UPDATE: We published this story back on September 12 last year about a provider quitting MCNA in disgust over a $33,000 recoupment demand.
This provider added a comment on this story last week which we want to highlight as he has now quit DentaQuest for similar reasons and dropped out of Texas Medicaid.
It is a sad story for needy children and highlights our recent survey results that show the increasing dissatisfaction of Medicaid dentists with Medicaid.
“It has been a while since I visited this page. Yes, we did get an attorney involved. Unfortunately, the outcome from Dentaquest (as yet) is “We are Judge, Jury and Executioner”. We terminated our contract with Dentaquest and Medicaid as a whole.
“It is extremely unfortunate as we have seen some of these patients since they were 6 months old and have witnessed them grow into young adults. In this area, there aren’t too many Medicaid providers, but that has never been the concern of the MCO’s. Our Dr’s. have had enough of someone sitting behind a desk, who doesn’t have a dental or medical degree, who do not have the patients best interest at heart and perhaps never looked down an oral cavity, other than their own, dictate how we practice dentistry.
“They have never worked on a four-year-old screaming bloody murder while working on a filling and for them to quote “it isn’t good dental practice to do a filling on a baby tooth”. Just let it rot in the kid’s mouth! It will eventually fall out!
“Wisdom teeth have to be approved, we all know that and have had every single one approved. The approval letter is toilet paper and we all know what to do with that!
“Dentaquest states even though we approved a D7240 we will downgrade to a D7210 and recoup the difference. These procedures were completed in 2016 and 2017 and supposedly approved by a licensed dentist at Dentaquest.
“If the pre auths were approved by a licensed dentist, then the audits have to be done by a blind janitor. Look at the pano’s for crying out loud!! The tooth is completely under bone!
“For those of you who are still running this rat race. I have the utmost respect and sympathy. We wish you luck in navigating this game with every changing rules.”
From time to time, TDMR receives correspondence from dentists expressing their frustration and anger with one or both of the current DMOs managing Texas Medicaid.
Last week, we received an email from a dental provider about a recoupment demand made by MCNA. Apparently, it took the company three years to review the documents he had sent them per their initial request. He has agreed to let us publish his email.
He also let us know that he has just sent MCNA a letter informing them that he has voluntarily terminated his participation. He said that “I know several others who have been tortured by this MCO. It’s like we don’t have a say. They are a law unto themselves.”
Here is what he told us.
I received a letter from MCNA informing me that they have completed a review of records I submitted over three years ago.
Strangely, they’re recouping over $33,000 of payments made for all the procedures in the records I sent them.
Some of the reasons given were “no exams was done because note says patient present with parent for treatment”. Others were there was no radiographic evidence of decay on occlusal! The list goes on and on.
Don’t we as clinicians have any right? How can we allow these people to destroy us?
It is our usual policy to ask the DMO representatives for their comment on such situations before publishing. However, MCNA hasn’t responded to our last few emails so we did not bother.
Complaints to HHS about DMOs
Last year, we informed readers that there is a person in HHS to whom provider complaints about DMOs can be addressed. This is Marguerite Laccabue, Dental Director at Texas Health and Human Services Commission, Medicaid and CHIP Division.
Her contact information is:
Marguerite.Laccabue@hhsc.state.tx.us(512) 424-6514
There is also the Managed Care Complaints email address.
Managed Care Inquiries and Complaints MailboxHPM_Complaints@hhsc.state.tx.us
Does anyone want to complain in person?
Well, there is a State Medicaid Managed Care Advisory Committee meeting next week in Austin. The public is invited and there is a public comment section on the agenda.
Here are the details:
Health and Human Services Commission Brown-Heatly Building Public Hearing Room 4900 North Lamar Blvd. Austin, TX 78751September 12, 2018 – 10:00am
Add to your calendar
This meeting will be webcast. To access the webcast, go to https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings the day and time of the meeting.
- Call to order
- Roll call
- Adoption of June 18, 2018, draft minutes
- Re-adoption of Committee Bylaws
- Health and Human Services Commission (HHSC) procurement processes
- Managed care oversight initiatives
- Subcommittee reports:
- Subcommittee on Goal 1 (Provide HHSC leadership with an accurate and balanced view of both challenges and opportunities identified in the Medicaid managed care delivery system, and offer innovative and operationally practical solutions)
- Subcommittee on Goal 2 (Develop sound recommendations that directly affect Medicaid managed care clients by prioritizing quality health outcomes, patient safety, and fiscal responsibility in the delivery of programs and services)
- Subcommittee on Goal 3 (Advise HHSC on activities related to ensuring clients or members are receiving timely care coordination for medically and functionally necessary services across all Medicaid managed care programs. This will include recommendations for continuous collaborative communication between HHSC, managed care organizations, members, and providers, as well as for the rapid resolution of eligibility and enrollment issues)
- Vote on committee recommendations to the HHSC Executive Commissioner
- Expiring member terms
- Committee report to the HHSC Executive Commissioner
- Report content
- Timeline
- Public comment
- Adjournment
Contact: Questions regarding agenda items, content, or meeting arrangements should be directed to Becky Alejandro, Health and Human Services Commission, 512-462-6334, or Rebecca.alejandro@hhsc.state.tx.us.
This meeting is open to the public. No reservations are required, and there is no cost to attend this meeting.
People with disabilities who wish to attend the meeting and require auxiliary aids or services should contact Alejandro at 512-462-6334 at least 72 hours before the meeting so appropriate arrangements can be made.
