As a heads up for dentists across the state, it appears there is a long shot possibility that something still might come home to roost for those that billed Texas Medicaid for orthodontic treatments to children from 2004 to 2012.
Xerox wants to include dentists in lawsuit
The Texas Supreme Court has agreed to hear arguments from Xerox, the state’s disgraced former Medicaid claims administrator, about why the company should be able to include dentists who submitted claims that did not qualify as medically necessary during those years as responsible third parties to the fraud case against it by the state. Xerox is saying that the case should be a breach of contract case rather than fraud which prevents the addition of the dentists.
Xerox “dental specialists” rubber stamping
To recap, the state is suing Xerox for fraud under the Texas Medicaid Fraud Prevention Act because it hired unqualified staff to review Medicaid orthodontic prior authorization requests. These staff people were basically high school graduates who worked from home as “dental specialists” and “rubber stamped” hundreds of millions of dollars of treatment that the federal government has deemed medically unnecessary. The state is on the hook to repay the federal government some $133 million. The state says Xerox misled health officials about the qualifications of these “dental specialists.”
Federal audits of the orthodontic spending did not blame dental practitioners for the orthodontic debacle.
Lower courts denied motions
The Texas Supreme Court has decided to hear the arguments from Xerox despite a Travis County district court judge and the Third Court of Appeals earlier denying the motion A hearing will take place December 6.