Here is the June/July edition of the Texas Medicaid News!
Hello and welcome to the Texas Medicaid news update, I’m Andy Zajac. Things have been hot and heavy over the last few weeks in Austin.
1) Our top story is that Texas Health and Human Services Executive Commissioner Kyle Janek finally resigned. Things couldn’t have been worse for Janek over the last seven months as scandal piled on top of scandal at HHSC. From Jack Stick and 21CT to Terrell State Hospital, to violating state rules in giving $100,000 of agency money to his aide for an MBA, Janek appeared doomed. Former HHSC Deputy Commissioner Chris Traylor has been appointed by the Governor to the position. Traylor, a longtime HHSC executive, had announced his retirement but is now confirmed as taking Janek’s place.
3. Legislation to reform the HHSC Office of Inspector General has been just signed by Governor Greg Abbott. The Texas House of Representatives had passed Senate Bill 207, 142-0 a few weeks ago. The bill makes State Office of Administrative Hearing decisions final in Medicaid payment hold hearings and provides for better due process for providers.
3. In another huge development, the Department of Health and Human Services released an audit that Texas owes the federal government some $133 million for wrongfully approved Medicaid orthodontic services from 2008 to 2010. The federal auditor in her report laid responsibility for the overpayment squarely at the feet of the state and its Medicaid claims administrator of the day, Xerox, who were responsible for giving prior authorization for each orthodontic service before it was rendered. Both the state and Xerox had been attempting to blame dentists in the state for the high level of Medicaid orthodontic spending during the time period.
4. The Texas State Office of Administrative Hearings (SOAH) made an unprecedented ruling to award a Medicaid dentist back some $380,000 in legal fees from the Health and Human Service Commission Office of Inspector General (OIG) on a Medicaid payment hold case. The judges basically ruled that the state should have never moved forward with the case due to lack of evidence. Texas dentists continue to be found innocent of accusations of fraud when they get to an impartial court.
5. In national news, the Department of Justice launched its largest ever healthcare fraud roundup. The Justice Department has just charged 243 people across the nation, including 46 doctors, nurses and other medical professionals, with defrauding the Medicare system of $712 million through false billing.
The action follows a recent announcement by Assistant Attorney General Leslie R. Caldwell that the Department of Justice will pursue charges against executives for financial fraud and will be held accountable for fraud schemes that occur under their watch.