As we approach the New Year, we at TDMR have taken a few minutes to contemplate the last few years – six so far. We had no idea back in 2012 that we would still be going strong today.
Come a long way
On December 7, 2012, we launched this website and published our first article “Harlingen Family Dentistry Wins Major, Precedent-Setting Decision in Texas Medicaid Orthodontics Case.”
Since then we have published 435 more original stories including this one and aggregated some 1,790 media articles dealing with state and national Medicaid and related health issues for our readers.
Today, some 15,477 Medicaid providers in Texas, 420 media organizations and more than 2,800 other interested parties around the nation, including many from the Centers for Medicaid and Medicare, receive our news alerts.
The bad old days
It wasn’t that way back in 2012. If anyone cares to remember, the environment was extremely hostile. More than a year of media exposes led by WFAA in Dallas and legislative hearings not only in Austin but also in DC created the perception that Texas Medicaid dentists and orthodontists were nothing but “fraudsters” for the large amount of Medicaid orthodontic spending in Texas from 2007 to 2012. This fallacy was a convenient out for state bureaucrats who wanted to pretend they had no responsibility in the matter and a boon for hungry qui tam lawyers seeking a big payday. The latter’s henchmen still publish the occasional comment on our stories today.
The truth of the matter, as almost always, was not so simplistic and took time to come out. Administrative courts found no evidence of Medicaid fraud by dental providers. Legislators began to question the reckless assertions by bureaucrats of large amounts of dental Medicaid fraud. District courts returned monies being withheld by the state to dentists.
In the end, more scandals ended up bringing down the executive commissioner of HHSC and several of his executive staff including the unlamented Jack Stick and the HHSC Inspector General Doug Wilson. The state also turned on its Medicaid contractor Xerox, now Conduent, firing and then suing them for $2 billion for Medicaid fraud.
A total sea change
TDMR’s position all along has been that we welcome an investigation into any provider. Any wrongdoing should be uncovered and punished. BUT, we believe in and pushed for DUE PROCESS, innocence until proven guilty and, if necessary, a trial before a jury of one’s peers to ultimately prove guilt or innocence. These latter points had been ignored for the sake of expedience and the hope of covering incompetence and greed.
It was also our position to speak out. Many accused were afraid to do so because they feared potential retribution. When a state executive shows up to informal provider meetings carrying a stuffed wolf and has also been heard stating that “if Jesus Christ were a Medicaid provider, he could find a program violation on him,” there is a good reason for thinking that way.
But, as dangerous as it sounds, that is the time to speak up because it is only going to get worse if you don’t.
Proud of our part
So we are proud to have been an integral part of this sea change. When representatives from TDMR started meeting with state legislators back in mid-2012 before any thought of a website, the legislators told them one for one that they were not aware there was a second side to the orthodontic story. We were happy to tell them.
We were also happy to be a key player in the push for due process rights for all Medicaid providers passed unanimously by the House and Senate and signed into law by then-governor Rick Perry in 2013.
Today, we are happy to keep tabs on problems with DMOs and watch with interest the unfolding and perhaps the unraveling of this multi-billion dollar Medicaid fraud suit against Xerox/Conduent this coming year.
So we wish all our readers a very happy New Year for 2019. Live long and prosper.
You are correct but that should not be a reason to turn a blind eye to the continuing problem of fraud in Medicaid. Funding mechanisms, such as 100% Federal reimbursemenbt of new beneficiaries under PPACA, distorted dollar matching and enforcement-first oversight with little or no preventve tools addressing the root causes of fraud contribute to this burgoening problem. The problem is how enforcement is handled, the amount and scope of fraud continues to increase.
No time for self-congratulation. Time to address the problem-which continues to grow