“You’ve Heard of the Gambinos and Gottis, Right? How About Xerox?”

On September 3rd, Douglas Wilson Inspector General for the Texas Health and Human Commission Office of Inspector General, testified on the implementation by his department of due process rights under SB 1803 before the House Human Services Committee.

Wilson testified for over 50 minutes answering questions primarily from Chairman Richard Peña Raymond, Rep. Pat Fallon and Rep. John Zerwas.

Xerox hired high school graduates to review Medicaid orthodontic prior authorizations

A major topic discussed was the role of Xerox as the state’s Medicaid claims administrator and their “rubber stamping” of Medicaid orthodontic prior authorizations for which the state is now suing the company .  Chair Raymond starts the questioning by humorously asking Wilson if he has heard of the Gambino and Gotti organized crime families and then asks him if he had heard about Xerox [18:00].

Feds to seek money back from Texas

Two major revelations came from that testimony:

1.  It was revealed that Xerox hired high school graduates to review the dental claims [20:20] as “dental specialists.”

2.  The federal government through HHS-OIG  will soon be issuing a second audit report which will contain monetary amounts and will be seeking monies back from Texas, possibly hundreds of millions of dollars.  The first report found the state responsible for the Medicaid payments, not the contractor. [23:14].

Alaska now suing Xerox too

It should be noted that it was reported today that the State of Alaska is now suing Xerox for its failed Medicaid software.

OIG has settled 14 cases for $14 million

Wilson also testified that so far in the dental cases OIG has investigated in the last few years, 14 so far have been settled and the state has recouped $14 million, although it only has collected $5 million at this time.

Rep. Fallon and Rep. Zerwas questioned Wilson about his staffing and how long it took to dispose of cases and the results  OIG now has 75-80 investigators but closes less than 100 investigations a year.  Wilson estimated that there are approximately 78,000 Medicaid providers in Texas so they only get to the worst cases especially now that they have their new data analysis software.  Wilson is supposed to compile and provide more detailed information to the representatives.

The OIG extrapolation of Medicaid program errors into millions of dollars of repayments from providers  was also discussed.

Here is the written presentation supplied by Wilson.

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