AUSTIN — Texas state government ultimately is to blame for hundreds of millions of dollars of Medicaid spending wasted on braces and orthodontic work that were not medically necessary, according to federal auditors.
The audit report, released last week, concludes that it was a private contractor that did not follow state and federal protocols for pre-approving procedures, but the state was “ultimately responsible” because it is its job to monitor contract compliance.
Under federal law, Medicaid only is supposed to pay for braces that are needed to help a Medicaid recipient eat or breathe.
It is unclear how much was spent on unneeded braces, but state officials have said they believe a “substantial percentage” of the $1.1 billion approved by the contractor for orthodontic services was illegal.
The waste led Texas to spend almost as much on Medicaid orthodontic services in 2009 as the rest of the country combined, according to WFAA-TV in Dallas.
The state filed a lawsuit in May against the private contractor, called the Texas Medicaid & Healthcare Partnership, through its parent company Xerox Corp.