For the last several years, TDMR has provided contact information on its website for reporting Medicaid fraud, waste and abuse to both state and federal healthcare authorities. From the links provided on practically every page of our website, anyone could go … Read More
TDMR received a notice yesterday from the Health and Human Services Inspector General office that Inspector General Stuart Bowen will be hosting, along with Sen. Chuy Hinojosa, a “Rio Grande Valley Medicaid Integrity Symposium.” The event is to take place … Read More
House Bill 1420 was introduced into the legislation session yesterday by House Representative Mando Martinez. The bill is captioned as “Relating to the imposition of a late payment penalty against Medicaid managed care organizations that fail to timely pay certain … Read More
The following is a statement received from MB2 Dental Solutions, the Dallas-area dental service organization, that recently settled with federal and state authorities for a whopping $8.45 million over allegations of Medicaid fraud. A company representative told us that they … Read More
In August of last year, the Sunset Advisory Commission requested a review by a blue ribbon panel of dental experts into dental anesthesia-related deaths in Texas as part of its review process of the State Board of Dental Examiners. On … Read More
TDMR has learned from a staffer in the office of Sen. Juan “Chuy” Hinojosa that they have been informed by Health and Human Services that managed care organizations, including MCNA, do not have any right under any Texas or federal … Read More
Did you know that HHS, formerly HHSC, has a Managed Care Inquiries and Complaints mailbox? It does. It also has a person to field those inquiries and complaints. That person is Dr. Marguerite Laccabue, MPH, DDS, Dental Director of the Office of … Read More
At the same stakeholders meeting last February that representatives from MCNA and Dentaquest provided briefings, the then-dental director for the Health and Human Services Inspector General, Dr. Linda Altenhoff, presented on rules and regulations regarding solicitation by dental providers. Altenhoff … Read More
In February of last year, Texas Health and Human Services Dental Director Marguerite Laccabue held a dental stakeholders meeting in Austin. It doesn’t appear from the HHSC online video of the proceedings that it was well-attended or promoted as the … Read More
TDMR has obtained a copy of a January 4 letter from State Sen. Juan “Chuy” Hinojosa to Charles Smith, the Executive Commissioner of Texas Health and Human Services asking Smith to review MCO “credible allegations of fraud” payment holds. While … Read More
TDMR received the following email from a Texas dentist. He has given permission for us to publish it and we are doing so anonymously to hopefully prevent any further retribution against himself and his practice. I am writing this email … Read More
Tuesday, TDMR republished a press release issued by the Department of Justice, U.S. Attorney’s Office, Northern District of Texas that Carrollton-based MB2 Dental Solutions and 21 pediatric dental practices affiliated with MB2 had agreed to an $8.45 million settlement to resolve … Read More
Last Thursday, Texas Health and Human Services held its Biannual Managed Care Stakeholder Meeting in Austin. The meeting was primarily hosted by Jami Snyder, the Associate Commissioner for the Medicaid & CHIP Services Department of HHS. During the open discussion … Read More
2016 ended very badly for Texas Medicaid. It was a very poor Christmas for many. There were a number of important divisive events that occurred which we decided not to comment on during the holiday season. We didn’t want to spread … Read More
Back in December, TDMR asked dentists to take an online survey to ascertain their views on Texas Medicaid dental managed care. We now have these results which are provided below and can be downloaded. Limitation of survey results Before we … Read More
TDMR has been notified that Texas Health and Human Services is holding its biannual meeting on managed care next Thursday in Austin. It is open to the public and is taking public comment on several items. If you can’t make … Read More
Sen. Lois Kolkhorst asked a pertinent question to Inspector General Stuart Bowen this past September, “Are you auditing MCOs for fraud?” The question came in the context of a hearing being held by the Senate Committee on Health and Human … Read More
The Office of Audit Services of the HHS-OIG released a report today that they found Florida’s Agency for Health Care Administration was paying state MCOs their capitation rate for deceased Medicaid beneficiaries. They estimated that “these overpayments amount to approximately 2 … Read More
In testimony before the Senate Committee on Health and Human Services in September, Inspector General Stuart Bowen shocked committee chairman Sen. Charles Schwertner with the revelation that the 22 MCOs (managed care organizations) operating in Texas had only found and … Read More
The hearing before the Senate Committee on Health and Human Services September 13 held a few more surprises for Medicaid providers, particularly dental providers. It turns out that all MCOs (managed care organizations) in Texas Medicaid including Dentaquest and MCNA … Read More
