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
Last Friday, HHSC sent out the following notice: If you’re interested in Medicaid managed care issues, you might be interested in being a member of the State Medicaid Managed Care Advisory Committee. The Texas Health and Human Services Commission executive … Read More
In 2012, Tanya Walker took the $200 her father loaned her to see a doctor. She was in the aftermath of a divorce and needed a prescription for antidepressants, she said. But her doctor in Texarkana found signs of hypertension … Read More
Nearly 20% of Texans under the age of 65 don’t have health insurance and most of them are working, according to a new analysis that could further pressure that state’s policymakers and politicians to expand Medicaid coverage for the poor. Texas has … Read More
It appears that Texas Office of the Attorney General (OAG) forgot to sue Xerox to recover over $133 million that the federal government determined it was owed because of the state’s lack of oversight over Xerox, its then-Medicaid claims administrator, … Read More
UPDATE: We’ve added below an additional HHSC presentation given to the House Committee on General Investigating & Ethics which gives further details of MCO contract management. This morning HHSC sent out a notice that it was looking for public comments … Read More
You just found out about this? So did we. Just learned of it TDMR learned of it about 10 days ago when a provider gave us a copy of a letter they received from DentaQuest dated July 27 but received … Read More
TDMR recently reached out to Rep. Richard Peña Raymond, chair of the House Human Services Committee to get his views on the current scene and the future of dental Medicaid in Texas. Supporter of dental Medicaid Raymond has been a major force … Read More
Since our recent stories about the new dental RFP for Medicaid and DentaQuest’s capitation payment move, TDMR has received several emails from dental providers about their concerns over the RFP choices and provider lack of power against such large companies. … Read More
We have closed our revised 2018 Dental Management Organization annual survey and are today giving you the results. Our survey sample is not that large, unfortunately. At the end of the day, only 39 providers entered the survey as we … Read More
An industry insider has told TDMR that he thinks six dental management companies will vie for the Texas Medicaid dental contract RFP that closes in September. He named the two current contractors, MCNA and DentaQuest, and included Liberty Dental and … Read More
The new audit is yet another scandal at an agency plagued by contracting woes. Six of the commission’s leaders have left in the last several months. BY EMMA PLATOFF Republished from the Texas Tribune A new state audit has found that … Read More
