TDMR has responded in the McAllen Monitor to a piece reprinted there from the Texas Tribune from April 25th “Legislators Seek Action on Medicaid Fraud Measures.”
TDMR Director of Communications Chuck Young penned an opinion piece regarding problems in the article and how it does not reflect the current legal facts regarding findings of dental fraud in Texas and that lack of due process rights has put many good providers against a wall.
Here is the response:
Allegations of Medicaid Fraud remain unproven, group says
A recent piece carried in The Monitor and written by the Texas Tribune’s Becca Aaronson (“Legislators seek action on Medicaid fraud measures”) paints a picture of massive, out of control fraud across the state of Texas, perpetrated by dentists and especially orthodontists. Throughout the article, this “fraud” is referred to as a fact.
Indeed, the article begins:
“After the discovery that the state was spending millions of dollars on fraudulent Medicaid dental and orthodontic care, state lawmakers held hearings ahead of the legislative session…”
This sets the tone for the rest of the piece. Unfortunately, that tone has been all too common in media coverage of this issue, coverage that has been so biased as to defy belief.
The fact, as opposed to spin, is that while the state of Texas CLAIMS to have “identified” massive fraud, it has yet to PROVE any fraud, despite devoting enormous resources to investigating this supposed fraud epidemic. What the state HAS done is to work around issues like “charges” and “indictments”. They avoid any semblance of due process by simply cutting off payments to Medicaid providers against whom they can construct a so-called “credible allegation of fraud”. Based on these allegations, the state then “extrapolates” — through some very strange math — and comes up with astronomical levels of “fraud”.
Now, we find these allegations to be IN-credible, not credible; but that isn’t the point.
The point is this: when speaking of someone suspected of criminal behavior, even people who’ve been indicted and charged, it’s customary in media to speak of that person as “allegedly” having committed the crimes in question. Ms. Aaronson has instead repeatedly referred to people who’ve been “identified” (not charged, let alone convicted) as having committed fraud; she treats them AS IF these crimes are a matter of public record. She has, basically, portrayed a whole class of people as criminals when the only action against them has been a payment hold — and each and every one of those payment holds has been based on an “ALLEGATION of fraud.”
Some simple math aptly demonstrates Ms. Aaronson’s bias. The word “fraud” occurs in some form in her piece 15 times, not counting the title, url, and so forth. The word “allege” occurs in some form just twice — and only once is that word married to the word “fraud”. This sort of thing is borderline defamatory; in fact, Belo Corp’s WFAA — whose incredibly irresponsible work has been the basis of much of the misinformation around this issue — is actually being sued for defamation.
But besides the fact that Ms. Aaronson has acted as judge and jury by thoughtlessly parroting the state’s line, she has omitted several key facts from her piece. Just a sampling:
* These payment holds are a brand new tool, based on a broad interpretation of the PPACA (aka “Obamacare”).
* In fact, they’re so new that the first ever Texas challenge to a payment hold occured quite recently, in the case of Harlingen Family Dentistry (“HFD”). In that case, the state’s expert witnesses were found to be “not credible”, and HFD’s payment hold was reduced from 100% to 9%.
* Other providers are not as lucky; many go bankrupt before ever having their day in court. Even in the best of circumstances, they may lose half their business, fire a hundred employees, and end up leaving tens of thousands of Medicaid eligible kids in the lurch.
* State regulators have been accused by whistleblowers of “reinterpreting” laws to trump up charges against providers.
… and the list goes on. In fact, a furious fight has been waged by providers in the current legislative session to bring some sanity to this situation. We’re not sure that will happen, because the really deep problem — the hostility of the current majority leadership to Medicaid — has yet to be addressed.
Medicaid, and public health overall, is a complex issue. It can’t be addressed in a single article. But the fact is that current Texas policies have been catastrophic to Medicaid providers — ESPECIALLY in the Rio Grande Valley. Not only amongst dentists, but across a variety of disciplines, we’ve seen the same tragedy enacted: massive financial damages have accrued, thousands of jobs have been lost, reputations have been destroyed, and countless children have had their access to care restricted — in violation of their statutory civil rights.
We don’t expect this imbalance to be rectified overnight. We do ask that until people have been found GUILTY of a crime, that they be treated as INNOCENT. Because we’re pretty sure that “innocent until proven guilty” is a principle that most journalists, and most Americans, still believe in.
Texas Dentists for Medicaid Reform