All 50 states, the District of Columbia, and Congress are all having the same nightmare. It is called Medicaid. Now there is a chance to turn bad dreams into great, big happy ones. Texas is in a unique position to … Read More
U.S. President Donald Trump’s first budget proposal will spare big social welfare programs such as Social Security and Medicare from any cuts, Treasury Secretary Steven Mnuchin said in an interview broadcast on Sunday. Mnuchin said Trump would use his first … Read More
Jeff Leston, the founder of Castlestone LLC, has provided TDMR with his take on how to improve government healthcare plans such as Texas Medicaid to reduce waste, fraud and abuse. Castlestone is a company created to use the infrastructure of … Read More
How to deal with Medicaid expansion has become the latest sticking point in Republicans’ effort to dismantle the Affordable Care Act. While most lawmakers acknowledge it’s a major source of tension, there appears to have not been any decisions made … Read More
For the last several years, TDMR has provided contact information on its website for reporting Medicaid fraud, waste and abuse to both state and federal healthcare authorities. From the links provided on practically every page of our website, anyone could go … Read More
Lee College’s Center for Workforce and Community Development will host two free health care fraud prevention seminars on Feb. 28. “We’re excited to offer both a morning and evening presentation to the public. It’s an important topic, and we want … Read More
AUSTIN—Pointing to significant taxpayer savings and more efficient care, the Texas Association of Business (TAB) today urged the Texas Legislature to allow for the transition of the Medicaid prescription drug benefit to private health plan management to occur as scheduled. … Read More
TDMR received a notice yesterday from the Health and Human Services Inspector General office that Inspector General Stuart Bowen will be hosting, along with Sen. Chuy Hinojosa, a “Rio Grande Valley Medicaid Integrity Symposium.” The event is to take place … Read More
It’s light on details, but so far the Trump administration has proposed one big change to how we pay for health care in the U.S. President Trump wants to turn the federal Medicaid program into a block grant system. This … Read More
House Bill 1420 was introduced into the legislation session yesterday by House Representative Mando Martinez. The bill is captioned as “Relating to the imposition of a late payment penalty against Medicaid managed care organizations that fail to timely pay certain … Read More
As Texas House and Senate leaders gird for a high-stakes fight over the state budget, a preliminary round of that showdown is taking shape over whether to partially undo cuts to a Medicaid program that reimburses therapists who serve low-income … Read More
Poor Americans insured by Medicaid will pay more out-of-pocket toward their healthcare services under proposals favored by Dr. Tom Price, Donald Trump’s pick to be U.S. Secretary of Health and Human Services. During the first of two committee hearings he … Read More
States may receive their Medicaid funding in block grants under President Donald Trump’s plan to replace the Affordable Care Act, one of his advisers reported this weekend. White House adviser Kellyanne Conway, appearing on Sunday Today, said that moving the … Read More
The administrator of five Houston-area home health agencies pleaded guilty today to conspiring to defraud the State of Texas’ Medicaid-funded Home and Community-Based Service and the Primary Home Care Programs of more than $7.8 million. These programs provide qualified individuals … Read More
Did you know that HHS, formerly HHSC, has a Managed Care Inquiries and Complaints mailbox? It does. It also has a person to field those inquiries and complaints. That person is Dr. Marguerite Laccabue, MPH, DDS, Dental Director of the Office of … Read More
AUSTIN – The leaders of the Texas Legislature appear to be unwilling or unable to hire a state auditor, an unprecedented situation that has deprived residents of their most powerful government watchdog for more than a year. Lt. Gov. Dan … Read More
Last Thursday, Texas Health and Human Services held its Biannual Managed Care Stakeholder Meeting in Austin. The meeting was primarily hosted by Jami Snyder, the Associate Commissioner for the Medicaid & CHIP Services Department of HHS. During the open discussion … Read More
Back in December, TDMR asked dentists to take an online survey to ascertain their views on Texas Medicaid dental managed care. We now have these results which are provided below and can be downloaded. Limitation of survey results Before we … Read More
The statistics are encouraging: In the half a year since the state expanded access to Medicaid, doctors in Louisiana have diagnosed 1,770 cases of high blood pressure, 728 cases of diabetes and more than 90 cases of cancer.That’s good news. … Read More
Democrats and their enablers in the media are hyperventilating about the GOP’s drive to cap federal Medicaid funding with a series of “block grants” to the states as part of their replacement plan for Obamacare.”25 million people could lose health … Read More
