to find out how many dentists were indicted for Medicaid fraud by the OAG’s Medicaid Fraud Control Unit (MFCU), the section of the OAG … Read More
At the end of April, a three-judge panel of the Fifth District Court of Appeals in Dallas ordered a malpractice lawsuit against the firm of Sommerman McCaffity Quesada & Geisler and Al Ellis, of counsel at the firm, to continue. The case … Read More
HHS sent out this notice today. The 86th Legislature included a cost containment rider in the FY 2020-21 General Appropriations Act directing the Health and Human Services Commission to achieve $350 million in savings by focusing efforts on “increasing fraud, … Read More