If you are quitting MCNA the best thing you can do is file a law suit. Just a small one, but usually contractually they cannot be renewed as a DMO if there is a pending suit. MCNA is very difficult to work with, and each year or every six months they find some small area to save money or to make a non-payment.
There is a need for providers to encourage HHSC to vote for more DMO’s. If HHSC would choose 4 DMO’s providers could cancel contracts with one that is unfair without destroying their practice.
Unfortunately, even after you resign from MCNA your problems will only get worse. That’s when they turn you over to the OIG and that nightmare begins.
The MCOs are judge, jury and executioner and no one is looking out for the providers. HHSC loves MCNA.
If you file a lawsuit, publish your contact info and maybe some of the rest of use can jump on board and share the cost.
I wouldn’t mind paying into a fund to have attorneys on retainer for providers.
I got one of those MCNA audits back then for around 30K. Everything was perfect. Should have got an attorney. People who worked for MCNA actually apologized to me saying it was wrong. One woman got fired for sending me a Christmas card thanking me for helping with their special needs patients.
I feel bad for what’s happened to Texas Medicaid Dental Providers, especially for the orthodontists several years ago. Some of the doctors were crooks and took advantage of the system but most weren’t and strives to provide great care for their patients. I wonder if the dentist that just quit the Medicaid program actually stopped to think that the very people he probably votes for determine Medicaid policy. The Great State of Texas has long been under the control of the Republican Party. From gerrymandering to setting Medicaid budget and policy these are the folks he should be pissed at. He or any Dentists may want to take that into consideration the next time they’re at the ballot box.
It has nothing to do with political affiliation. It has to do with money. Take your misinformation elsewhere please, it doesn’t help solve this problem.
If you think politics is responsible for Medicaid woes, simply look at California and New York and you will find the same, if not more egregious conduct by Medicaid reps.
Texas Politics is the a huge factor in all things Texas (obviously) including Medicaid. The fact you mentioned California shows your bias and that you’re obviously an impressionable right wing loon.
Same happened to Illinois dentists. This seems like free labor for Medicaid providing dentist. We just don’t know that at any time they can claim to take the pay away.
I see all these comments about getting lawyers involved. I posted a meeting with an administrative attorney and got no response. If people are interested contact me.
Henry,
I am interested in retaining an attorney to help us. We need to get more organized…tired of been bully by DQ and MCNA.
I am a Medicaid provider still. I terminated my contract with MCNA and this September is going to be 5 years. With Dentaquest next June is 5 years.
I went through the same nightmare. Even a breach of contract from MCNA was found by my attorney. I had followed all the steps even the HHS opened an investigation after my complaint was placed. After a long agonizing time, nothing was found in the investigation. I had to close my Medicaid practice and nothing was done against MCNA and Dentaquest. I terminated with Medicaid as well but Medicaid insinuated if I returned I could get my monies back.
I was worn out and without funds to continue by myself against these MCOs and also had the risk of losing a lawsuit if placed. Regardless, I did return with Medicaid.
I have been a Medicaid provider since 1994. I am a provider but no patients come to my practice because I am not contracted with MCNA or Dentaquest.
There should be another alternative – to have all patients back to traditional Medicaid. It seems to go against patient rights when comes to choosing a Medicaid provider.
The only hope is if all providers terminate with MCNA and Dentaquest It is on our end to fix the issue. Without providers, the MCO’s will vanish.
I am against these detrimental abuses from the corporate invasion into our profession.
Glen,
I also terminated both DQ and MCNA but still active with TMHP. MCNA began to be nice and accommodating after I sent in my request to term. If possible, please arrange a time when we can speak over the phone and compared notes. Hoping to hear from you soon.
I am a person on MCNA Dental in Utah. I had to file a lawsuit for them to give me services that were medically needed. The only way the VPs started responding and getting on the calls with the Judge is when I started FOIA requests for the Texas Office of Inspector General found them guilty themselves of 77,000 in kick backs and Medicaid paying MCNA for consulting services that were not covered. I sent so many FOIA requests and they tried to innondate me with all these stupid papers that I already had that I didn’t even open them. I handed all the info over to the judge in my hearing and alllllll the sudden the VPs and the “integrity” VPS Dr. Altenhoff who herself is under investigation for millions of dollars were on the call. I had no lawyer and guess what I won the case and got even more. They don’t like being blasted all over social media either. That is also something I did. I had members of the Utah Legislature re-tweeting my claims and seeing my pics and videos. So, that is what I did. I was only requesting 3 porcelain crowns because they don’t cover them in Utah and I have a movement disorder that ruined my teeth and because they pretty much thought I would call uncle and the Utah Dept of Health didn’t want people to know they signed a contract with MCNA to. be the dental Medicaid oversight people while they were still under investigation in Texas. I would FOIA the heck out of them and blast them with live videos on social media of yourself or if your patients want people to know. I had over 400 views just on fb. They weren’t to happy. Oh and remember to “tag” MCNA when on social media. They are on fb and twitter. Good luck. MCNA sucks but, now I have every single tooth covered with ceramic crowns cuz I didn’t shut up.
I live’n Texas and tired of MCNA Dental, my daughter has a dental medical necesity since few yrs ago but MCNA keeps ignoring my request for dental, I’m ready for a lawsuit, where do I start? I can’t find any attorney that takes Medicaid cases! advise please