Progressives have already homed in on Republican efforts to privatize Medicare as one of the major domestic political battles of 2017. If Donald J. Trump decides to gut the basic guarantee of Medicare and revamp its structure so that it … Read More
Sen. Lois Kolkhorst asked a pertinent question to Inspector General Stuart Bowen this past September, “Are you auditing MCOs for fraud?” The question came in the context of a hearing being held by the Senate Committee on Health and Human … Read More
AUSTIN, Texas (AP) — Some $350 million in cuts to a Texas Medicaid program providing therapy for disabled children have taken effect.The reductions sparked outcry after being approved by the GOP-controlled Legislature last year.They reduce revenue for some Texas therapy … Read More
On Dec. 7, 2016, just in time for the holiday season, the Office of Inspector General (OIG) released a policy statement regarding the nominal value of gifts that healthcare providers may give to Medicare and Medicaid beneficiaries. In short, the … Read More
There have been rumors flying by the last few weeks that Inspector General Stuart Bowen wants to make it easier to place “credible allegation of fraud” (CAF) payment holds against Medicaid providers. We had no idea that this was difficult … Read More
There may be help on the way for tens of thousands of disabled Texas children on the verge of losing much needed therapy to budget cuts.State House Speaker Joe Straus told the Texas Tribune lawmakers will work to make sure … Read More
December 1, 2016 — The number of U.S. children receiving dental care significantly increased from 2000 to 2014, according to a new study in Pediatrics. Even more positively, the researchers found a steep narrowing of coverage disparities in race/ethnicity and … Read More
Just before the Thanksgiving holiday, TDMR received a flurry of emails and phone calls regarding our story about a dentist who was having payments recouped by MCNA for treatments the company had previously approved. He was being forced to travel … Read More
DALLAS (AP) – Prosecutors say a Texas woman who operated a home health care company has pleaded guilty in a case linked to more than $40 million in fraudulent services. Myrna S. Parcon pleaded guilty Tuesday in Dallas to conspiracy … Read More
Pfizer (PFE -0.6%) takes exception to the release of Medicaid rebate data to state lawmakers by the Texas Health and Human Services Commission. The agency, which initially said no, acquiesced after the Texas Attorney General determined that the release would … Read More
UPDATE: We now have a copy of the letter from Delta Dental to Texas dentists regarding joining their “Texas Medicaid network.” (see below) TDMR received an interesting email after our recent story on dental managed care and the possibility of … Read More
The Audit division of the Health and Human Services Office of Inspector General released a report at the end of October (although TDMR just received the email notification about it today) about an audit they conducted on the practice of … Read More
Last year, the Texas legislature approved a $350 million cut in Medicaid reimbursement rates to early childhood intervention therapists and providers. The cuts, made to help balance a billion dollars in property tax relief, affect the most vulnerable Texas children … Read More
Even as the share of children in Texas without health insurance continues to decline, the state still has nearly twice the national average, according to a new study. A Georgetown University Center for Children and Families report released Thursday found that Texas … Read More
HHSC ensures that policies are medically appropriate, patient-centered, transparent and based on the best available evidence. The agency’s medical and dental policies outline the types of procedures and treatments for which HHSC will pay for specific conditions. Medical practitioners, program … Read More
Overinflated promises being made for expansion of Texas’ Medicaid program remind us of two time-proven adages: “If it looks too good to be true, it probably is,” and “There ain’t no such thing as a free lunch.” Recent newspaper articles … Read More
States are beginning to turn to hospitals to cover the cost of Medicaid expansion once the federal match begins to drop next year.The Affordable Care Act provides 100% federal financing for those made newly eligible for Medicaid under the law. … Read More
It all started with a battle over information: In one corner was the Texas Health and Human Services Commission. In the other were Texas lawmakers. The commission holds the details of the state’s Medicaid contracts with large pharmaceutical companies, which show … Read More
When it comes to a patient’s health, the old phrase, “The doctor knows best,” still rings true, especially for medications. When the Texas Legislature meets in January, there will be plenty of budget and policy battles waged. The battles fought over one of … Read More
In August, TDMR conducted its annual online survey of Medicaid providers. This time, however, the focus of the survey was expanded from only dentists to all Medicaid providers to see how the two compare. Completed surveys were filled out by … Read More