There have been rumors flying by the last few weeks that Inspector General Stuart Bowen wants to make it easier to place “credible allegation of fraud” (CAF) payment holds against Medicaid providers. We had no idea that this was difficult … Read More
Just before the Thanksgiving holiday, TDMR received a flurry of emails and phone calls regarding our story about a dentist who was having payments recouped by MCNA for treatments the company had previously approved. He was being forced to travel … Read More
Our story on MCNA secretly recouping payments from a dentist who had an MCNA pre-approved treatment plan for a young Medicaid-eligible cancer patient touched a raw nerve with a number of dentists from around the state. The story received a … Read More
In response to TDMR’s latest story on payment holds placed on Medicaid dentists by MCNA, TDMR received an emotional missive from a Medicaid dentist about his negative experience with MCNA. He gave permission to publish his comments. The legislative session … Read More
UPDATE: We now have a copy of the letter from Delta Dental to Texas dentists regarding joining their “Texas Medicaid network.” (see below) TDMR received an interesting email after our recent story on dental managed care and the possibility of … Read More
The Audit division of the Health and Human Services Office of Inspector General released a report at the end of October (although TDMR just received the email notification about it today) about an audit they conducted on the practice of … Read More
A source informed TDMR in late October that they estimated the number of dentists in Texas on payment holds placed by Medicaid dental maintenance organization MCNA to be around 200. Spate of payment holds TDMR reported back in August about … Read More
There is a rumor circulating that the Texas Health and Human Services Commission is putting together a new request for proposals (RFP) for dental managed care organizations for Texas Medicaid. While this may or may not be the case as … Read More
Last November, former Texas Medicaid director Billy Millwee, now a private consultant, appeared before the Little Hoover Commission in Sacramento, California. The LHC is an independent state oversight agency that was created in 1962 with the mission to investigate California … Read More
Dr. Linda Altenhoff is no longer with the Inspector General’s office as Chief Dental Officer. In August, she moved over to MCNA and is now Associate Dental Director for MCNA Texas and works out of San Antonio. Named IG Chief Dental … Read More
The Sunset Advisory Commission has made public its decisions regarding its sunset review of the State Board of Dental Examiners based on its staff report and hearings held. These have been available since August on the Commission website and … Read More
The Texas Tribune this morning published an article that indicates the fate of Texas Health and Human Services Inspector General Stuart Bowen is uncertain at this time. Planned Parenthood investigation tied to fund-raising effort The context of the story was … Read More
TDMR has been making changes over the past few months. Updated website and content You might have noticed that the look of our website has been updated. It is easier to view on smartphones and tablets as well as being a … Read More
In August, TDMR conducted its annual online survey of Medicaid providers. This time, however, the focus of the survey was expanded from only dentists to all Medicaid providers to see how the two compare. Completed surveys were filled out by … Read More
We received an email from a dentist with some very useful advice regarding denied treatment by dental MCOs (managed care organization). He specifically mentions MCNA. I just wanted to pass on the name of a resource that I recently found … Read More
On September 1, the first phase of the consolidation of the Texas Health and Human Services system became operational. SB 200, the Health and Human Services Commission sunset bill passed last legislative session called for transferring the Department of Assistive and … Read More
Today, we received an email notification from the Health and Human Services Commission that as long as Medicaid provider re-enrollment applications have been received by the Texas Medicaid and Healthcare Partnership on or before September 24, those providers will not face … Read More
The Department of Health and Human Services Office of Inspector General audit released earlier this week found Texas had miscalculated payments for the Medicaid Supplemental Physician Payments program and owed the federal government some $57.9 million for the period 2004 … Read More
The audit section of the Department of Health and Human Services Office of Inspector General issued a report earlier this month that Texas now owed the federal government some $57.9 million because the state Health and Human Services Commission did … Read More
The latest quarterly report issued by IG last week reminds Medicaid providers that CMS has a deadline of September 25 for re-enrollment of all Medicaid providers (deadline originally March). All providers who enrolled prior to January 1, 2013, must … Read More
