In Texas for the last two years, dental Medicaid providers, including myself, have been under the gun of allegations of Medicaid fraud, particularly large practices in orthodontics. This is largely because of unchecked and unmonitored snafus by the Texas Health and Human Services Commission, their Office of Inspector General and their private sector partner, the Texas Medicaid and Health Partnership. Dental Medicaid providers and their patients are being hung out to dry. Many dentists are being bankrupted by the retroactive application of new standards for Medicaid orthodontic pre-approvals rather than these agencies facing the truth - they screwed up. Yes, every Medicaid application from before 2011 was totally pre-approved by TMHP with all x-rays and documents submitted. Backing this up, the only legal decision rendered to date on a large orthodontic practice (the documents of which are on this site) the judges ruled no evidence of fraud or misrepresentation by the provider and they found the state's expert witnesses (Office of the Inspector General) were not credible. Real fraud needs to be punished not honest providers by an "agency run amok" as HHSC-OIG was characterized by one lawyer in a recent legislative hearing in Austin. A spot light needs to shine on this issue.
Byron Harris and WFAA have been front and center in carrying the "dental Medicaid fraud" story. But when it comes to reporting on the other side - when there is no fraud and good dentists are going bankrupt as a result of "credible allegation of fraud" holds being placed on their funds by the Office of the Inspector General HHSC - not so … [Read more...]
Or how to run an efficient, cost effective Medicaid practice and win... The majority party in Texas is making a lot of noise about Medicaid. When they talk about a "Texas Solution", they usually involve "free markets" in the discussion. According to the Texas Public Policy Foundation's recent paper, a "free market" involves subsidizing … [Read more...]
On the night of September 11th, Jack Stick was arrested by an Austin Police officer for drinking while intoxicated. Stick is the Deputy Inspector General for Enforcement for the Office of Inspector General Texas Health and Human Services Commission. Stick has been calling the shots on identifying and investigating Medicaid providers for … [Read more...]
The New York Daily News has published a very timely article about Dr. Leonard Morse of Brooklyn. Dr. Morse was a successful dentist whose practice catered primarily to Medicaid patients; he was one of New York Medicaid's top billers. Per the Daily News, he "had a thriving Park Slope practice with 30,000 patients before Spitzer [former New York … [Read more...]
You want to know about Medicaid? Here is the start. It is time to talk -- and in legal terms. Find below an excerpt of a motion filed by the firm of Brown McCarroll, L.L.P., one of the largest and most prominent law firms representing health care providers in Texas. You can get the full document here if you want, including the attachments. … [Read more...]
Down in Harlingen there's a large dental practice owned by Dr. Juan Villarreal. Harlingen Family Dentistry (HFD) was started in 1983 and was one of the first orthodontic Medicaid providers in the Rio Grande Valley. The reimbursement rates were so low at that time that few if any orthodontists would treat Medicaid children. Dr. Villarreal's practice … [Read more...]
