TDMR recently received information from an open records request to the Texas Medicaid Fraud Control Unit of the Office of the Attorney General. The request asked for a list of investigations conducted by MFCU on dentists between 2011 and 2016 when dentists and orthodontists were accused of hundreds of millions of dollars of Medicaid fraud over the great ACS/Xerox/Conduent orthodontic prior authorization debacle.
Allegations of massive dental Medicaid fraud gripped Texas
As a short recap, Texas bureaucrats and politicos were embarrassed by WFAA media reports starting in May of 2011 that it was spending more on orthodontia than almost the rest of the nation combined. Rather than look at their own hands which had responsibility for monitoring and controlling the prior authorization process and spending of its private Medicaid contractor, a conspiracy theory that hundreds of Texas Medicaid dentists schemed to defraud Texas taxpayers was promoted by HHSC executives to the media and legislature which created an aura that a majority of Texas Medicaid dentists were corrupt.
Former HHSC Inspector General Doug Wilson and HHSC chief counsel Jack Stick, both now long gone through firing or resignation, promoted these allegations to lobby the legislature to increase funds for OIG’s budget.
We thought it would be interesting to look back now and see how much criminal Medicaid fraud was actually ferreted out considering the immense foofaraw back in the day.
365 MFCU investigations between 2011 and 2016
While MFCU could not supply names or documents relating to those who were investigated but not charged, they provided the total number of investigations done during that time period and a list of individuals indicted. This included both dentists and non-dentists.
MFCU, per the information received, conducted 365 investigations between 2011 and 2016 of dentists and dental entities. They provided a list of 28 individuals that had been indicted over that time period.
When we reviewed the list, we found that 11 were not dentists but office staff or administrators.
Of the 17 dentists, we found that nine were indicted prior to 2011 but that their cases stretched into the time bracket that was requested. For the record, six of these nine dentists had their cases dismissed or were acquitted.
Of the eight dentists remaining, one indictment was for injury to a child, elderly or invalid. Another was about allowing a non-dentist to practice dentistry and was apparently settled with an agreement with the TSBDE. Another dentist was apparently acquitted as we could find no record of a conviction and the individual is still practicing albeit not in Texas.
5 dentists indicted and convicted relating to the time period
That leaves five. Two were a husband and wife team. Another two were over 60 years old.
Here are the press releases issued by the justice authorities.
https://www.justice.gov/usao-edtx/pr/beaumont-orthodontist-sentenced-health-care-fraud-violations
No big billers
Not a lot of money there. No big billers of Medicaid orthodontia or dental services.
So much for the criminal conspiracy.
Great post, thanks for sharing !!!